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Rheumatology 2001; 40: 1422-1423
© 2001 British Society for Rheumatology
Letters to the Editor |
The predictive value of ANA and anti-dsDNA antibodies for flares in SLE
Laboratorio di Patologia Clinica, Ospedale Civile, 30027 S. Donà di Piave (VE) and
1 Laboratorio di Microbiologia e Immunologia, Azienda Ospedaliera S. Maria della Misericordia, 33170 Pordenone, Italy
SIR, We read with interest the article by Mirzayan et al. [1]. In their prospective study of 120 systemic lupus erythematosus (SLE) patients, they found that flares at 1 yr were predicted by antinuclear (ANA) but not by anti-double-stranded DNA (anti-dsDNA) autoantibodies. Although the association was weak, the finding is interesting as it is a general experience that anti-dsDNA [2] but not ANA are helpful for assessing disease activity [3]. However, no mention of the ANA immunohistochemical pattern is made, and this would also be important to know. Indeed, if a homogeneous pattern is found, which is correlated with the presence of anti-dsDNA, a concordance between ANA and anti-dsDNA results could be expected. However, if the prevalent pattern is speckled, indicative of the possible presence of antibodies directed against RNP, Sm o Ro/SSA, this would imply that the quantitative assay of these specific antibodies might be useful in monitoring the course of SLE, a circumstance which has never been clearly demonstrated to date [4, 5].
They also argue that an elevated Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score does not necessarily mean that the patient has a flare because if anti-dsDNA antibodies stay above the cut-off point throughout the follow-up period, the SLEDAI score will always be elevated even if the patient is clinically in remission. There are also some missing data here; we would like to know whether a separate analysis was conducted for subjects with persistently high anti-dsDNA antibodies, and for those with antibody titre fluctuations. Indeed, an increase in anti-dsDNA titre in individual patients will better predict flares than an anti-dsDNA titre persistently above the cut-off level [2, 6]. As previous studies [2, 7, 8] have suggested that in SLE there is a difference in the utility of immunological tests based on the type of organ involvement that may occur in a flare, it would be interesting to know if the authors also evaluated the predictive value of laboratory tests separately for the specific disease subsets of SLE.
Notes
Correspondence to: N. Bizzaro, Laboratorio di Patologia Clinica, Ospedale Civile, via N. Sauro 25, 30027 S. Donà di Piave (VE), Italy. 
References
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Mirzayan MJ, Schmidt RE, Witte T. Prognostic parameters for flare in systemic lupus erythematosus. Rheumatology2000;39:1316–9.
[Abstract/Free Full Text] - ter Borg EJ, Horst G, Hummel EJ, Limburg PC, Kallenberg CGM. Measurement of increases in anti-double-stranded DNA antibody levels as a predictor of disease exacerbation in systemic lupus erythematosus. A long-term, prospective study. Arthritis Rheum1990;33:634–43.[Web of Science][Medline]
- Corzillius M, Liang MH. Monitoring patients with SLE. In: Lahita RG, ed. Systemic lupus erythematosus, 3rd edn. San Diego: Academic Press, 1999:467–76.
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Spronk PE, Limburg PC, Kallenberg CGM. Serological markers of disease activity in systemic lupus erythematosus. Lupus1995;4:86–94.
[Abstract/Free Full Text] - Derksen RH, Meilof JF. Anti-Ro/SSA and anti-La/SSB autoantibody levels in relation to systemic lupus erythematosus disease activity and congenital heart block: a longitudinal study comprising two consecutive pregnancies in a patient with systemic lupus erythematosus. Arthritis Rheum1992;35:953–9.[Web of Science][Medline]
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Swaak AJK, Groenwold J, Aarden LA, Statius van Eps LW, Feltkamp TEW. Prognostic value of anti-dsDNA in SLE. Ann Rheum Dis1982;41:388–95.
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Swaak AJG, Groenwold J, Bronsveld W. Predictive value of complement profiles and anti-dsDNA in systemic lupus erythematosus. Ann Rheum Dis1986;45:359–66.
[Abstract/Free Full Text] - Le Blanc BA, Gladman DD, Urowitz MB. Serologically active clinically quiescent systemic lupus erythematosus—Predictors of clinical flares. J Rheumatol1994;21:2239–41.[Web of Science][Medline]
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