Autoantibody Assessment in Clinical Routine

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Patients exhibiting symptoms of suspected SLE should be screened for ANAs using indirect immunofluorescence on HEp-2 cells. Because ANAs are detectable in more than 95% of SLE patients, a negative result largely excludes this diagnosis. In extremely rare cases with clinical continuity of suspicion of SLE, a wide variety of autoantibody tests should be performed. The subsequent analysis of autoanti-bodies and their profile characteristic in SLE helps to consolidate the diagnosis and to predict lupus subsets with typical organ manifestations (Fig. 11.2).

Fig. 11.2 Decision tree of autoantibody testing in patients with clinical suspicion of SLE.

Some of them are included in the revised criteria of the American College of Rheumatology for the classification of SLE [22, 23]. A person is said to have SLE if four or more of the 11 criteria are present, either serially or simultaneously, during any interval or observation.

1. Malar rash

2. Discoid rash

3. Photosensitivity

4. Oral ulcers

5. Arthritis

6. Serositis a) Pleuritis or b) Pericarditis

7. Renal disorder a) Persistent proteinuria (>0.5 g/24 h or 3+) or b) Cellular casts

8. Neurologic disorder a) Seizures or b) Psychosis (having excluded other causes, e.g., drugs)

9. Hematologic disorder a) Hemolytic anemia or b) Leukopenia (<4/nl) or c) Lymphopenia (<1.5/nl) or d) Thrombocytopenia (< 100/nl)

10. Immunological disorders a) Raised anti-dsDNA antibody binding or b) Anti-Sm antibody or c) Positive finding of antiphospholipid antibodies based on:

i. IgG/M anticardiolipin antibodies ii. Lupus anticoagulant iii. False positive serological test for syphilis, present for at least 6 months

11. Antinuclear antibody in raised titer

The majority of autoantibodies do not correlate with disease activity. Therefore, it seems to be sufficient to control these antibodies in annual periods. Only antibodies to dsDNA, which may fluctuate with lupus activity in many patients but not in all, belong together with measurement of complement levels to the routine tools in monitoring disease activity.

It remains to be seen whether one or more other antibody tests such as anti-nucleosome, anti-ribosomal P, and anti-C1q will be accepted in routine parameters. Assumedly, future therapeutic options more selectively targeting the (auto)-immune system will require new biomarkers that include an extended palette of autoantibody tests [177-179].


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