Prognostic Relevance of Circulating Autoantibodies

ANAs are frequently found in patients with CLE (DLE or SCLE). Using sensitive techniques, ANAs can be detected in 25%-80% of these patients (Millard et al. 1979, O'Loughlin et al. 1978, Sontheimer 1989,Wallace et al. 1992).ANAs are useful diagnostic markers in CLE. However, the relevance of positive ANA titers as a prognostic marker is limited. Only high levels of ANA (>1:320) in patients with CLE (DLE or SCLE) indicate patients at risk for developing a severe disease course (Tebbe et al. 1997). Anti-ds-DNA antibodies are highly sensitive for the diagnosis of LE,but widely used enzyme-linked immunosorbent assay (ELISA) tests for the detection of anti-DNA antibodies detect not only high-affinity antibodies of the IgG type but also less specific, low-affinity antibodies of the IgM type (Egner 2000). Therefore, a consider able number of patients with CLE have positive test results. In a study comparing a wide panel of clinical and serologic data from patients, anti-ds-DNA antibodies tested with a highly sensitive ELISA were not identified as a factor indicating the risk of transition from CLE to SLE (Tebbe et al. 1997).

Anti-Ro/SSA is a diagnostic marker for SCLE occurring in 60%-70% of all cases (Provost et al. 1993). Prognostic relevance was analyzed in a 10-year follow-up study including 100 anti-Ro/SSA antibody-positive patients. Sixty-five percent of the anti-Ro/SSA-positive patients revealed chronic progressive disease when followed for 10 years and more. At least 25% of these positive patients demonstrated a dynamic change in clinical presentation with development of Sjogren's syndrome and/or progressive rheumatoid-like arthritis (Simmons-O'Brien et al. 1995). Anti-Ro/SSA-posi-tive patients should be routinely evaluated to recognize early transition to systemic disease. Anti-La/SSB antibodies can be found in 12%-42% of patients with SCLE, mostly associated with anti-Ro/SSA antibodies (Callen et al. 1986,Herrero et al. 1988, Mooney and Wade 1989).

Other autoantibodies are rarely found in CLE, with the exception of anticardio-lipin antibodies (ACAs). ACAs of the IgG or IgM type could be detected in 16%-50% of the patients with CLE, being only slightly elevated in most cases (Fonesca et al. 1992, Tebbe and Orfanos 1992). However, according to different study populations or techniques, lower prevalence rates of positive ACA tests were reported in other studies (Kind et al. 1992, Wallace et al. 1992). The relevance of elevated ACAs in CLE concerning the prognostic outcome of the disease is still unclear because follow-up studies are missing.

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