Clinical and prognostic value of autoantibodies in Puerto Ricans with systemic lupus erythematosus

Abstract

The aim of this study was to determine the association between lupus autoantibodies and the clinical manifestations and outcome in a cohort of Puerto Ricans patients with systemic lupus erythematosus (SLE). All patients fulfilled the American College of Rheumatology classification criteria for SLE. Demographic parameters, clinical manifestations over time and damage accrual were obtained at the last study visit. Disease damage was assessed with the Systemic Lupus International Collaborating Clinics Damage Index (SDI). ANA, ANA pattern, and anti-dsDNA, anti-Smith, anti-Ro (SSA), anti-La (SSB) and anti-snRNP antibodies were measured at the time of SLE diagnosis. Chi-square test, Fisher exact test, ANOVA, logistic regression and general lineal model analyses were used to evaluate these associations. Ninety-six percent of patients were females. The cohort had a mean age of 40.2 +/- 12.0 years and mean disease duration of 9.6 +/- 7.0 years. Patients with elevated anti-dsDNA antibodies were more likely to have vasculitis, pericardial effusion, renal involvement, anaemia, leukopenia, lymphopenia and thrombocytopenia. Anti-Smith antibodies were positively associated with skin ulcerations, elevated liver enzymes, renal involvement and thrombocytopenia. Anti-Ro antibodies were related with the presence of discoid lupus, serositis, pneumonitis, elevated liver enzymes, hemolytic anaemia, leukopenia and lymphopenia. No positive associations were found for anti-snRNP or anti-La antibodies. The presence of anti-dsDNA, anti-Smith and anti-Ro antibodies was associated with higher SDI scores. In conclusion, anti-dsDNA, anti-Smith and anti-Ro antibodies are associated with several clinical manifestations and more damage accrual in Puerto Ricans with SLE. These findings provide valuable clinical and prognostic information for this ethnic population.

Clinical associations of anti-Smith antibodies in PROFILE: a multi-ethnic lupus cohort

“…Associations between autoantibodies and renal involvement have been extensively studied; however, only the relationship between anti-dsDNA antibodies and lupus nephritis has been consistently established [2, 4, 13]. We found that anti-Sm antibodies were significantly associated with renal involvement.…”

“…Previous data regarding this association have been inconsistent [4–10, 12–17, 23, 24, 27–34]. A prospective cohort study of 201 Puerto Rican patients showed associations of anti-Sm antibodies with proteinuria, hematuria, urinary cellular casts, nephrotic syndrome, renal insufficiency, and end-stage renal disease [4]. Also, in a case-control study, Alba et al found that anti-Sm antibodies were linked with biopsy-proven lupus nephritis [13].…”

“…Their frequency in SLE has been reported between 9 and 49 % depending on the demographic and ethnic characteristics of the study populations [3–12]. Several authors have described associations of anti-Sm antibodies with specific subsets of organ/system involvement and disease activity [2, 4, 7, 8, 10, 12–19]. However, most studies used to evaluate these associations are relatively small, differ on study designs, or are limited to specific ethnic populations.…”

El Lupus Eritematoso Sistémico: una mirada especial en Colombia

“…Así, la población blanca que vive en los Estados unidos o en el Reino Unido parece tener un mejor pronóstico que la población asiática que ha emigrado a estos países. Estudios recientes realizados en América Latina en pacientes adultos con LES mostraron que la población mestiza multiétnica presentó casos más severos que los pacientes de origen Europeo puro [4].Aunque la etiología y mecanismo patogénico del LES no ha sido claramente elucidado se acepta que es una patología multifactorial, resultante de la interacción compleja de factores genéticos y ambientales [5]. Se caracteriza por la producción de autoanticuerpos y la formación y depósito de complejos inmunes.…”

“…En Colombia, a diferencia de otros países, los pacientes con LES mueren principalmente por las complicaciones de tipo renal [4]. Por tanto, es muy importante además de los autoanticuerpos mencionados, la determinación de otros que también contribuyen a la lesión glomerular.…”