Clinical and Serologic Correlations and Autoantibody Clusters in Systemic Lupus Erythematosus

Abstract

Ethnicity and environmental factors could be involved in the heterogeneity of systemic lupus erythematosus (SLE). We conducted this study to define clinical and serologic correlations and autoantibody clusters in SLE patients in South China. We retrospectively reviewed the records of 917 patients with SLE admitted to our hospital between January 2005 and June 2008. We found the following associations between autoantibodies and clinical manifestations to be statistically significant: anti-double-stranded DNA (anti-dsDNA) with higher prevalence of renal disorder, leukopenia, and anemia; anti-Sm with higher prevalence of malar rash/discoid rash, pericarditis, and leukopenia; anti-ribonucleoprotein (anti-RNP) with higher prevalence of Raynaud phenomenon and photosensitivity; anti-deoxyribonucleoprotein (anti-DNP) with higher prevalence of arthritis and lower prevalence of renal disorder; anti-Scl-70 with higher prevalence of anemia and Raynaud phenomenon; anti-Jo-1 with higher prevalence of pericarditis; and anti-centromere with higher prevalence of Raynaud phenomenon. Three autoantibody clusters were identified: Cluster 1 (anti-Ro, anti-Sm, and anti-RNP [Ro/Sm/RNP], with a significantly lower percentage of elderly SLE and higher prevalence of photosensitivity, malar rash/discoid rash, Raynaud phenomenon, and leukopenia); Cluster 2 (anti-Ro [Ro], with a lower percentage of pediatric SLE); and Cluster 3 (the absence of anti-extractable nuclear antigen antibodies [ENA ve], with a lower percentage of adult SLE and lower prevalence of alopecia). In summary, this study not only confirms both anti-dsDNA and anti-Sm as specific markers for classifying SLE, but also demonstrates that photosensitivity is not associated with anti-Ro but with anti-RNP, and a negative association is found between renal disorder and anti-DNP in patients in South China. These results are different from results found in other populations. The higher prevalence of anti-dsDNA and renal disorder results in less difference in the prevalence of anti-dsDNA and renal disorder among the 3 autoantibody clusters in SLE patients in South China, which could be related to ethnicity and widespread industrial pollution in South China.

Chinese SLE Treatment and Research group (CSTAR) registry: I. Major clinical characteristics of Chinese patients with systemic lupus erythematosus

“…Most studies on phenotypes or survival of this population were from Hong Kong, 20,21 and most studies conducted in mainland China were retrospective or regional analyses. 22 CSTAR was the first to create a working group on lupus nationwide, and then launched the first multicenter registry of lupus cases in China. CSTAR sampled a representative and large-sized cohort of Chinese patients with SLE.…”

Updated Analysis of Standardized Photoprovocation in Patients With Cutaneous Lupus Erythematosus

“…A previous study by our group also demonstrated that patients with a positive photoprovocation revealed anti-Ro/SSA and anti-La/SSB antibodies more often than patients with a negative result, but this difference was not statistically significant (19). Tang and coworkers demonstrated a significant correlation between photosensitivity and the levels of anti-RNP antibodies in SLE patients (35). Also, a correlation between positive photoprovocation results and positive antibody titers in CLE patients has been suggested (19,33); however, no statistically significant correlations between seropositivity for autoantibodies and photoprovocation results were observed in the present study.…”

Therapeutic opportunities in systemic lupus erythematosus: state of the art and prospects for the new decade

“…APA are strongly associated with features of the antiphospholipid syndrome (APS) (arterial/venous thrombosis, fetal loss, thrombocytopenia) (OR ranging 2.8–5.4), central nervous system involvement (OR ranging 3.1–4.5 for any neuropsychiatric involvement/damage, 3.3–22.2 for cerebrovascular disease), severe renal involvement (RR 2.2 for progression to end-stage renal disease), damage accrual (OR ranging 1.9–2.8) and death 13 14. Anti-C1q antibodies correlate with renal disease,15 and antibodies to extractable nuclear antigens (anti-Ro/La/Sm/RNP) have been associated with mucocutaneous involvement and less severe nephropathy in most studies 11. It has been suggested that these clinicoserological subsets correspond to distinct genetic variants of susceptibility/severity genes, but this requires further investigation 16.…”

“…Analysis of large SLE cohorts has defined clusters of autoantibodies associated with distinct features of disease severity 10 11. Serum anti-dsDNA titres—measured by the Farr assay but not by ELISA—have been correlated with nephritis (OR typically in the range of 1.6–1.8), progression to end-stage renal disease (OR 4.1) and increased disease severity, damage or poor survival 12 13.…”