Background: Juvenile-onset systemic lupus erythematosus (JSLE) has a higher mortality risk compared to adultonset SLE. We compared the diagnostic value of anti-cmDNA antibodies with that of antinucleosome antibodies (AnuA), anti-Sm antibodies, and anti-dsDNA antibodies and human B lymphocyte Raji cells with that of human promyelocytic leukemia HL60 cells as substrates in an indirect immunofluorescence assay to detect anti-cmDNA antibodies in JSLE patients. Methods: We recruited 92 JSLE patients and 71 patients with other juvenile-onset rheumatic diseases. Anti-cmDNA antibodies and antinuclear antibodies (ANA) were detected in patient sera using indirect immunofluorescence assays. Anti-dsDNA antibodies were detected by combining ELISA and indirect immunofluorescence. Anti-Sm antibodies were detected by double immunodiffusion assay and immunoblotting, while AnuA were detected by ELISA. results: The JSLE group had a significantly higher percentage of patients positive for anti-cmDNA compared to patients with other rheumatoid diseases. Using one antibody for diagnosis, anti-cm DNA antibodies had the highest accuracy at 84.0%; using two antibodies, the combination of anti-cm DNA and anti-dsDNA antibodies had 90.8% accuracy. Raji cells used as substrate demonstrated a stronger intensity of fluorescent patterns compared to HL60 cells. conclusion: The high sensitivity, specificity, and accuracy of detection of anti-cmDNA antibodies make it a valuable diagnostic tool for JSLE. s ystemic lupus erythematosus (SLE) is an autoimmune disease characterized by the presence of autoimmune antibodies against a number of nuclear and nonnuclear antigens, resulting in immune complex-mediated inflammation and systemic, multiple organ failure (1). Almost 15-20% of all SLE patients are below the age of 18 (ref. 2). Juvenile SLE (JSLE) is characterized by an exaggerated immune response with highly activated autoreactive B lymphocytes, dysregulated immune regulatory pathways, and frequent involvement of the renal, hematological and central nervous systems (3)(4)(5). Children with JSLE also have a higher disease severity and a significantly higher mortality risk compared to patients with adult onset disease (6,7). Timely diagnosis and treatment have been shown to significantly improve the prognosis and the clinical management of JSLE (8).Disease activity in SLE patients is currently evaluated using the SLE activity index (SLEDAI), the systemic lupus activity measure, and the British Isles Lupus Assessment Group (9). Recently, the anti-Smith (Sm) antibodies, anticell membrane DNA (cmDNA) antibodies, antidouble strand DNA (dsDNA) antibodies, antinuclear antigen (ANA) antibodies, antinucleosome (AnuA) antibodies, anti-C1q antibodies, and antiphospholipid antibodies have been proposed as useful biomarkers of JSLE (10-16). Anti-dsDNA antibodies, anti-Sm antibodies and antiphospholipid antibodies are included in the diagnostic criteria outlined by the American College of Rheumatology (10). JSLE patients were shown to be more frequently positive ...

Aim To analyze the clinical features of lupus‐like tuberculosis (TB). Methods Three cases of TB imitating systemic lupus erythematosus (SLE) flare were collected in our hospital. Based on literature review, there are only 3 reports of TB resembling lupus flare rather than SLE per se. Results The 3 cases of lupus mimickers, with a mean age of 30.3 years, ranging from 27 to 32 years, had atypical features of SLE, namely no typical butterfly erythema, lupus hair, alopecia or proteinuria, similar to the patients reported in the 3 previously mentioned studies. Emergence of different autoantibodies like anti‐nuclear antibodies, anti‐double‐stranded DNA, anti‐nucleosome antibodies, and anti‐histone antibodies could occur in TB, mostly as an epiphenomenon. In patients with specific serological anti‐Sm and hypocomplementemia, active TB cannot be easily ruled out. The presence of autoantibodies neither altered the clinical manifestations and radiographic findings of active TB, nor were detectable after infections are resolved. The resistance of the SLE manifestations to the steroid and immunosuppressive treatment suggests the contribution of an infectious disease. Conclusion TB stimulated the production of autoantibodies, with shared affinity for mycobacteria and human antigens, which may have led to lupus mimickers.