Antibodies to extractable nuclear antigens (ENAS) in systemic lupus erythematosus patients: correlations with clinical manifestations and disease activity

Abstract

The aim was to explore possible correlations of antibodies to extractable nuclear antigens (ENA) with clinical manifestations and disease activity indices in systemic lupus erythematosus (SLE) patients. A total of 70 consecutive SLE patients (64 females) were included. Disease activity was assessed by SLE activity index (SLEDAI), and British Isles Lupus Assessment Group (BILAG). Anti-Ro/SSA correlated positively with, headache (r=0.24, p=0.04), blurring of vision (r=0.25, p=0.03) and SLEDAI (r=0.25, p=0.04) and negatively with C3 (r=-0.35, p=0.003). Anti-Ro/SSA correlated with anti La/SSB antibodies (r=0.69, p<0.001), but not with anti-DNA, anti-RNP and anti-Sm antibodies. Anti-La/SSB antibodies correlated with headache (r=0.26, p=0.03), SLEDAI (r=0.25, p=0.03) and negatively with C3 (r=-0.34, p=0.004). Anti-La/SSB did not correlate with anti-RNP or anti-Sm antibodies. Anti-Sm antibodies correlated with disease duration (r=0.34, p=0.003), 24 hours urinary proteins (r=0.31, p=0.008), SLEDAI (r=0.31, p=0.009), BILAG renal score (r=0.29, p=0.02) and negatively with age at onset (r=-0.27, p=0.02), WBCs (r=-0.29, p=0.014) and C4 (r=-0.25, p=0.049). In multivariate analyses, anti-Ro/SSA antibodies remained associated with headache, blurring of vision and C3 and anti-La/SSB antibodies remained associated with C3 and with headache. Anti-Sm antibodies were independently associated with disease duration and total SLEDAI scores, while anti-RNP antibodies remained significantly associated with BILAG mucocutaneous scores only. Antibodies to ENAs are associated with clinical aspects of SLE and may play a role in the assessment of disease activity. Insight into these ENAs may lead to new approaches to diagnostic testing, accurate evaluation of disease activity and lead to target approach for SLE.

Autoantibody Profile of Egyptian Juvenile Systemic Lupus Erythematosus Patients and Its Association with Clinical Characteristics and Disease Activity

“…33 Meanwhile, an Egyptian study found a much lower frequency of the U1-RNP antibodies (10%). 11 In our study, considering the correlation between autoantibodies and tissue involvement, we found that the anti-dsDNA antibodies have a significant association with mucocutaneous (malar rash, photosensitivity, oral ulcer, alopecia), renal and hematological manifestations. A study by Jurencak et al found that LN and malar rash with anti-dsDNA have a significant association.…”

“…46 It was also significantly associated with consumed C3 (p=0.020), proteinuria (p=0.039), and LAC (p<0.001). Emad et al found a significant correlation with C3 (p value = 0.004), 11 while Hiraki et al correlated them to LAC antibodies. 25 In the opposite of our study, Kini et al observed that the different anti-ENA antibodies and the characteristic organ involvement did not have any association.…”

“…Swedish study demonstrated Anti-SSA was only associated with mucocutaneous manifestation but not with arthritis, 44 while Li et al reported a positive association between anti-SSA and both mucocutaneous manifestation and arthritis. 45 Laboratory parameters of LN (consumed C3, C4 (p=0.048, p=0.037), proteinuria (p=0.049)), and both of ACL, LAC antibodies (p=0.043, p=0.038) were 11 The reason for the contradictory findings may be sought in differences in methodology as well as in genetic factors. Anti-SSB antibody was clinically related to malar rash, serositis, thromboembolic, musculoskeletal, and neuropsychiatric manifestations.…”

“…9,10 However, the clinical significance of anti-ENA antibodies remains unclear, but it may predict the involvement of different organs as well as the severity of the disease, helping in making an early diagnosis and in the specification of involved organs as well as initiation the appropriate treatment as early as possible. 11 In this study, we aimed to estimate the frequency of ANA, anti-dsDNA, and anti-ENA antibodies among patients with JSLE and their association with the different clinical manifestations and the activity of the disease.…”

“… 9 , 10 However, the clinical significance of anti-ENA antibodies remains unclear, but it may predict the involvement of different organs as well as the severity of the disease, helping in making an early diagnosis and in the specification of involved organs as well as initiation the appropriate treatment as early as possible. 11 …”