Antinucleosome Antibodies in Patients with Juvenile Systemic Lupus Erythematosus

Abstract

Our objective was to evaluate the frequency of antinucleosome antibodies (anti-Ncs) in juvenile systemic lupus erythematosus (JSLE) comparing it to that observed for anti-DNA and to correlate the presence of these antibodies with clinical manifestations and disease activity. Anti-Ncs and anti-DNA were detected by ELISA in 74 patients with JSLE and 64 normal controls. Clinical records were reviewed. Disease activity was assessed by SLEDAI score. Anti-Ncs and anti-DNA showed sensitivity of 52.7% and 54% and specificity of 98.4% and 95.3%, respectively. Disagreement between the two assays was found in 25.7% of the cases: isolated positive Anti-Ncs in nine cases (12.2%) and isolated positive anti-DNA in 10 cases (13.5%). Agreement was found in 74.3%: both positive antibodies in 30 cases and both negative in 25. The presence of anti-Ncs was significantly associated with malar erythema, hemolytic anemia, anti-DNA and low complement levels, but not with renal manifestations. The presence of anti-Ncs was associated with a higher SLEDAI median (P < 0.001) and its titers correlated with the SLEDAI score (r = 0.504; P < 0.001). The frequency, sensitivity and specificity values were similar between anti-Ncs and anti-DNA antibodies in patients with JSLE. Nevertheless, the discordance of 25.7% between the two assays suggests that both antibodies may have a complementary diagnostic role. The association and correlation between anti-Ncs and several disease activity parameters demonstrated its usufulness in the follow-up of these patients.

Desempenho diagnóstico e associações clínicas dos anticorpos contra componentes da cromatina no lúpus eritematoso sistêmico juvenil

“…On the other hand, 15 of 23 (65%) anti-dsDNA ELISA positive samples were also positive in the IgG anti-NCS and anti-CHR-60 assays, and 4% of the JSLE patients were negative in these assays. Such dissociation has been reported previously 13,38,40,42,43,[46][47][48] and indicates that these autoantibody systems have complementary roles in the diagnosis of SLE. This may have an impact in clinical practice inasmuch as the demonstration of anti-NCS antibodies in the absence of other autoantibodies may be particularly helpful in patients with few clinical manifestations (e.g.…”

“…Interestingly, however, the presence of antibodies against chromatin components was largely associated in the literature with markers of active lupus nephritis. Several studies have previously demonstrated an association of anti-nucleosome antibodies and disease activity or active nephritis in SLE 11,13,14,35,38,40,43,48 It has been also pointed that anti-nucleosome antibodies are highly correlated with renal failure and progression to kidney transplantation in SLE. 49 The present study confi rmed such association also for JSLE and further extended the observation to several autoantibody specifi cities within the supra-molecular chromatin system.…”

“…11 Although several studies evaluated the diagnostic performance of anti-NCS or anti-CHR antibodies in adult SLE patients, there are only a few studies about these autoantibodies in JSLE. [12][13][14] The aim of the present study was to investigate the diagnostic performance of antibodies to the chromatin antigenic system in JSLE as well as their associations with Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and with individual clinical manifestations of the disease, with emphasis on lupus nephritis.…”

Pesquisa de anticorpos antinucleossoma em lúpus eritematoso sistêmico

“…Alguns trabalhos também têm demonstrado correlação dos anticorpos AN com parâmetros conhecidos de atividade de doença. Desse modo, dois trabalhos estudando anticorpos AN em LES na população brasileira encontraram sua associação com atividade de doença, particularmente renal (20,21) . Por outro lado, Quattrocchi et al (22) , estudando anticorpos AN em 47 casos de LES e em 62 pacientes com outras colagenoses, tais como artrite reumatóide, doença mista do tecido conjuntivo, ES e síndrome de Sjögren, além de 22 controles sadios, observaram que, apesar de confirmarem a alta sensibilidade desse teste para LES, não encontraram correlação com atividade de doença em LES, avaliada pelo ECLAM.…”

Psychiatric Illness of Systemic Lupus Erythematosus in Childhood: Spectrum of Clinically Important Manifestations

“…Наряду с АНФ, при СКВ важное значение имеет выявление антител к нативной ДНК (анти-ДНК), РНП, антигену Смита (анти-Sm), анти-Ro/SS-A и анти-La/SS-B (в совокупности -так называе-мые «экстрагируемые ядерные антигены»). Согласно дан-ным литературы, при СКВ с ювенильным дебютом анти-ДНК выявляются у 54-93%; анти-Sm -у 17-52%; анти-РНП -у 22-50%; анти-Ro/SS-A -у 33-54%; анти-La/SS-B -у 14-32% больных [25][26][27][28][29][30][31][32]. С учетом более широкого спектра антител, выявляемых в детской популяции, на эта-пе диагностики СКВ с ювенильным дебютом настоятельно рекомендуется их исследование.…”