Autoantibodies spectrum in lupus nephritis in a cohort of Egyptian patients: relation to disease activity and prognostic value

Abstract

Background Specific autoantibodies are considered as an important marker in autoimmune rheumatic diseases and are of great value for the diagnosis and prognosis of systemic lupus erythematosus (SLE) patients. A total of eighteen autoantibodies were analyzed for their positivity in SLE patients and we evaluated the clinical relevance of the five most frequent autoantibodies: anti-dsDNA, anti-nucleosome, anti-histone, anti-Ro60, and anti-Ro52 on disease activity and renal affection in SLE Egyptian patients. Results Immunological profile and correlation of the five autoantibodies with disease activity and histopathological pattern of renal involvement were analyzed for 190 SLE patients. Lupus nephritis (LN) patients showed much worse constitutional and mucocutaneous manifestations than patients without nephritis. Autoantibody profile showed a significant increased frequency of anti-dsDNA, anti-nucleosome, anti-histone, anti-Ro-60, and anti-Ro52 antibodies in LN patients. The impact of the co-positivity of the autoantibodies on the renal function was obvious. Moreover, the disease activity increased by the increased frequency of autoantibodies positivity in LN patients. ROC curve analysis showed that anti-nucleosome had the highest sensitivity; 93% followed by anti-dsDNA 83.3% then anti-histone 73.8%, but anti-Ro60 and anti-Ro52 showed a humble sensitivity. Furthermore, the highest frequency of positivity for the five autoantibodies was found in class-III and class-IV LN patients. Conclusion Detection of anti-dsDNA, anti-nucleosome, anti-histone, and anti-Ro60 in SLE patients may be important for predicting disease progression and kidney affection. Moreover, anti-nucleosome and anti-dsDNA show high sensitivity and specificity for lupus nephritis, thus patients with four to five positive autoantibody panels should be kept under close monitoring as they may warrant considering aggressive therapy to control their disease and prevent renal damage.

Co-positivity of anti-dsDNA, anti-nucleosome, and anti-smith autoantibodies as serological biomarkers for disease activity in systemic lupus erythematosus

“…Our findings suggested that the mean SLEDAI score increased with the increased number of autoantibodies positivity, and this was obvious in comparing the mean rank of SLEDAI of patients who are positive for two or three autoantibodies with those who are negative for all autoantibodies (p = 0.001) and also on comparing one positive with two positives, one positive with three positives and two positives with three positives (p = 0.016, p = 0.007, p = 0.001, respectively). This result is near to that of Elsayed and Mohafez, who found that when the autoantibodies positivity increased, the mean rank of SLEDAI increased [22].…”

“…Genetic variants of FC receptors were associated with susceptibility to SLE and with the disease severity [34]. Autoantibodies are essential biomarkers for autoimmune diseases, and they have important diagnostic and prognostic values in SLE [22]. Recently, there is a huge interest towards the use of ANA as a predictor for disease progression in SLE, aiming to decrease morbidity and mortality [33].…”

“…Thus, serial measurements of anti-nucleosome antibodies may provide a good reflection for the assessment of disease activity [8]. Elsayed and Mohafez found that antinucleosome and anti-dsDNA both show a positive correlation with SLEDAI, but anti-dsDNA antibodies show a stronger correlation with SLEDAI than anti-nucleosome antibodies [22]. Živković et al found a significant correlation between anti-dsDNA and anti-nucleosome antibodies, which suggested a link between ds-DNAspecific immune response and nucleosomes in patients with SLE.…”

“…Antinucleosome antibodies were suggested as important markers and as complementary to anti-dsDNA antibodies for SLE diagnosis, and they should be included in the criteria for the diagnosis of SLE [25]. Recently, it has been suggested that combined positivity for antinucleosome and anti-dsDNA antibodies may have a prognostic value especially for renal affection, and this supports the routine assessment of these autoantibodies [22]. Despite previous studies reported increased anti-nucleosome antibodies in SLE patients particularly with increased disease activity, few data are available showing their suitability for monitoring disease activity [26].…”

“…Assessment of anti-chromatin antibodies including anti-histone and anti-nucleosome may be important for identifying the high-risk patients for proliferative lupus nephritis (LN) [21]. Anti-nucleosome autoantibodies have nearly equal specificity and higher sensitivity than anti-dsDNA antibodies in LN patients [22]. So, it is important to evaluate the effect of anti-nucleosome autoantibody positivity on SLEDAI score [23] particularly in patients with renal involvement [24].…”