Diagnosis and risk stratification in patients with anti-RNP autoimmunity

Carpintero, Maria; Martinez, Laisel; Fernández, Irina; Romero, A. C. Garza; Mejía, Cris; Zang, Yunjuan; Hoffman, Robert W.; Greidinger, Eric L.

doi:10.1177/0961203315575586

Cited by 34 publications

(31 citation statements)

References 34 publications

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“…All 55 MCTD patients evaluated in this study were defined as unclear cases given that none of them fulfilled all four MCTD classification criteria sets and/or fulfilled at least one SLE classification criteria set. All the individuals included represent well characterized patients that have been the subject of previous publications (Maldonado et al, 2006; Perkins et al, 2008; Somarelli et al, 2011; Mesa et al, 2013; Carpintero et al 2015). …”

Section: Methodsmentioning

confidence: 99%

Can SLE classification rules be effectively applied to diagnose unclear SLE cases?

Mesa

Fernandez

et al. 2016

Lupus

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Summary Objective Develop a novel classification criteria to distinguish between unclear SLE and MCTD cases. Methods A total of 205 variables from 111 SLE and 55 MCTD patients were evaluated to uncover unique molecular and clinical markers for each disease. Binomial logistic regressions (BLR) were performed on currently used SLE and MCTD classification criteria sets to obtain six reduced models with power to discriminate between unclear SLE and MCTD patients which were confirmed by Receiving Operating Characteristic (ROC) curve. Decision trees were employed to delineate novel classification rules to discriminate between unclear SLE and MCTD patients. Results SLE and MCTD patients exhibited contrasting molecular markers and clinical manifestations. Furthermore, reduced models highlighted SLE patients exhibit prevalence of skin rashes and renal disease while MCTD cases show dominance of myositis and muscle weakness. Additionally decision trees analyses revealed a novel classification rule tailored to differentiate unclear SLE and MCTD patients (Lu-vs-M) with an overall accuracy of 88%. Conclusions Validation of our novel proposed classification rule (Lu-vs-M) includes novel contrasting characteristics (calcinosis, CPK elevated and anti-IgM reactivity for U1-70K, U1A and U1C) between SLE and MCTD patients and showed a 33% improvement in distinguishing these disorders when compare to currently used classification criteria sets. Pending additional validation, our novel classification rule is a promising method to distinguish between patients with unclear SLE and MCTD diagnosis.

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Section: Methodsmentioning

confidence: 99%

Can SLE classification rules be effectively applied to diagnose unclear SLE cases?

Mesa

Fernandez

et al. 2016

Lupus

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“…There is notable overlap between ACR and SLICC criteria, and studies in multiple ethnicities suggest that a large majority of patients meet ACR and SLICC classification criteria simultaneously. However, among 20 mixed connective tissue disease patients, 14 met ACR criteria, while 19 met SLICC criteria (49). Further, in those who do not meet ACR and SLICC criteria simultaneously, the SLICC criteria seem to allow for earlier classification (50, 51).…”

Section: Changing Concepts Of the Pre-classification Periodmentioning

confidence: 99%

Preclinical lupus

Bourn

James

2015

Current Opinion in Rheumatology

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Purpose of review Systemic lupus erythematosus (SLE) is often preceded by immune dysregulation and clinical manifestations below the threshold for SLE classification. This review discusses current and evolving concepts about the pre-classification period of SLE, including clinical and mechanistic observations, and potential avenues for early identification and intervention. Recent findings Although incomplete lupus erythematosus (ILE) involves fewer clinical manifestations than SLE, ILE can cause organ damage and mortality. Common clinical features in ILE include antinuclear antibody seropositivity, polyarthritis, immunologic manifestations, and hematological disorders. Despite having lower disease activity and damage scores than SLE patients, ILE patients may develop pulmonary arterial hypertension or renal, neurological, or peripheral vascular damage. The recently proposed SLICC SLE classification criteria could shift the period considered “preclinical SLE”. Murine studies suggest that the balance of T helper/T regulatory cells, peroxisome proliferator-activated receptor γ activity, and plasmacytoid dendritic cell pathways may be valuable targets for early intervention. Summary Advances in our understanding of early SLE, including stages before clinical features are fully developed, will improve our ability to identify individuals at high risk of classification for potential prevention trials, provide necessary information to improve diagnostic testing, and perhaps identify novel targets for directed therapeutics in clinical SLE.

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“…Tissue ischemia in the study mice was evaluated by trained study personnel who were blinded with regard to the treatment arm(s). Studies with human sera were performed using a sample of clinically characterized RNP-positive patients recruited for study at our center for whom antisera were available, and a cohort of healthy subjects (19).…”

Section: Methodsmentioning

confidence: 99%

“…Human and animal studies. Patients who were seen at our center between 2006 and 2015 were characterized as being RNP-positive if they had a positive result of a clinical laboratory anti-RNP test and/or if anti-RNP antibodies were identified in our laboratory by enzyme-linked immunosorbent assay (ELISA) or immunoblotting (19,20). Subject data were obtained by structured interview, physical examination, laboratory screening, and review of medical records (15).…”

Section: Methodsmentioning

confidence: 99%