Objective
To examine correlations between blood levels of complement split product
iC
3b and serum component C3 with clinically meaningful changes in disease activity in patients with systemic lupus erythematosus (
SLE
).
Methods
A total of 159 consecutive patients with
SLE
, diagnosed according to the American College of Rheumatology or Systemic Lupus International Collaborating Clinics classification criteria, were enrolled in
CASTLE
(Complement Activation Signatures in Systemic Lupus Erythematosus), a prospective observational study. Patients with 1–7 study visits were included in this longitudinal analysis. In addition, 48 healthy volunteers were enrolled to establish a normal reference value for the ratio of blood
iC
3b to serum C3 concentrations. Serum C3 and C4 levels were measured by nephelometry, and blood
iC
3b levels were measured by a lateral flow assay.
SLE
disease activity was monitored with the Responder Index 50 instrument of the
SLE
Disease Activity Index 2000.
Results
Relative changes in the
iC
3b:C3 ratio, levels of anti–double‐stranded
DNA
(anti‐ds
DNA
) antibodies, and use of a supraphysiologic dose of prednisone (>7.5 mg/day) each independently correlated with
SLE
disease activity, as determined in multilevel multiple logistic regression analyses. Only the
iC
3b:C3 ratio was significantly associated with clinically meaningful improvements in disease activity among patients with
SLE
who were receiving a supraphysiologic dose of prednisone. The
iC
3b:C3 ratio outperformed C3 and C4 levels with regard to discriminating active
SLE
from inactive
SLE
, and major flares from no disease activity. The
iC
3:C3 ratio, anti‐ds
DNA
antibody levels, erythrocyte sedimentation rate, and use of a supraphysiologic prednisone dose were each independently associated with the presence of lupus nephritis, whereas none of these measures was associated with
SLE
rash. The association of the
iC
3b:C3 ratio with lupus nephritis was independent of other observed clinical manifestations.
Conclusion
The ratio of blood
iC
3b to serum C3 concentrations correlates with the extent of
SLE
disease activity and with clinically meaningful changes in disease activity in patients with
SLE
. Furthermore, the
iC
3b:C3 ratio may discriminate between active and inactive...