Measurement of systemic lupus erythematosus activity in clinical research

510

227

To evaluate the predictive power of changes in levels of antibodies to double-stranded DNA (antidsDNA) as a predictor of disease exacerbations in systemic lupus erythematosus (SLE), we performed a prospective study on 72 unselected patients with SLE (mean duration of study 18.5 months, range 6-35 months). Patients were seen at least once every 3 months, and disease activity was scored according to a specific protocol. Plasma samples were obtained at least once every month and were assessed for anti-dsDNA antibody (by the Crifhidiu luciliue assay, an enzymelinked immunosorbent assay [ELISA], and the Farr assay) and for complement components C3 and C4. Twenty-seven of 33 disease exacerbations observed during the study period were accompanied by a positive test result for anti-dsDNA antibody (27 by the Farr assay, 19 by the C luciliae assay, and 23 by the ELISA). Twentyfour of these exacerbations were preceded by a significant increase in anti-dsDNA antibody levels (23 by the Farr assay, 12 by the C luciliae assay, and 17 by the ELISA). The first observance of a significant increase in anti-dsDNA antibody levels preceded the exacerbation by 8-10 weeks. Significant increases in anti-dsDNA antibody levels not followed by an exacerbation were observed in 5 cases by the Farr assay, in 7 cases by the C luciliue assay, and in 3 cases by the ELISA; however, in 3 cases, 2 cases, and 1 case, respectively, these increases were followed by an increase in disease activity that did not fulfill the criteria for an exacerbation. Serial measurement of anti-dsDNA antibody levels was more sensitive for predicting exacerbations than was measurement of C3 andor C4 levels (P < 0.03). Serial assessment of anti-dsDNA antibody levels, especially by the Farr assay, is a sensitive and reasonably specific method for predicting disease exacerbations in SLE.Systemic lupus erythematosus (SLE) is characterized by protean clinical manifestations and the occurrence of a variety of autoantibodies. Among these, anti-double-stranded DNA (anti-dsDNA) antibodies are highly specific for SLE and are detected at a high frequency (75-

Section: Patients An11 Methodsmentioning

confidence: 90%

Measurement of increases in anti‐double‐stranded dna antibody levels as a predictor of disease exacerbation in systemic lupus erythematosus

Borg

Horst

Hummel

et al. 1990

510

227

“…Physician assessment has been used to construct and validate objective measures of disease activity (23,24). In this study, a single physician, blinded to the findings, had assessed the disease activity of all the SLE patients.…”

Section: Discussionmentioning

confidence: 99%

Ureaplasma urealyticum and mycoplasma hominis in women with systemic lupus erythematosus

Ginsburg

Kundsin

Walter

et al. 1992

Objective. To determine the prevalence of genitourinary mycoplasma infection in women with systemic lupus erythematosus (SLE).Methods. Urine specimens from 49 patients with SLE and 22 patients with chronic fatigue syndrome (CFS) were cultured for mycoplasma. Patient records were reviewed for medical history and SLE disease activity.Results. Sixty-three percent of the SLE patients were culture positive, compared with 4.5% of the CFS patients (P < 0.001). Neither corticosteroid treatment, SLE activity, nor age accounted for this difference.Conclusion. Genitourinary mycoplasma colonization occurs significantly more frequently in SLE than in CFS.The mycoplasmas are a group of microorganisms which cause a variety of human diseases involv-

“…MRI and CT scans are highly sensitive for identifying lesions in SLE patients with focal neurologic abnormalities and structural defects (3,8,13,17), but findings are often normal in patients who present with diffuse CNS involvement (9,53). Since the majority of patients with NPSLE have diffuse abnormalities rather than focal lesions (6,7) as was the case in our study population, QEEG would appear to be a more reliable indicator of CNS dysfunction in these patients, compared with other imaging techniques.…”

Section: Discussionmentioning

confidence: 99%

“…Estimates of the prevalence of neuropsychiatric SLE (NPSLE) vary between 24% and 75% (1)(2)(3)(4)(5)(6)(7). This variability is partially due to the lack of uniform diagnostic criteria for determining central nervous system (CNS) involve-ment, the inability during acute episodes to obtain tissue for pathologic study, and inherent difficulties in distinguishing primary neurologic and psychiatric abnormalities from those that are secondary to SLE or other organic causes (8)(9)(10).…”

mentioning

confidence: 99%

Quantitative electroencephalography: A new approach to the diagnosis of cerebral dysfunction in systemic lupus erythematosus

Ritchlin

Chabot

Alper

et al. 1992

Objective. Neuropsychiatric manifestations are common in patients with systemic lupus erythematosus (SLE), but accurate diagnosis is often difficult. We conducted a prospective study to determine the utility of neurometric quantitative electroencephalography (QEEG) as an indicator of cerebral dysfunction in SLE patients. Methods. Fifty-two SLE patients were divided into 4 groups based on the results of neuropsychiatric evaluations. These included patients with objective evidence of neuropsychiatric SLE (NPSLE), patients with neuropsychiatric symptoms, patients with no evidence of NPSLE, and patients with a prior history of NPSLE. All QEEG findings were compared with data in an age-regressed normative database and with findings in an independent sample of normal subjects.Results. QEEG sensitivity was 87%, and specificity was 75%. QEEG results were abnormal in 74% of the SLE patients with neuropsychiatric symptoms and in 28% of the patients with no evidence of active NPSLE. QEEG profiles varied as a function of the severity and type of neuropsychiatric manifestation present. Within this patient population, QEEG was more sensitive than magnetic resonance imaging, computed tomography scanning, or conventional EEG.Conclusion. Neurometric QEEG may be a sensitive indicator of cerebral dysfunction in patients with NPSLE and can differentiate patients with diverse neuropsychiatric manifestations. When combined with a careful clinical history and evaluation, QEEG provides information that may be useful for the early detection of NPSLE and for serial evaluation of disease activity and treatment efficacy.Neurologic and psychiatric manifestations of systemic lupus erythematosus (SLE) are common, occurring at any time during the illness, and often in the absence of generalized disease activity. Estimates of the prevalence of neuropsychiatric SLE (NPSLE) vary between 24% and 75% (1-7). This variability is partially due to the lack of uniform diagnostic criteria for determining central nervous system (CNS) involve-