Risk of systemic lupus erythematosus flares according to autoantibody positivity at the time of diagnosis

Abstract

To estimate the risk of systemic lupus erythematosus (SLE) flares based on the autoantibody positivity at the time of SLE diagnosis. This retrospective cohort study included 228 patients with newly diagnosed SLE. Clinical characteristics including autoantibody positivity at the time of diagnosis of SLE were reviewed. Flares were defined as a new British Isles Lupus Assessment Group (BILAG) A score or BILAG B score for at least one organ system. Multivariable Cox regression analyses were performed to estimate the risk of flares according to autoantibody positivity. Anti-dsDNA, anti-Sm, anti-U1RNP, anti-Ro, and anti-La antibodies (Abs) were positive in 50.0%, 30.7%, 42.5%, 54.8%, and 22.4% of the patients, respectively. The incidence rate of flares was 28.2/100 person-years. Multivariable Cox regression analysis, adjusted for potential confounders, revealed that anti-dsDNA Ab positivity (adjusted hazard ratio [HR]: 1.46, p = 0.037) and anti-Sm Ab positivity (adjusted HR: 1.81, p = 0.004) at the time of diagnosis of SLE were associated with higher risk of flares. To better delineate the flare risk, patients were categorized as double-negative, single-positive, double-positive for anti-dsDNA and anti-Sm Abs. Compared with double-negativity, double-positivity (adjusted HR: 3.34, p < 0.001) was associated with higher risk of flares, while anti-dsDNA Ab single-positivity (adjusted HR: 1.11, p = 0.620) or anti-Sm Ab single-positivity (adjusted HR: 1.32, p = 0.270) was not associated with higher risk of flares. Patients who are double-positive for anti-dsDNA and anti-Sm Abs at the time of the diagnosis of SLE are at higher risk of flares and may benefit from stringent monitoring and early preventive treatment.

Frequency and Factors Associated With Flare-ups in Lupus Patients With Lupus Nephritis in French Guiana

“…These ndings are consistent with other observations described in the literature, in which anti-dna antibody positivity was associated with renal involvement and overall disease activity. [14,17,18] The factors with signi cantly higher frequencies in patients with lupus ares in the present study were high levels of anti-Dna and anti-Smith antibodies, fever, pleurisy, discoid rash, verspetillo, oral ulceration, and high Sledai score. These factors have also been found to vary in other studies worldwide [12].…”

“…According to an Indian study published in 2015, 71.69% of patients experienced at least one relapse over a 6-month period [11]. Despite current therapeutic advances, relapse remains inherent to the natural history of lupus and can be of variable severity [10,13,14,15,16]. Compared to those in our two groups, lupus ares were more frequent (62.22%) in patients with renal involvement (Fig.…”

“…These factors have also been found to vary in other studies worldwide [12]. A South Korean study published in 2023, which assessed the risk of relapse in relation to antibody positivity, revealed that double positivity for anti-DNase and anti-Smith antibodies at diagnosis was associated with an increased risk of relapse [14].…”