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SMART-SLE: serology monitoring and repeat testing in systemic lupus erythematosus-an analysis of anti-double-stranded DNA monitoring

Yeo AL 1 , Kandane-Rathnayake R 1 , Koelmeyer R 1 , Golder V 1 , Louthrenoo W 2 , Chen YH 3 Show all authors , Cho J 4 , Lateef A 4 , Hamijoyo L 5 , Luo SF 6 , Wu YJ 6 , Navarra SV 7 , Zamora L 7 , Li Z 8 , An Y 8 , Sockalingam S 9 , Katsumata Y 10 , Harigai M 10 , Hao Y 11 , Zhang Z 11 , Basnayake BMDB 12 , Chan M 13 , Kikuchi J 14 , Takeuchi T 14 , Bae SC 15 , Oon S 16 , O'Neill S 17 , Goldblatt F 18 , Ng KPL 19 , Law A 20 , Tugnet N 21 , Kumar S 22 , Tee C 23 , Tee M 23 , Ohkubo N 24 , Tanaka Y 24 , Lau CS 25 , Nikpour M 16 , Hoi A 1 , Leech M 1 , Morand EF 1 , Asia Pacific Lupus Collaboration

Affiliations 

  • 1 School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Victoria, Australia
  • 2 Department of Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
  • 3 Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan
  • 4 Rheumatology Divsion, National University Hospital, Singapore
  • 5 Department of Medicine, University of Padjadjaran, Bandung, Indonesia
  • 6 Department of Rheumatology, Chang Gung Memorial Hospital, Guishan Township, Taiwan
  • 7 Joint and Bone Center, University of Santo Tomas Hospital, Manila, Philippines
  • 8 Department of Rheumatology and Immunology, People's Hospital Peking University Health Sciences Centre, Beijing, China
  • 9 Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
  • 10 Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
  • 11 Rheumatology and Immunology Department, Peking University First Hospital, Beijing, China
  • 12 Division of Nephrology, Teaching Hospital, Kandy, Sri Lanka
  • 13 Department of Rheumatology, Allergy and Immunology Tan Tock Seng Hospital, Singapore
  • 14 Division of Rheumatology, Department of Internal Medicine, Keio University, Tokyo, Japan
  • 15 Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases and Hanyang University Institute for Rheumatology Research and Hanyang University Institute of Bioscience and Biotechnology, Seoul, South Korea
  • 16 Department of Medicine, The University of Melbourne at St Vincent's Hospital, Fitzroy, Victoria, Australia
  • 17 Rheumatology Department, Level 1 Liverpool Hospital, Liverpool, NSW, Australia
  • 18 Rheumatology Unit, Royal Adelaide Hospital and Flinders Medical Centre, Adelaide, South Australia, Australia
  • 19 Department of Medicine, Waitemata District Health Board, Auckland, New Zealand
  • 20 Singapore General Hospital, Singapore
  • 21 Department of Rheumatology, Auckland District Health Board, Auckland, New Zealand
  • 22 Department of Rheumatology, Middlemore Hospital, Auckland, New Zealand
  • 23 University of the Philippines, Quezon City, Philippines
  • 24 The First Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
  • 25 Division of Rheumatology and Clinical Immunology, University of Hong Kong, Hong Kong, Hong Kong, China
Rheumatology (Oxford), 2024 Feb 01;63(2):525-533.
PMID: 37208196 DOI: 10.1093/rheumatology/kead231

Abstract

OBJECTIVE: Disease activity monitoring in SLE includes serial measurement of anti-double stranded-DNA (dsDNA) antibodies, but in patients who are persistently anti-dsDNA positive, the utility of repeated measurement is unclear. We investigated the usefulness of serial anti-dsDNA testing in predicting flare in SLE patients who are persistently anti-dsDNA positive.

METHODS: Data were analysed from patients in a multinational longitudinal cohort with known anti-dsDNA results from 2013 to 2021. Patients were categorized based on their anti-dsDNA results as persistently negative, fluctuating or persistently positive. Cox regression models were used to examine longitudinal associations of anti-dsDNA results with flare.

RESULTS: Data from 37 582 visits of 3484 patients were analysed. Of the patients 1029 (29.5%) had persistently positive anti-dsDNA and 1195 (34.3%) had fluctuating results. Anti-dsDNA expressed as a ratio to the normal cut-off was associated with the risk of subsequent flare, including in the persistently positive cohort (adjusted hazard ratio [HR] 1.56; 95% CI: 1.30, 1.87; P 3. Both increases and decreases in anti-dsDNA more than 2-fold compared with the previous visit were associated with increased risk of flare in the fluctuating cohort (adjusted HR 1.33; 95% CI: 1.08, 1.65; P = 0.008) and the persistently positive cohort (adjusted HR 1.36; 95% CI: 1.08, 1.71; P = 0.009).

CONCLUSION: Absolute value and change in anti-dsDNA titres predict flares, including in persistently anti-dsDNA positive patients. This indicates that repeat monitoring of dsDNA has value in routine testing.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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