Background: The role of anti-nucleosome antibodies as an immunological parameter capable of describing disease activity and severity in systemic lupus erythematosus (SLE) is still debated. Objectives: To evaluate a possible role of anti-nucleosome antibodies in defining and monitoring disease activity and renal involvement in SLE patients. Methods: 35 SLE patients with renal involvement were evaluated for anti-nucleosome antibodies, clinical and laboratory parameters, autoimmunity, disease activity (SLEDAI[1]) and chronic organ damage (SLICC[2]). Seventeen out of 35 patients had a follow-up visit, for a total of 52 observations. Anti-nucleosome antibodies levels were detected by ELISA (Orgentec Diagnostika GmbH, Mainz, Germany) and considered positive when > 20 U/ml. Results: The 35 SLE patients had a mean age of 37.1±12.0 years, a mean disease duration of 8.9±7.6 years, 87.5% were female. SLEDAI was 7.6±6.0, SLICC 0.9±1.5, 24 hours proteinuria 1.7±2.0 g, creatinine 1.8±1.6 mg/dl and creatinine clearance 67.0±41.2 ml/min, C3 68.8±29.0 mg/dl and C4 12.4±6.6 mg/dl. Twenty out of 35 patients (57%) were positive for anti-dsDNA and 26 (74%) for anti-nucleosome (with a mean titre of 346.1±686.3 U/ml). In 52 observations, anti-nucleosome levels correlated directly with SLEDAI (r=0.44, p=0.001), 24 hours proteinuria (r=0.33, p=0.02), and inversely with C3 (r=-0.42, p=0.002) and C4 levels (r=-0.34, p=0.01), and with SLICC (r=-0.42, p=0.002). No correlation was found with age, disease duration and renal function. Patients anti-nucleosome positive (70%) had higher SLEDAI (7.4±5.4 vs 2.9±2.9, p=0.03) and proteinuria values (1.7±1.9 vs 0.6±0.7, p=0.007) and lower C3 (66.1±26.2 vs 86.4±28.2, p=0.02), C4 (11.5±5.4 vs 17.4±11.8, p=0.05) and SLICC (0.4±1.0 vs 1.5±1.6, p=0.01) levels with respect to patients anti-nucleosome negative. At the second observation, the 17 patients with a follow-up visit (mean follow-up 8.2±4.1 months), had significantly lower levels of anti-nucleosome with respect to baseline (70.9±111.8 vs 616.9±908.5, p=0.001), lower SLEDAI (9.5±5.6 vs 2.7±3.2, p=0.003), lower proteinuria levels (2.4±2.4 vs 0.6±0.4, p=0.001) and higher values of C3, C4 and creatinine clearance (p=0.001). All patients with high disease activity (SLEDAI ≥ 10) were positive for anti-nucleosome and had higher anti-nucleosome titre (691.1±965.7) with respect to 49% of the patients with low disease activity (95.8±179.1, p=0.001). No correlations was seen between SLEDAI and SLICC. Conclusion: Data showed a possible correlation of anti-nucleosome with systemic disease activity defined by the SLEDAI, and in particular with active renal involvement. In the follow-up anti-nucleosome seems to decrease once there is an improvement of nephritis activity parameters. Furthermore, anti-nucleosome levels inversely correlated with chronic organ damage regardless of age and disease duration. References: [1] Bombardier C, Gladman DD, Urowitz MB, Caron D, Chang CH. Derivation of the SLEDAI. A disease activity index for lupus patients. The Committee on Prognosis Studies in SLE. Arthritis Rheum 1992; 35: 630-40. [2] Stoll T, Seifert B, Isenberg DA. SLICC/ACR Damage Index is valid, and renal pulmonary organ scores are predictors of severe outcome in patients with systemic lupus erythematosus. Br J Rheumatol 1996; 35: 248-54.
Anti-nucleosome antibodies: correlations with activity and chronicity disease indexes in systemic lupus erythematosus patients with renal involvement
Gremese E;
2007-01-01
Abstract
Background: The role of anti-nucleosome antibodies as an immunological parameter capable of describing disease activity and severity in systemic lupus erythematosus (SLE) is still debated. Objectives: To evaluate a possible role of anti-nucleosome antibodies in defining and monitoring disease activity and renal involvement in SLE patients. Methods: 35 SLE patients with renal involvement were evaluated for anti-nucleosome antibodies, clinical and laboratory parameters, autoimmunity, disease activity (SLEDAI[1]) and chronic organ damage (SLICC[2]). Seventeen out of 35 patients had a follow-up visit, for a total of 52 observations. Anti-nucleosome antibodies levels were detected by ELISA (Orgentec Diagnostika GmbH, Mainz, Germany) and considered positive when > 20 U/ml. Results: The 35 SLE patients had a mean age of 37.1±12.0 years, a mean disease duration of 8.9±7.6 years, 87.5% were female. SLEDAI was 7.6±6.0, SLICC 0.9±1.5, 24 hours proteinuria 1.7±2.0 g, creatinine 1.8±1.6 mg/dl and creatinine clearance 67.0±41.2 ml/min, C3 68.8±29.0 mg/dl and C4 12.4±6.6 mg/dl. Twenty out of 35 patients (57%) were positive for anti-dsDNA and 26 (74%) for anti-nucleosome (with a mean titre of 346.1±686.3 U/ml). In 52 observations, anti-nucleosome levels correlated directly with SLEDAI (r=0.44, p=0.001), 24 hours proteinuria (r=0.33, p=0.02), and inversely with C3 (r=-0.42, p=0.002) and C4 levels (r=-0.34, p=0.01), and with SLICC (r=-0.42, p=0.002). No correlation was found with age, disease duration and renal function. Patients anti-nucleosome positive (70%) had higher SLEDAI (7.4±5.4 vs 2.9±2.9, p=0.03) and proteinuria values (1.7±1.9 vs 0.6±0.7, p=0.007) and lower C3 (66.1±26.2 vs 86.4±28.2, p=0.02), C4 (11.5±5.4 vs 17.4±11.8, p=0.05) and SLICC (0.4±1.0 vs 1.5±1.6, p=0.01) levels with respect to patients anti-nucleosome negative. At the second observation, the 17 patients with a follow-up visit (mean follow-up 8.2±4.1 months), had significantly lower levels of anti-nucleosome with respect to baseline (70.9±111.8 vs 616.9±908.5, p=0.001), lower SLEDAI (9.5±5.6 vs 2.7±3.2, p=0.003), lower proteinuria levels (2.4±2.4 vs 0.6±0.4, p=0.001) and higher values of C3, C4 and creatinine clearance (p=0.001). All patients with high disease activity (SLEDAI ≥ 10) were positive for anti-nucleosome and had higher anti-nucleosome titre (691.1±965.7) with respect to 49% of the patients with low disease activity (95.8±179.1, p=0.001). No correlations was seen between SLEDAI and SLICC. Conclusion: Data showed a possible correlation of anti-nucleosome with systemic disease activity defined by the SLEDAI, and in particular with active renal involvement. In the follow-up anti-nucleosome seems to decrease once there is an improvement of nephritis activity parameters. Furthermore, anti-nucleosome levels inversely correlated with chronic organ damage regardless of age and disease duration. References: [1] Bombardier C, Gladman DD, Urowitz MB, Caron D, Chang CH. Derivation of the SLEDAI. A disease activity index for lupus patients. The Committee on Prognosis Studies in SLE. Arthritis Rheum 1992; 35: 630-40. [2] Stoll T, Seifert B, Isenberg DA. SLICC/ACR Damage Index is valid, and renal pulmonary organ scores are predictors of severe outcome in patients with systemic lupus erythematosus. Br J Rheumatol 1996; 35: 248-54.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
