Immunodiagnosis of Systemic Lupus Erythematosus (SLE) in a tertiary care hospital
Keywords:
Autoantibodies, systemic lupus erythematosus, SLE, ANA, Ds-DNA, Lupus
Abstract
Objectives To diagnose patients with Systemic lupus erythematosus clinically and compare various immunological tests available to detect their specificity and sensitivity of the various parameters employed. Methods It was a hospital-based cross-sectional study. All patients satisfying the revised American College of Rheumatology criteria (1982) for SLE were included in the study over a period of 3 years. A total of two hundred and four individuals were included. The patients were divided into three groups- (Group I- Confirmed SLE patients-32, Group II- Incomplete SLE patients- 60, and Group III -patients with other autoimmune disorders- 42) and 70 persons were included as controls. Results Patients were divided into three groups I, II, III and their clinical & laboratory features were compared. Females (90.6%) were more affected than males (9.4%) and 69% were in the age group of 20-40 years. The average age of onset of disease was 24.4 years. Predominant clinical features were arthritis (81.25%), skin rashes (72%), myalgia (68.75%), alopecia (68.75%), fever (65%) and oral ulcers 18(56.25%). Anti-ds-DNA test and ANA test were positive in all the patients and the anti-DNP test was positive in 59.3% patients. Females were more affected (81.7%) than males (18.3%). 85% were between 21-50 years The average age of patients was 30.16 years with a range of 10-70 years. Patients were regularly followed up and 32 patients (26.67%) developed complete SLE. The most common manifestations were arthritis (88.3%), fever (43.3%) skin rashes (68.3%). 10.34% of ILE patients developed full SLE and all were females. Average age of disease onset was 24years. Anti-ds-DNA antibodies was detected in 28 patients (23.4%), ANA in (25%) patients and Anti-DNP antibodies in 12 (10%) patients. Females (81%) were affected than males (19%). 86% were between 21-50 years. The average age of patients was 33.24 years. The predominant clinical features were arthritis (78.6%) and myalgia (76.2%). Anti-ds-DNA antibodies were detected in 6%, ANA in 35.7% patients & Anti-DNP antibodies in 3.6%. Antibodies to ds-DNA were present in low titers in this group. Conclusion A clear separation between SLE and other autoimmune disorder was found with the anti-ds-DNA test. It has a high specificity for the differential diagnosis of SLE. Our study, comparing three assays with respect to their ability to predict disease activity, indicated that ds- DNA ELISA is the best method.References
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2. Hargreaves MM, Richmond H, Morton R : Presentation of two bone marrow elements: the 'tart' cell and the 'LE' cell.Proc Mayo Clin 23:25-30, 1948.
3. Miescher P, Fauconnet M, Berand T : Experimental immunonucleophagocytes and the LE phenomenon. Exp Med Surg 11:173-177, 1953.
4. Cepellini R, Polli C, Celada F : A DNA-reacting factor in serum of a patient with Lupus erythematosus diffusers. Proc. Soc Exp Biol Med 1957;96:572-576.
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11. American College of Rheumatologya (ACR 1999) Ad Hoc Committee on Systemic Lupus Erythematosus Guidelines. Guidelines for Referral and Management of Systemic Lupus Erythematosus in Adults. Arthritis Rheum 1999;42(9):1785-96.
12. Vila LM, Alarcon GS, McGwin G Jr et al. For the LUMINA study group. Early clinical manifestations, diseases activity and damage of Systemic Lupus Erythematosus among 2 distinct US Hispanic subpopulations. Rheumatology (Oxford) 2004; 43:358-363.
13. Burlingame RW, Cervera R. Anti-chromatin (anti-nucleosome) autoantibodies. Autoimmune Rev. Dec 2002;1(6):321-8.
14. Baig MM, Shere SJ. Prevalence of autoantibodies in Saudi population. J Med 1989; 20(3,4):286-90.
15. De Vlam K, De Keyser F, Verbruggen G, et al. Detection and identification of antinuclear autoantibodies in the serum of normal blood donors. Clin Exp Rheumatol 1993; 11(4):393-7.
16. Vazquez-Del Mercado M, Gonzalez-Bernaldez M, Garcia-De La Torre I. Prevalence of antinuclear antibodies in a Huichol population of Mexico. Lupus 1995; 4(2):164-5.
17. Teubner A, Tillmann HL, Schuppan D, et al. Prevalence of circulating autoantibodies in healthy individuals. Med Klin (Munich). 2002 Nov 15;97 (11):645-9.
18. Masi AT, Kaslow RA. Sex effects in systemic lupus erythematosus: a clue to pathogenesis. Arthritis Rheum. 1978;21:480-484.
19. Paul BJ, Muhammed Fassaludeen, Nandakumar, MV Razia. Clinical profile of Systemic lupus erythematosus in Northern Kerala. J Indian Rheumatol Assoc 2003:11:94-97.
20. Malaviya AN, Singh RR, Kumar A, De A et al. systemic lupus erythematosus in northern India: A review of 329 cases. J Assoc Physicians India 1988;36:476-480.
21. Vaidya S, Samant RS, Nadkar MY, Borges NE. Systemic lupus erythematosus- a review of 220 patients. J Indian Rheumatol Assoc 1997; 5: 14-18.
22. Masi AT, Kaslow RA. Sex effects in systemic lupus erythematosus: a clue to pathogenesis. Arthritis Rheum. 1978;21:480-484.
23. White R H, and D L R obbins. Clinical significance and interpretation of antinuclear antibodies. West J Med. 1987. 147:210-213.
24. Jaskowski TD, Schroder C, Martins TB et al. Screening for antinuclear antibodies by enzyme immunoassays. Am J Clin Pathol. 1996 Apr;105(4):468-7.
25. Arbuckle MR, James JA, Kohlhase KF, et al. Development of anti- dsDNA autoantibodies prior to clinical diagnosis of systemic lupus erythematosus. Scand J Immunol.Jul-Aug 2001;54(1-2):211-9.
26. Greer JM and Panush RS. Incomplete lupus erythematosus. Journal Watch (General) 1989:2-2
27. Swaak AJ, van de Brink H, Smeenk RJ, et al. Incomplete lupus erythematosus: results of a multicentric study under the supervision of the EULAR Standing Committee on International Clinical Studies Including Therapeutic Trials (ESCISIT). Rheumatology (oxford). 2001 Jan;40(1):89-94.
28. Vila LM, Mayor AM, Valentin AH, et al. Clinical outcome and predictors of disease evolution in incomplete lupus erythematosus. Lupus. 2000;9(2):110-5.
29. Notman DD, Kurata N,Tan EM. Profiles of antinuclear antibodies in systemic rheumatic diseases. Ann Intern Med. 1975 Oct;83(4):464-9.
2. Hargreaves MM, Richmond H, Morton R : Presentation of two bone marrow elements: the 'tart' cell and the 'LE' cell.Proc Mayo Clin 23:25-30, 1948.
3. Miescher P, Fauconnet M, Berand T : Experimental immunonucleophagocytes and the LE phenomenon. Exp Med Surg 11:173-177, 1953.
4. Cepellini R, Polli C, Celada F : A DNA-reacting factor in serum of a patient with Lupus erythematosus diffusers. Proc. Soc Exp Biol Med 1957;96:572-576.
5. Robbins WC, Holman HR, Deicher H, Kunkel HG: Complement fixation with cell nuclei and DNA in Lupus erythematosus. Proc Soc Exp Biol Med 96:575-579, 1957.
6. Kumar A. Indian guidelines on the management of SLE. J Indian Rheumatol Assoc 2002:10:80-96.
7. Rahman MA, Isenberg DA. Autoantibodies in systemic lupus erythematosus. Curr Opin Rheumatol 1994; 6:468-73.
8. Pisetsky DS. Anti-DNA antibodies in systemic lupus erythematosus. Rheum Dis Clin North AM 1992;18:437- 54
9. Smeenk RJ, Van den Brink HG, et al. Anti-dsDNA: choice of assay in relation to clinical value. Rheumatol Int 1991;11:101-7.
10. Ter Borg EJ, Horst G, Hummel EJ, et al: Measurement of increases in anti double-stranded DNA antibody levels as a predictor of disease exacerbation in systemic lupus erythematosus. Arthritis and Rheum 1990;33:634-43.
11. American College of Rheumatologya (ACR 1999) Ad Hoc Committee on Systemic Lupus Erythematosus Guidelines. Guidelines for Referral and Management of Systemic Lupus Erythematosus in Adults. Arthritis Rheum 1999;42(9):1785-96.
12. Vila LM, Alarcon GS, McGwin G Jr et al. For the LUMINA study group. Early clinical manifestations, diseases activity and damage of Systemic Lupus Erythematosus among 2 distinct US Hispanic subpopulations. Rheumatology (Oxford) 2004; 43:358-363.
13. Burlingame RW, Cervera R. Anti-chromatin (anti-nucleosome) autoantibodies. Autoimmune Rev. Dec 2002;1(6):321-8.
14. Baig MM, Shere SJ. Prevalence of autoantibodies in Saudi population. J Med 1989; 20(3,4):286-90.
15. De Vlam K, De Keyser F, Verbruggen G, et al. Detection and identification of antinuclear autoantibodies in the serum of normal blood donors. Clin Exp Rheumatol 1993; 11(4):393-7.
16. Vazquez-Del Mercado M, Gonzalez-Bernaldez M, Garcia-De La Torre I. Prevalence of antinuclear antibodies in a Huichol population of Mexico. Lupus 1995; 4(2):164-5.
17. Teubner A, Tillmann HL, Schuppan D, et al. Prevalence of circulating autoantibodies in healthy individuals. Med Klin (Munich). 2002 Nov 15;97 (11):645-9.
18. Masi AT, Kaslow RA. Sex effects in systemic lupus erythematosus: a clue to pathogenesis. Arthritis Rheum. 1978;21:480-484.
19. Paul BJ, Muhammed Fassaludeen, Nandakumar, MV Razia. Clinical profile of Systemic lupus erythematosus in Northern Kerala. J Indian Rheumatol Assoc 2003:11:94-97.
20. Malaviya AN, Singh RR, Kumar A, De A et al. systemic lupus erythematosus in northern India: A review of 329 cases. J Assoc Physicians India 1988;36:476-480.
21. Vaidya S, Samant RS, Nadkar MY, Borges NE. Systemic lupus erythematosus- a review of 220 patients. J Indian Rheumatol Assoc 1997; 5: 14-18.
22. Masi AT, Kaslow RA. Sex effects in systemic lupus erythematosus: a clue to pathogenesis. Arthritis Rheum. 1978;21:480-484.
23. White R H, and D L R obbins. Clinical significance and interpretation of antinuclear antibodies. West J Med. 1987. 147:210-213.
24. Jaskowski TD, Schroder C, Martins TB et al. Screening for antinuclear antibodies by enzyme immunoassays. Am J Clin Pathol. 1996 Apr;105(4):468-7.
25. Arbuckle MR, James JA, Kohlhase KF, et al. Development of anti- dsDNA autoantibodies prior to clinical diagnosis of systemic lupus erythematosus. Scand J Immunol.Jul-Aug 2001;54(1-2):211-9.
26. Greer JM and Panush RS. Incomplete lupus erythematosus. Journal Watch (General) 1989:2-2
27. Swaak AJ, van de Brink H, Smeenk RJ, et al. Incomplete lupus erythematosus: results of a multicentric study under the supervision of the EULAR Standing Committee on International Clinical Studies Including Therapeutic Trials (ESCISIT). Rheumatology (oxford). 2001 Jan;40(1):89-94.
28. Vila LM, Mayor AM, Valentin AH, et al. Clinical outcome and predictors of disease evolution in incomplete lupus erythematosus. Lupus. 2000;9(2):110-5.
29. Notman DD, Kurata N,Tan EM. Profiles of antinuclear antibodies in systemic rheumatic diseases. Ann Intern Med. 1975 Oct;83(4):464-9.
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2020-05-02
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