Anti-nucleosome antibodies outperform traditional biomarkers as longitudinal indicators of disease activity in systemic lupus erythematosus

The aim of this study was to determine whether anti-nucleosome antibodies function as activity-specific biomarkers in SLE. Fifty-one patients were recruited and followed prospectively with periodic clinical and biochemical assessments over a 14-month period. Disease activity was determined by the SL...

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Published in:Rheumatology (Oxford, England) England), 2015-03, Vol.54 (3), p.449-457
Main Authors: Li, Timothy, Prokopec, Stephenie D, Morrison, Stacey, Lou, Wendy, Reich, Heather, Gladman, Dafna, Urowitz, Murray, Scholey, James, Fortin, Paul R, Boutros, Paul C, Wither, Joan, Landolt-Marticorena, Carolina
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Antibodies, Anti-Idiotypic - blood
Biomarkers - blood
Clinical Science
Complement C3 - metabolism
Cross-Sectional Studies
DNA - immunology
Female
Humans
Longitudinal Studies
Lupus Erythematosus, Systemic - blood
Lupus Erythematosus, Systemic - diagnosis
Male
Middle Aged
Nucleosomes - immunology
Prospective Studies
Sensitivity and Specificity
Severity of Illness Index
Time Factors
Young Adult
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Summary:The aim of this study was to determine whether anti-nucleosome antibodies function as activity-specific biomarkers in SLE. Fifty-one patients were recruited and followed prospectively with periodic clinical and biochemical assessments over a 14-month period. Disease activity was determined by the SLEDAI-2K. Anti-nucleosome antibody levels were measured by an ELISA and its utility as an activity-specific biomarker as compared with that of anti-dsDNA antibodies and C3 was assessed both at baseline and in longitudinal analysis. Anti-nucleosome antibodies were significantly elevated in SLE patients vs controls and showed a moderate positive correlation with disease activity. The utility of anti-nucleosome antibodies in identifying patients with active disease in a cross-sectional analysis was comparable to that of anti-dsDNA antibodies and C3. Analysis of variance demonstrated that the level of anti-nucleosome antibodies and C3 varied significantly with changes in disease activity over time. Changes in clinical state were not mirrored by changes in anti-dsDNA antibodies. In time-dependent analysis, anti-nucleosome antibodies showed a better fit over time than anti-dsDNA antibodies and C3. In pairwise comparisons, C3 and anti-nucleosome antibodies outperformed other models, including the conventional pairing of C3 and anti-dsDNA antibodies, however, no biomarker alone or as a group accurately predicted impending remissions or exacerbations. Anti-nucleosome antibodies demonstrate greater fidelity as a biomarker for changes in SLE disease activity than traditional biomarkers, supporting the routine monitoring of this antibody in clinical practice.
ISSN:1462-0324
1462-0332
DOI:10.1093/rheumatology/keu326