Autoantibodies in systemic lupus erythematosus

Comparison of historical and current assessment of seropositivity

A. Ippolito, D. J. Wallace, D. Gladman, P. R. Fortin, M. Urowitz, V. Werth, M. Costner, C. Gordon, G. S. Alarcón, R. Ramsey-Goldman, P. Maddison, A. Clarke, S. Bernatsky, S. Manzi, S. C. Bae, J. T. Merrill, E. Ginzler, J. G. Hanly, O. Nived, G. Sturfelt & 14 others J. Sanchez-Guerrero, I. Bruce, C. Aranow, D. Isenberg, A. Zoma, L. S. Magder, J. Buyon, K. Kalunian, M. A. Dooley, K. Steinsson, R. F. Van Vollenhoven, T. Stoll, M. Weisman, Michelle Petri

Research output: Contribution to journalArticle

Abstract

Systemic lupus erythematosus (SLE) is characterized by multiple autoantibodies and complement activation. Recent studies have suggested that anti-nuclear antibody (ANA) positivity may disappear over time in some SLE patients. Anti-double-stranded DNA (dsDNA) antibody titers and complement levels may vary with time and immunosuppressive treatment, while the behavior of anti-extractable nuclear antigen (ENA) over time is less well understood. This study sought to determine the correlation between historical autoantibody tests and current testing in patients with SLE. Three hundred and two SLE patients from the ACR Reclassification of SLE (AROSE) database with both historical and current laboratory data were selected for analysis. The historical laboratory data were compared with the current autoantibody tests done at the reference laboratory and tested for agreement using percent agreement and Kappa statistic. Serologic tests included ANA, anti-dsDNA, anti-Smith, anti-ribonucleoprotein (RNP), anti-Ro, anti-La, rheumatoid factor (RF), C3 and C4. Among those historically negative for immunologic markers, a current assessment of the markers by the reference laboratory generally yielded a low percentage of additional positives (3-13%). However, 6/11 (55%) of those historically negative for ANA were positive by the reference laboratory, and the reference laboratory test also identified 20% more patients with anti-RNP and 18% more with RF. Among those historically positive for immunologic markers, the reference laboratory results were generally positive on the same laboratory test (range 57% to 97%). However, among those with a history of low C3 or C4, the current reference laboratory results indicated low C3 or C4 a low percentage of the time (18% and 39%, respectively). ANA positivity remained positive over time, in contrast to previous studies. Anti-Ro, La, RNP, Smith and anti-dsDNA antibodies had substantial agreement over time, while complement had less agreement. This variation could partially be explained by variability of the historical assays, which were done by local laboratories over varying periods of time. Variation in the results for complement, however, is more likely to be explained by response to treatment. These findings deserve consideration in the context of diagnosis and enrolment in clinical trials.

Original languageEnglish (US)
Pages (from-to)250-255
Number of pages6
JournalLupus
Volume20
Issue number3
DOIs
StatePublished - Mar 2011

Fingerprint

Systemic Lupus Erythematosus
Autoantibodies
Anti-Idiotypic Antibodies
Rheumatoid Factor
Biomarkers
Nuclear Antigens
Ribonucleoproteins
Antibodies
Complement Activation
DNA
Serologic Tests
Immunosuppressive Agents
Clinical Trials
Databases
Therapeutics

Keywords

  • ANA
  • autoantibodies
  • systemic lupus erythematosus

ASJC Scopus subject areas

  • Rheumatology

Cite this

Autoantibodies in systemic lupus erythematosus : Comparison of historical and current assessment of seropositivity. / Ippolito, A.; Wallace, D. J.; Gladman, D.; Fortin, P. R.; Urowitz, M.; Werth, V.; Costner, M.; Gordon, C.; Alarcón, G. S.; Ramsey-Goldman, R.; Maddison, P.; Clarke, A.; Bernatsky, S.; Manzi, S.; Bae, S. C.; Merrill, J. T.; Ginzler, E.; Hanly, J. G.; Nived, O.; Sturfelt, G.; Sanchez-Guerrero, J.; Bruce, I.; Aranow, C.; Isenberg, D.; Zoma, A.; Magder, L. S.; Buyon, J.; Kalunian, K.; Dooley, M. A.; Steinsson, K.; Van Vollenhoven, R. F.; Stoll, T.; Weisman, M.; Petri, Michelle.

In: Lupus, Vol. 20, No. 3, 03.2011, p. 250-255.

Research output: Contribution to journalArticle

Ippolito, A, Wallace, DJ, Gladman, D, Fortin, PR, Urowitz, M, Werth, V, Costner, M, Gordon, C, Alarcón, GS, Ramsey-Goldman, R, Maddison, P, Clarke, A, Bernatsky, S, Manzi, S, Bae, SC, Merrill, JT, Ginzler, E, Hanly, JG, Nived, O, Sturfelt, G, Sanchez-Guerrero, J, Bruce, I, Aranow, C, Isenberg, D, Zoma, A, Magder, LS, Buyon, J, Kalunian, K, Dooley, MA, Steinsson, K, Van Vollenhoven, RF, Stoll, T, Weisman, M & Petri, M 2011, 'Autoantibodies in systemic lupus erythematosus: Comparison of historical and current assessment of seropositivity', Lupus, vol. 20, no. 3, pp. 250-255. https://doi.org/10.1177/0961203310385738
Ippolito, A. ; Wallace, D. J. ; Gladman, D. ; Fortin, P. R. ; Urowitz, M. ; Werth, V. ; Costner, M. ; Gordon, C. ; Alarcón, G. S. ; Ramsey-Goldman, R. ; Maddison, P. ; Clarke, A. ; Bernatsky, S. ; Manzi, S. ; Bae, S. C. ; Merrill, J. T. ; Ginzler, E. ; Hanly, J. G. ; Nived, O. ; Sturfelt, G. ; Sanchez-Guerrero, J. ; Bruce, I. ; Aranow, C. ; Isenberg, D. ; Zoma, A. ; Magder, L. S. ; Buyon, J. ; Kalunian, K. ; Dooley, M. A. ; Steinsson, K. ; Van Vollenhoven, R. F. ; Stoll, T. ; Weisman, M. ; Petri, Michelle. / Autoantibodies in systemic lupus erythematosus : Comparison of historical and current assessment of seropositivity. In: Lupus. 2011 ; Vol. 20, No. 3. pp. 250-255.
@article{dd09200215064f7288e6903a75208b22,
title = "Autoantibodies in systemic lupus erythematosus: Comparison of historical and current assessment of seropositivity",
abstract = "Systemic lupus erythematosus (SLE) is characterized by multiple autoantibodies and complement activation. Recent studies have suggested that anti-nuclear antibody (ANA) positivity may disappear over time in some SLE patients. Anti-double-stranded DNA (dsDNA) antibody titers and complement levels may vary with time and immunosuppressive treatment, while the behavior of anti-extractable nuclear antigen (ENA) over time is less well understood. This study sought to determine the correlation between historical autoantibody tests and current testing in patients with SLE. Three hundred and two SLE patients from the ACR Reclassification of SLE (AROSE) database with both historical and current laboratory data were selected for analysis. The historical laboratory data were compared with the current autoantibody tests done at the reference laboratory and tested for agreement using percent agreement and Kappa statistic. Serologic tests included ANA, anti-dsDNA, anti-Smith, anti-ribonucleoprotein (RNP), anti-Ro, anti-La, rheumatoid factor (RF), C3 and C4. Among those historically negative for immunologic markers, a current assessment of the markers by the reference laboratory generally yielded a low percentage of additional positives (3-13{\%}). However, 6/11 (55{\%}) of those historically negative for ANA were positive by the reference laboratory, and the reference laboratory test also identified 20{\%} more patients with anti-RNP and 18{\%} more with RF. Among those historically positive for immunologic markers, the reference laboratory results were generally positive on the same laboratory test (range 57{\%} to 97{\%}). However, among those with a history of low C3 or C4, the current reference laboratory results indicated low C3 or C4 a low percentage of the time (18{\%} and 39{\%}, respectively). ANA positivity remained positive over time, in contrast to previous studies. Anti-Ro, La, RNP, Smith and anti-dsDNA antibodies had substantial agreement over time, while complement had less agreement. This variation could partially be explained by variability of the historical assays, which were done by local laboratories over varying periods of time. Variation in the results for complement, however, is more likely to be explained by response to treatment. These findings deserve consideration in the context of diagnosis and enrolment in clinical trials.",
keywords = "ANA, autoantibodies, systemic lupus erythematosus",
author = "A. Ippolito and Wallace, {D. J.} and D. Gladman and Fortin, {P. R.} and M. Urowitz and V. Werth and M. Costner and C. Gordon and Alarc{\'o}n, {G. S.} and R. Ramsey-Goldman and P. Maddison and A. Clarke and S. Bernatsky and S. Manzi and Bae, {S. C.} and Merrill, {J. T.} and E. Ginzler and Hanly, {J. G.} and O. Nived and G. Sturfelt and J. Sanchez-Guerrero and I. Bruce and C. Aranow and D. Isenberg and A. Zoma and Magder, {L. S.} and J. Buyon and K. Kalunian and Dooley, {M. A.} and K. Steinsson and {Van Vollenhoven}, {R. F.} and T. Stoll and M. Weisman and Michelle Petri",
year = "2011",
month = "3",
doi = "10.1177/0961203310385738",
language = "English (US)",
volume = "20",
pages = "250--255",
journal = "Lupus",
issn = "0961-2033",
publisher = "SAGE Publications Ltd",
number = "3",

}

TY - JOUR

T1 - Autoantibodies in systemic lupus erythematosus

T2 - Comparison of historical and current assessment of seropositivity

AU - Ippolito, A.

AU - Wallace, D. J.

AU - Gladman, D.

AU - Fortin, P. R.

AU - Urowitz, M.

AU - Werth, V.

AU - Costner, M.

AU - Gordon, C.

AU - Alarcón, G. S.

AU - Ramsey-Goldman, R.

AU - Maddison, P.

AU - Clarke, A.

AU - Bernatsky, S.

AU - Manzi, S.

AU - Bae, S. C.

AU - Merrill, J. T.

AU - Ginzler, E.

AU - Hanly, J. G.

AU - Nived, O.

AU - Sturfelt, G.

AU - Sanchez-Guerrero, J.

AU - Bruce, I.

AU - Aranow, C.

AU - Isenberg, D.

AU - Zoma, A.

AU - Magder, L. S.

AU - Buyon, J.

AU - Kalunian, K.

AU - Dooley, M. A.

AU - Steinsson, K.

AU - Van Vollenhoven, R. F.

AU - Stoll, T.

AU - Weisman, M.

AU - Petri, Michelle

PY - 2011/3

Y1 - 2011/3

N2 - Systemic lupus erythematosus (SLE) is characterized by multiple autoantibodies and complement activation. Recent studies have suggested that anti-nuclear antibody (ANA) positivity may disappear over time in some SLE patients. Anti-double-stranded DNA (dsDNA) antibody titers and complement levels may vary with time and immunosuppressive treatment, while the behavior of anti-extractable nuclear antigen (ENA) over time is less well understood. This study sought to determine the correlation between historical autoantibody tests and current testing in patients with SLE. Three hundred and two SLE patients from the ACR Reclassification of SLE (AROSE) database with both historical and current laboratory data were selected for analysis. The historical laboratory data were compared with the current autoantibody tests done at the reference laboratory and tested for agreement using percent agreement and Kappa statistic. Serologic tests included ANA, anti-dsDNA, anti-Smith, anti-ribonucleoprotein (RNP), anti-Ro, anti-La, rheumatoid factor (RF), C3 and C4. Among those historically negative for immunologic markers, a current assessment of the markers by the reference laboratory generally yielded a low percentage of additional positives (3-13%). However, 6/11 (55%) of those historically negative for ANA were positive by the reference laboratory, and the reference laboratory test also identified 20% more patients with anti-RNP and 18% more with RF. Among those historically positive for immunologic markers, the reference laboratory results were generally positive on the same laboratory test (range 57% to 97%). However, among those with a history of low C3 or C4, the current reference laboratory results indicated low C3 or C4 a low percentage of the time (18% and 39%, respectively). ANA positivity remained positive over time, in contrast to previous studies. Anti-Ro, La, RNP, Smith and anti-dsDNA antibodies had substantial agreement over time, while complement had less agreement. This variation could partially be explained by variability of the historical assays, which were done by local laboratories over varying periods of time. Variation in the results for complement, however, is more likely to be explained by response to treatment. These findings deserve consideration in the context of diagnosis and enrolment in clinical trials.

AB - Systemic lupus erythematosus (SLE) is characterized by multiple autoantibodies and complement activation. Recent studies have suggested that anti-nuclear antibody (ANA) positivity may disappear over time in some SLE patients. Anti-double-stranded DNA (dsDNA) antibody titers and complement levels may vary with time and immunosuppressive treatment, while the behavior of anti-extractable nuclear antigen (ENA) over time is less well understood. This study sought to determine the correlation between historical autoantibody tests and current testing in patients with SLE. Three hundred and two SLE patients from the ACR Reclassification of SLE (AROSE) database with both historical and current laboratory data were selected for analysis. The historical laboratory data were compared with the current autoantibody tests done at the reference laboratory and tested for agreement using percent agreement and Kappa statistic. Serologic tests included ANA, anti-dsDNA, anti-Smith, anti-ribonucleoprotein (RNP), anti-Ro, anti-La, rheumatoid factor (RF), C3 and C4. Among those historically negative for immunologic markers, a current assessment of the markers by the reference laboratory generally yielded a low percentage of additional positives (3-13%). However, 6/11 (55%) of those historically negative for ANA were positive by the reference laboratory, and the reference laboratory test also identified 20% more patients with anti-RNP and 18% more with RF. Among those historically positive for immunologic markers, the reference laboratory results were generally positive on the same laboratory test (range 57% to 97%). However, among those with a history of low C3 or C4, the current reference laboratory results indicated low C3 or C4 a low percentage of the time (18% and 39%, respectively). ANA positivity remained positive over time, in contrast to previous studies. Anti-Ro, La, RNP, Smith and anti-dsDNA antibodies had substantial agreement over time, while complement had less agreement. This variation could partially be explained by variability of the historical assays, which were done by local laboratories over varying periods of time. Variation in the results for complement, however, is more likely to be explained by response to treatment. These findings deserve consideration in the context of diagnosis and enrolment in clinical trials.

KW - ANA

KW - autoantibodies

KW - systemic lupus erythematosus

UR - http://www.scopus.com/inward/record.url?scp=79958255101&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79958255101&partnerID=8YFLogxK

U2 - 10.1177/0961203310385738

DO - 10.1177/0961203310385738

M3 - Article

VL - 20

SP - 250

EP - 255

JO - Lupus

JF - Lupus

SN - 0961-2033

IS - 3

ER -