SMART-SLE: serology monitoring and repeat testing in systemic lupus erythematosus—an analysis of anti-double-stranded DNA monitoring
Document Type
Article
Publication Date
1-1-2024
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<0.001) and fluctuating cohort (adjusted HR 1.46; 95% CI: 1.28, 1.66), both for a ratio >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; P¼0.008) and the persistently positive cohort (adjusted HR 1.36; 95% CI: 1.08, 1.71; P¼0.009). 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. © The Author(s) 2023. Published by Oxford University Press on behalf of the British Society for Rheumatology.
Keywords
Antibodies, Antinuclear, Data Collection, DNA, Hematologic Tests, Humans, Lupus Erythematosus, Systemic, antimalarial agent, azathioprine, belimumab, cyclophosphamide, cyclosporine, double stranded DNA antibody, leflunomide, methotrexate, mycophenolic acid, prednisolone, rituximab, tacrolimus, antinuclear antibody, DNA, adult, Article, cohort analysis, disease exacerbation, female, human, longitudinal study, major clinical study, male, risk assessment, serology, systemic lupus erythematosus, blood examination, information processing
Divisions
medicinedept
Funders
Asia Pacific Lupus Collaboration
Publication Title
Rheumatology
Volume
63
Issue
2
Publisher
Oxford University Press
Additional Information
Cited by: 2