1. Elevated Subclinical Double-Stranded DNA Antibodies and Future Proliferative Lupus Nephritis
- Author
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Jessica J. Lee, Lisa K. Prince, Thomas P. Baker, Jess D. Edison, Patricia Papadopoulos, Kevin C. Abbott, and Stephen W. Olson
- Subjects
Adult ,Male ,medicine.medical_specialty ,Epidemiology ,Lupus nephritis ,Critical Care and Intensive Care Medicine ,Gastroenterology ,immune system diseases ,Internal medicine ,medicine ,Humans ,Lupus Erythematosus, Systemic ,skin and connective tissue diseases ,Subclinical infection ,Retrospective Studies ,Transplantation ,Lupus erythematosus ,biology ,business.industry ,C-reactive protein ,Case-control study ,Retrospective cohort study ,Original Articles ,DNA ,medicine.disease ,Lupus Nephritis ,C-Reactive Protein ,Nephrology ,Antibodies, Antinuclear ,Case-Control Studies ,Immunology ,biology.protein ,Female ,Antibody ,business ,Double stranded - Abstract
Elevated anti-double-stranded DNA (dsDNA) antibody and C-reactive protein are associated with proliferative lupus nephritis (PLN). Progression of quantitative anti-dsDNA antibody in patients with PLN has not been compared with that in patients with systemic lupus erythematosus (SLE) without LN before diagnosis. The temporal relationship between anti-dsDNA antibody and C-reactive protein elevation has also not been evaluated.This case-control Department of Defense Serum Repository (established in 1985) study compared longitudinal prediagnostic quantitative anti-dsDNA antibody and C-reactive protein levels in 23 patients with biopsy-proven PLN (Walter Reed Army Medical Center, 1993-2009) with levels in 21 controls with SLE but without LN matched for patient age, sex, race, and age of serum sample. The oldest (median, 2601 days; 25%, 1245 days, 75%, 3075 days), the second to last (368; 212, 635 days), and the last (180; 135, 477 days) serum sample before diagnosis were analyzed.More patients with PLN had an elevated anti-dsDNA antibody level than did the matched controls at any point (78% versus 5%; P0.001),1 year (82% versus 8%; P0.001), 1-4 years (53% versus 0%; P0.001), and4 years (33% versus 0%; P=0.04) before diagnosis. A rate of increase1 IU/ml per year (70% versus 0%; P0.001) was most specific for PLN. The anti-dsDNA antibody levels increased before C-reactive protein did in most patients with an antecedent elevation (92% versus 8%; P0.001).Elevated anti-dsDNA antibody usually precedes both clinical and subclinical evidence of proliferative LN, which suggests direct pathogenicity. Absolute anti-dsDNA antibody level and rate of increase could better establish risk of future PLN in patients with SLE.
- Published
- 2013