Serological detection of disease activity in SLE

doi:10.1016/0009-9120(92)90315-J

Clinical Biochemistry

Volume 25, Issue 3, June 1992, Pages 201-208

https://doi.org/10.1016/0009-9120(92)90315-J Get rights and content

Laboratory tests are commonly used to aid in monitoring disease activity in patients with systemic lupus erythematosus. Typically, tests for antinative DNA, complement, acute phase reactants, and sometimes circulating immune complexes are used for this purpose. More recently, tests for complement activation products and immunocyte activation have been suggested. We measured antinative DNA, C4, Westergren sedimentation rate, iC3b, Bb, and sIL-2R levels in a group of 100 patients with SLE evaluated clinically for activity by a modified version of the Systemic Lupus Activity Measure (SLAM); iC3b and Bb were studied in 71 of the patients and sIL-2R in 52. We found that sIL-2R and sedimentation rate correlated best with SLAM, anti-DNA was intermediate, and C4, iC3b, and Bb correlated the least. None of the tests predicted severity of disease, but sIL-2R was highest in patients with active renal disease.

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To determine the clinical value of assaying serum levels of neopterin, tumor necrosis factor-α (TNF-α) and soluble tumor necrosis factor receptor II (p75) (sTNFRII) in patients with systemic lupus erythematosus (SLE), manifested clinically with lupus nephritis (LN), neuropsychiatric lupus erythematosus (NPLE), and/or vasculitis compared with established parameters (complements C3 and C4).
Serum concentrations of neopterin, TNF-α and sTNFRII were studied in 40 female patients with SLE at various degrees of disease activity and in 10 healthy controls, matched for age and sex, using an ELISA kit. Disease activity was assessed by the SLE disease activity index (SLEDAI) score. Thirty-five, 30 and 28 of our patients presented with LN, NPLE and/or vasculitis, respectively, as the main clinical manifestation.
Serum levels of neopterin, TNF-α and sTNFRII were significantly increased, while the TNF-α/sTNFRII ratio, C3 and C4 levels of SLE patients were significantly lower than those of healthy controls. Neopterin and sTNFRII were the only parameters that showed significantly higher levels in SLE patients with mild activity compared to normal subjects and were the only parameters that showed a significant elevation in membranous nephritis and in mild NPLE compared to patients without nephritis and NPLE. Patients with vasculitis had significant elevation of serum neopterin, TNF-α and sTNFRII levels compared to patients without vasculitis. We found significant correlations between all measured variables and the SLEDAI score. Also, serum neopterin levels showed significant positive correlation with serum TNF-α, sTNFRII and TNF-α/sTNFRII levels. Serum neopterin and sTNFRII could be used to identify SLE patients from normals with a sensitivity and specificity of 100%. Multivariate linear regression analysis showed that serum sTNFRII was the only significant independent variable among parameters for prediction of SLE disease activity.
We suggest that serum sTNFRII and neopterin are more sensitive markers of disease activity than TNF-α, C3 or C4. However, sTNFRII may be a clinically useful independent marker for prediction of SLE disease activity and to differentiate normal subjects from those having mild SLE.
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Recently, pregnancy has become an important field of study among systemic lupus erythematosus (SLE) researchers. The advent of combined obstetric-medical clinics has improved both the course and the outcome of pregnancy in SLE patients. Several risk factors for both the mother and the fetus have also been described.⁵⁰ Consequently, our understanding of the complex relationships between SLE and pregnancy continues to develop, although some issues are still controversial, one of these being the relationship between pregnancy and lupus activity.
This article presents most of the recent findings on the interactions between SLE and pregnancy, as well as those on the diagnosis and management of SLE flares during pregnancy. The authors' experience in this field comes from the Lupus Pregnancy Clinic at St. Thomas' Hospital, where, within the last seven years, more than 180 pregnant women with SLE have received care. Studies concerning the course of disease activity, as well as the global pregnancy outcome of SLE patients (i.e., the Lupus Pregnancy Clinic and other centers) are reviewed. A management protocol for SLE flares during pregnancy is also provided. Lastly, a brief review of the immunologic changes during pregnancy, which might partly explain the changes in SLE activity within this period, is given.
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A number of valid and reliable indices are available for measuring clinical disease activity in SLE (Table 3). Despite their different approaches they have been shown to correlate well with each other and hence would appear to be measuring the same thing. The exact choice of instrument will be dictated by the purpose for which it is required. Although none is perfect they are useful for monitoring groups of patients in outcome studies in a research setting. Practically, disease activity indices are unlikely to be appropriate for dictating treatment decisions in individual cases: an instrument comprehensive and flexible enough for this purpose would undoubtedly be far too cumbersome for widespread use. Ultimately such fine tuning will continue to rely upon the skill and intuition of experienced physicians.
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Serological detection of disease activity in SLE

Clin Immunol Immunopathol

Am J Med

Am J Med

Immunological factors and clinical activity in lupus erythematosus

N Engl J Med

Serological tests in the assessment of disease activity in systemic lupus erythematosus

Scand J Rheumatol

Monitoring of systemic lupus

Lancet

The value of complement and immune complex determinations in monitoring disease activity in patients with systemic lupus erythematosus

Arthritis Rheum

Useful laboratory measurements in the management of systemic lupus erythematosus

Q J Med

Disease activity in the nephritis of systemic lupus erythematosus in relation to serum complement concentrations, DNA-binding capacity and precipitating anti-DNA antibody

Clin Exp Immunol

C4a anaphylotoxin levels as an indicator of disease activity in systemic lupus erythematosus

Clin Exp Immunol

Factor B activation products in patients with systemic lupus erythematosus: a marker of severe disease activity

Arthritis Rheum

Complement activation during systemic lupus erythematosus: C3a and C5a anaphylotoxins circulate during exacerbations of disease

Arthritis Rheum

Serum levels of interleukin-2 receptor and activity of rheumatic diseases characterized by immune system activation

Arthritis Rheum

Soluble interleukin-2 receptors in systemic lupus erythematosus

Arthritis Rheum

Relation between soluble interleukin-2 receptor and clinical findings in patients with systemic lupus erythematosus

Ann Rheum Dis

The soluble interleukin-2 receptor in rheumatic disease

Arthritis Rheum

Changes in plasma levels of interleukin-2 receptor in relation to disease exacerbations and levels of anti-dsDNA and complement in systemic lupus erythematosus

Clin Exp Immunol

Effectiveness of testing for anti-DNA and the complement components iC3b, Bb, and C4 in the assessment of activity of systemic lupus erythematosus

J Clin Lab Anal

Circulating IL-2R receptor levels and disease activity in systemic lupus erythematosus

Arthritis Rheum

The 1982 revised criteria for the classification of systemic lupus erythematosus

Arthritis Rheum