From the Guidelines
Anti-dsDNA antibodies should be used as a specific marker for systemic lupus erythematosus (SLE) in patients with clinical suspicion of the disease, and their levels should be monitored regularly to guide treatment decisions and assess disease progression. The use of anti-dsDNA antibodies in the diagnosis and follow-up of SLE is supported by recent studies, including a proposal from an expert panel published in Autoimmunity Reviews in 2023 1, 2, 3, 4, 5.
Key Points to Consider
- Anti-dsDNA antibodies are present in approximately 70-80% of patients with active SLE, making them a valuable diagnostic tool 1.
- The antibody levels often correlate with disease activity, especially lupus nephritis, allowing clinicians to monitor treatment effectiveness and predict flares 2.
- Testing is typically done via ELISA, Crithidia luciliae immunofluorescence test (CLIFT), or radioimmunoassay methods, and a double-screening strategy using a last-generation SPA and the CLIFT as the confirmation test is recommended 3.
- False positives can occur in conditions like chronic hepatitis, infectious mononucleosis, and with certain medications, and when interpreting results, it's essential to consider the clinical context and other laboratory findings 4.
- Regular monitoring of these antibodies in diagnosed patients helps guide treatment decisions and assess disease progression, and anti-nucleosome antibodies can be used to monitor the disease activity of patients with lupus nephritis who remain anti-dsDNA negative 2.
Clinical Implications
- Clinicians should use anti-dsDNA antibodies as part of the comprehensive lupus diagnostic criteria, considering the clinical context and other laboratory findings 1.
- The use of anti-dsDNA antibodies in the diagnosis and follow-up of SLE can help improve patient outcomes by guiding treatment decisions and assessing disease progression 2.
- Further research is needed to clarify the etiopathogenic role of anti-dsDNA and to establish the predictive value of anti-dsDNA with specificity and avidity for well-defined dsDNA structures 5.
From the Research
Anti-dsDNA Antibodies in Systemic Lupus Erythematosus
- Anti-dsDNA antibodies play a pivotal role in Systemic Lupus Erythematosus (SLE), and are involved in multiple organ damage, especially the kidney, skin, and central nervous system 6
- The presence of high-avidity anti-dsDNA antibodies is closely associated with disease activity and represents a risk for renal, joint, and serosal involvement 7
- Anti-dsDNA antibodies are a marker for SLE, and 70-98% of patients test positive 8
Clinical Features and Disease Activity
- Renal involvement is significantly more frequent in patients with persistent anti-dsDNA positivity (anti-dsDNA +) compared to those with initial positivity and subsequent negativity (anti-dsDNA ±) or persistent negativity (anti-dsDNA -) 8
- Serositis is significantly more frequent in patients with persistent anti-dsDNA negativity (anti-dsDNA -) compared to those with anti-dsDNA + or anti-dsDNA ± 8
- Disease activity, assessed by the European Consensus Lupus Activity Measurement (ECLAM), is not significantly different between patients with different anti-dsDNA statuses 8
Treatment and Management
- Therapeutic strategies targeting anti-dsDNA antibodies, such as B cell targeted biologics and synthetic mimic peptides, have shown promise in reducing disease activity and improving clinical outcomes 6
- Mycophenolate mofetil (MMF) may reduce the rate of severe flare and lower the incidence of lupus nephritis in patients with new-onset SLE and a high titer of anti-dsDNA antibody 9
- Treatment goals for SLE include achieving remission or low disease activity, and balancing treatment-related comorbidities 10