From the Guidelines
Anti-dsDNA antibodies are a crucial diagnostic and monitoring tool for systemic lupus erythematosus (SLE), with a high specificity of 95% for SLE, although sensitivity is lower at around 70%. Testing for these antibodies in serum is primarily used to help diagnose SLE and monitor disease activity 1. A positive anti-dsDNA test strongly suggests SLE, especially when combined with other clinical symptoms and laboratory findings. The test measures antibodies that target double-stranded DNA, which is a hallmark of the autoimmune process in lupus.
Key Points to Consider
- Elevated levels of anti-dsDNA antibodies often correlate with disease activity, particularly lupus nephritis, and may rise before clinical flares 1.
- Regular monitoring of anti-dsDNA levels can help guide treatment decisions, with decreasing levels potentially indicating effective therapy.
- However, interpretation should always be done in the clinical context, as some patients with SLE may never test positive, while false positives can occasionally occur in other conditions like chronic hepatitis, infectious mononucleosis, or other autoimmune diseases.
- The use of anti-dsDNA antibodies in diagnosis and monitoring should be guided by clinical suspicion and in conjunction with other diagnostic criteria and laboratory tests.
Recommendations for Practice
- A double-screening strategy using a last-generation SPA in the first place, and subsequently, the CLIFT as the confirmation test, is recommended for anti-dsDNA testing 1.
- In the event of a negative anti-dsDNA SPA result, a confirmatory CLIFT should be done only when other signs of clinical suspicion are present.
- Without a clinical suspicion, the result should be reported directly as negative anti-dsDNA.
- The laboratory should include the method used in their reports; if several methods are used, the results obtained with each method should be reported 1.
From the Research
Dsdna AB Serum
- Dsdna AB serum is related to Systemic Lupus Erythematosus (SLE), a chronic autoimmune disease characterized by inflammation and immune-mediated injury to multiple organ systems 2.
- Anti-dsDNA antibodies are part of the classification criteria and recommended for monitoring SLE with regards to lupus flares and therapy responses 3.
- The autoimmune response to chromatin or one of the nucleosome components (double stranded (ds)DNA and histones) is typically associated with the development of SLE 3.
- Coupling anti-dsDNA with anti-Chr Ab can be proposed to define endotypes, which is useful to follow disease activity, predict lupus nephritis/serositis, and anticipate therapeutic response in the DP+ group 3.
Treatment and Management
- Hydroxychloroquine should be administered to every lupus patient irrespective of organ involvement 4.
- Conventional immunosuppressive therapy includes corticosteroids, methotrexate, cyclophosphamide, mycophenolate mofetil, azathioprine, cyclosporine, and tacrolimus 4.
- Biologic agents targeting various pathogenetic paths have been applied, including belimumab, rituximab, and anifrolumab 4, 2.
- The primary goal of treatment is to achieve disease remission or quiescence, defined by minimal symptoms, low levels of autoimmune inflammatory markers, and minimal systemic glucocorticoid requirement 2.
Anti-dsDNA Antibodies
- Anti-dsDNA antibodies have been suggested to contribute to multiple end-organ injuries, especially to lupus nephritis, in patients with SLE 5.
- Serum levels of anti-DNA antibodies fluctuate with disease activity in patients with SLE 5.
- Anti-dsDNA antibodies can accumulate in the glomerular and tubular basement membrane, trigger the complement cascade, penetrate into living cells, modulate gene expression, and even induce profibrotic phenotypes of renal cells 5.