The predictive value of fluctuations in IgM and IgG class anti-dsDNA antibodies for relapses in systemic lupus erythematosus. A prospective long term observation

OBJECTIVE This study investigated the predictive value of rises in IgM class antibodies against double stranded DNA (anti-dsDNA) for ensuing relapses in systemic lupus erythematosus (SLE) in comparison with rises in IgG class antibodies. In addition, it was analysed whether rises in IgM class anti-d...

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Bibliographic Details
Published in:	Annals of the rheumatic diseases Vol. 56; no. 11; pp. 661 - 666
Main Authors:	Bootsma, Hendrika, Spronk, Peter E, Borg, Evert J Ter, Hummel, Elsje J, de Boer, Greetje, Limburg, Pieter C, Kallenberg, Cees G M
Format:	Journal Article
Language:	English
Published:	London BMJ Publishing Group Ltd and European League Against Rheumatism 01-11-1997 BMJ BMJ Publishing Group LTD
Subjects:	Adolescent Adult Aged anti-dsDNA Antibodies, Antinuclear - blood Biological and medical sciences Disease Enzyme-Linked Immunosorbent Assay Extended Reports Female Hospitals Humans immunoglobulin classes Immunoglobulin G - blood Immunoglobulin M - blood Immunoglobulins Laboratories Lupus Lupus Erythematosus, Systemic - diagnosis Lupus Erythematosus, Systemic - immunology Male Medical sciences Middle Aged Pathogenesis Predictive Value of Tests Prospective Studies Radioimmunoprecipitation Assay Recurrence Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis Studies systemic lupus erythematosus Human Immunopathology Connective tissue disease Skin disease Prognosis Antibody Autoantibody IgG Autoimmune disease Long term IgM Double stranded DNA Follow up study Systemic disease Predictive value Lupus erythematosus Disseminated ELISA assay
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Summary:	OBJECTIVE This study investigated the predictive value of rises in IgM class antibodies against double stranded DNA (anti-dsDNA) for ensuing relapses in systemic lupus erythematosus (SLE) in comparison with rises in IgG class antibodies. In addition, it was analysed whether rises in IgM class anti-dsDNA were associated with specific clinical manifestations of SLE. METHODS Thirty four of a cohort of 72 SLE patients who were positive for IgM class anti-dsDNA at the start of the study or at the time of a relapse were analysed monthly for class specific anti-dsDNA levels during a median observation period of 19.6 months. Disease activity was scored according to the SLE Disease Activity Index. Anti-dsDNA were measured by IgM and IgG class enzyme linked immunosorbent assay (ELISA) and by Farr assay. RESULTS During the study 18 of 34 patients experienced 26 relapses. Twenty two (85%) of the relapses were accompanied by a positive test for IgM class anti-dsDNA by ELISA, 23 (89%) were positive for IgG class anti-dsDNA by ELISA, and 25 (96%) were positive by Farr assay. Patients with rises in IgG class anti-dsDNA by ELISA or in anti-dsDNA by Farr assay had a significantly higher cumulative risk for relapses than patients without those increases (p=0.04 and p=0.03, respectively). This was not the case for rises in IgM class anti-dsDNA (p=0.16). Moreover, a rise in IgM class anti-dsDNA before a relapse was not associated, expressed in terms of odds ratios, with specific clinical manifestations of SLE. CONCLUSION Relapses of SLE are frequently accompanied by IgM class anti-dsDNA. Rises of IgM class anti-dsDNA, in contrast with rises in IgG class anti-dsDNA, are not a sensitive tool for predicting a relapse and are not associated with specific clinical manifestations of SLE.
Bibliography:	istex:B0FECBBB567996FCF819BC05B4D6107D4C96EE29 local:annrheumdis;56/11/661 ark:/67375/NVC-ZTSBMW8L-0 href:annrheumdis-56-661.pdf PMID:9462168 Dr H Bootsma, Department of Internal Medicine, Division of Rheumatology T3.250, University Hospital Groningen, PO Box 30.001, 9700 RB Groningen, the Netherlands. ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23 ObjectType-Article-1 ObjectType-Feature-2
ISSN:	0003-4967 1468-2060
DOI:	10.1136/ard.56.11.661