Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement

The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.


Detection of Anti-dsDNA in Subjects Referred for Inflammatory Rheumatic Disease Associates with Differing Clinical Phenotypes Depending On the Assay Used

Jacobsen1,  Soren, Sturfelt2,  Gunnar, Bengtsson3,  Anders, Compagno3,  Michele, Heegaard4,  Niels, Jonsen2,  Andreas, Jacobsen1,  Rasmus S.

University Hospital, Copenhagen, Denmark,
Inst of Clinical sciences, Lund, Sweden,
University Hospital, Lund, Sweden,
Statens Serum Institut, Copenhagen, Denmark,
University Hospital, Tromsø, Norway

Purpose:

Determination of anti-dsDNA antibodies is a serological cornerstone in diagnosis and classification of systemic lupus erythematosus (SLE) but may also be detected in other conditions. Furthermore, there is no present consensus on which assay to use. Purpose of the study was to establish which clinical features regardless of the SLE diagnosis that were associated with anti-dsDNA determined by various assays assays.

Method:

In a Scandinavian tri-center study, subjects were recruited from 1082 patients referred due to suspicion of rheumatic disease. 292 were ANA positive and 292 sex- and age-matched ANA negative controls were selected from the original cohort. All 584 subjects were phenotyped according to active manifestations including the current SLE classification criteria and a broad range of other clinical manifestations. In all subjects determination of anti-dsDNA was performed by means of 1–3) Chrithidiae luciliae immunofluorescence test (CLIFT, ImmunoConcept) in 3 different laboratories, 4) solution phase ELISA (SPADE, Tromsø), 5) Varelisa (Pharmacia), 6) EliA (Pharmacia) and 7) ELISA (Pharmacia). Cut-off levels according to instructions of the manufacturer or the performing laboratory were used. Statistical analysis included logistic stepwise regression analysis using dichotomized anti-dsDNA results as the dependent variable and clinical manifestations as explanatory variables.

Results:

The prevalence of positivity for the 7 anti-dsDNA tests ranged from 5.3 to 14.2%. The five most common SLE classification manifestations were non-erosive peripheral arthritis (28%), photosensitivity (10%), oral/nasal ulcers (6.0%), hematuria (3.8%) and proteinuria (3.1%). The five most common other manifestations were arthralgias (58%), morning stiffness (24%), headache (14%), Raynauds phenomenon (13%) and xerostomia (13%). Statistically significant hazard ratios deriving from the regression analyses are shown in the table:

 Butterfly rashAlopeciaCutaneous vasculitisLivedo reticulMorning stiffnessAxial arthritisPleuritisProtein-uriaOral/nasal ulcersLymphopeniaLymphadenopathy
CLIFT 1113.96.64.87.84.7
CLIFT 2176.78.5
CLIFT 34.3130.0412291127
SPADE6.10.34258.5
VARELISA3.34.10.132422
ELIA9.00.153723
ELISA0.22488.45.1

Conclusion:

Positive results in all 7 anti-dsDNA tests associated with pleuritis and proteinuria. However, the remaining clinical manifestations shown in the table had varying associations with the anti-dsDNA tests used. The results indicate that the correlation between clinical features and any anti-dsDNA test may vary depending on the assay used and on the laboratory performing the test, as shown for CLIFT.

To cite this abstract, please use the following information:
Jacobsen, Soren, Sturfelt, Gunnar, Bengtsson, Anders, Compagno, Michele, Heegaard, Niels, Jonsen, Andreas, et al; Detection of Anti-dsDNA in Subjects Referred for Inflammatory Rheumatic Disease Associates with Differing Clinical Phenotypes Depending On the Assay Used [abstract]. Arthritis Rheum 2009;60 Suppl 10 :909
DOI: 10.1002/art.25988

Abstract Supplement

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