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.
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.
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 13) 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.
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 rash||Alopecia||Cutaneous vasculitis||Livedo reticul||Morning stiffness||Axial arthritis||Pleuritis||Protein-uria||Oral/nasal ulcers||Lymphopenia||Lymphadenopathy|
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