Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Autoantibodies Predate the Onset of Systemic Lupus Erythematosus.

Rantapaa-Dahlqvist2,  Solbritt, Eriksson1,  Catharina, Kokkonen1,  Heidi, Johansson1,  Martin, Hallmans1,  Göran, Wadell1,  Göran

Umeå, Sweden
Rheumatology, Umeå, Sweden

Objective:

To identify the presence of autoantibodies in a Northern European population antedating disease onset of SLE using blood samples donated to the Medical Biobank of Northern Sweden before onset of symptoms and relate the predating antibodies with first symptoms of disease.

Methods:

The register of patients fulfilling the ACR criteria for SLE and the given date for the onset of symptoms was co-analysed with the register of the Medical Biobank and the Maternity cohort of northern Sweden. Thirty-eight patients (35 females and 3 males) were identified as donating blood samples prior to disease onset. A nested case-control study, designed 1:4, was performed with 152 age and sex matched controls being identified. Antibodies (abs) against SSA (60 and 52 kDa), SSB, Sm, RNP, Scl-70, Jo-1, dsDNA, Centromere B and histones were analysed using a multiplex detection kit, ANA-II Plus Test System (Athena Multi-Lyte®) on a Bio-Plex Array Reader (Luminex200, LabmapTM). Autoantibody tests for ANA were performed by indirect immunofluorescence on HEp2-cells at a sample dilution of 1:100.

Results:

In 22/35 (63 %) of the patients with SLE autoantibodies against nuclear antigens were detected in the blood 5.6 (±4.7; mean±SD) years before the onset of symptoms and 8.7 (±5.6) years before diagnosis. The sensitivity was highest for ANA at 45.7% with a specificity of 95%, followed by anti-dsDNA and anti-SSA abs both with a sensitivity of 20.0% at a specificity of 98.7% and 97.4%, respectively. The odds ratio (OR) for anti-DNA predicting disease was 18.13 (CI 95%: 3.58–91.84), and for ANA 11.5 (CI 95%: 4.54–28.87). The sensitivity for the other autoantibodies varied between 14.3% and 2.9% with specificity ranging between 97.4% and 100%. The autoantibody appearing first, i.e., 6.6±2.5 (mean±SD) years prior to the onset of symptoms is anti-SSA antibodies whilst those closest to disease onset are anti-Centromere B antibodies at 0.2 years, anti-Sm at 0.7 years, and anti-Scl70 at 1.4±0.6 years. The number of individuals with antibodies present increased the closer to onset of symptoms. The mean number of antibodies present in pre-diseased individuals was 1.4 and after disease onset 3.1 (p< 0.001). The time predating disease was shorter, and the number of antibodies greater, in those individuals with serositis as a presenting symptom in comparison to those with arthritis and skin manifestations.

Conclusion:

Autoantibodies against nuclear antigens can be detected in the blood of patients with SLE several years before the onset of symptoms and diagnosis. The most sensitive autoantibodies were ANA, SSA and dsDNA, with the highest predictive OR for anti-dsDNA abs. The autoantibody appearing first was anti-SSA abs.

To cite this abstract, please use the following information:
Rantapaa-Dahlqvist, Solbritt, Eriksson, Catharina, Kokkonen, Heidi, Johansson, Martin, Hallmans, Göran, Wadell, Göran; Autoantibodies Predate the Onset of Systemic Lupus Erythematosus. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1847
DOI: 10.1002/art.29612

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