Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.
Rapid Surges of Anti-dsDNA Titers Predict Severe Clinical Flares in Systemic Lupus Erythematosus.
Pan1, Nancy, Amigues2, Isabelle, Duculan3, Rolando, Aziz4, Faiza, Lyman1, Stephen L., Crow1, Mary K., Kirou1, Kyriakos A.
Hospital for Special Surgery, New York, NY
Hospital Saint Joseph Saint Luc, Paris, France
Mary Kirkland Center for Lupus Research-Hospital for Special Surgery, New York, NY
Interfaith Medical Center, Brooklyn, NY
Autoantibodies to double stranded (ds) DNA (anti-DNA) are very specific for the diagnosis of systemic lupus erythematosus (SLE). Anti-DNA titers are used by 76% of US rheumatologists to monitor disease activity, though there are conflicting reports as to its utility. Studies have shown increased anti-DNA titers with no clinical activity, and conversely, increased disease activity with low or absent anti-DNA titers. We hypothesized that a rapid and dramatic increase in anti-DNA titers ("anti-DNA surge") may herald a severe SLE flare.
A matched case-control study was conducted to assess the association between a preceding anti-DNA surge and a subsequent clinical flare in patients with SLE. The study protocol was approved by the institutional review board. All patients were identified from the Hospital for Special Surgery (HSS) SLE Registry and met the American College of Rheumatology 1982 revised classification criteria for SLE. Cases had to have a surge of anti-DNA, defined as an increase of anti-DNA titer by the Crithidia luciliae assay from 0 to 3+/4+, or from 1+ to 4+, within a period of less than 12 months. The date of the anti-DNA surge was defined as Day 0. Two control SLE patients were identified through the HSS registry for each case and were matched for age, sex and race, and Day 0 (visit date closest to corresponding date for case), but without an anti-DNA surge.
The primary outcome was Severe Flare by SELENA SLEDAI within 6 months of an anti-DNA surge. Secondary outcomes were a Renal Flare (by BILAG Renal A or B) within 6 months, occurrence of a Mild/Moderate Clinical Flare (by SELENA SLEDAI), and mild, moderate or severe flare by the mSFI (Modified SELENA Flare Index) within 6 months. Chi square analysis and logistic regression were used to detect associations of anti-DNA surges with clinical SLE flares, age, sex, race, and complement levels.
Twenty-three cases and 45 controls were identified. A higher proportion of cases, compared to controls, experienced a Severe Flare within 6 months of Day 0 (OR 6.3, p=0.02, CI 219). The cumulative risk of having a severe flare was significantly higher in cases (see figure). Anti-DNA surges also were associated with an increased risk for a severe or moderate flare by mSFI (OR 3.3, p=0.03, CI 1.19.5). An anti-DNA surge was not predictive of a Renal flare. Race, Hispanic ethnicity, and sex were not predictive of a severe SELENA flare. More dramatic anti-DNA surges (increase of titers from 04+) had a higher risk for a severe SELENA flare (OR 7.9, p=0.002) than less dramatic anti-DNA increases (OR 4.475, p=0.1).
A rapid, dramatic rise in anti-DNA titer was strongly associated with the development of a severe clinical SLE flare by SELENA SLEDAI within 6 months. We believe that clinicians should intensify follow-up for such patients and treat aggressively as soon as a clinical flare occurs.
To cite this abstract, please use the following information:
Pan, Nancy, Amigues, Isabelle, Duculan, Rolando, Aziz, Faiza, Lyman, Stephen L., Crow, Mary K., et al; Rapid Surges of Anti-dsDNA Titers Predict Severe Clinical Flares in Systemic Lupus Erythematosus. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :1709