The clinical significance of antinuclear antibodies and specific autoantibodies in juvenile and adult systemic lupus erythematosus patients
Pongsawat Rodsaward,1 Natcha Chottawornsak,2 Supaporn Suwanchote,1 Muanpetch Rachayon,1 Tawatchai Deekajorndech,4 Helen L Wright,5 Steven W Edwards,6 Michael W Beresford,7,8 Pawinee Rerknimitr,2,3 Direkrit Chiewchengchol1,3
1 Center of Excellence in Immunology and Immune-mediated Diseases, Department of Microbiology;
2 Division of Dermatology,
3 Skin and Allergy Research Unit, Department of Medicine;
4 Division of Nephrology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand;
5 Institute of Ageing and Chronic Disease;
6 Institute of Integrative Biology;
7 Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
8 Department of Pediatric Rheumatology, Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
Abstract
Background: Juvenile systemic lupus erythematosus (JSLE) and adult SLE (ASLE) patients present with different clinical manifestations, but it is unknown if there are differences in their antinuclear autoantibody (ANA) profiles or if staining patterns are associated with specific autoantibodies and clinical manifestations.
Objective: To determine whether distinct types and numbers of ANA-staining patterns are associated with specific autoantibodies and clinical manifestations in JSLE and ASLE patients.
Methods: A retrospective study was performed in Thai children (n = 146) and adults (n = 180) diagnosed with SLE using the Systemic Lupus International Collaborating Clinics classification criteria.
Results: JSLE patients with a homogeneous pattern of staining and anti-dsDNA or anti-nucleosome antibodies in serum, developed renal involvement, leukopenia and acute/subacute cutaneous LE. Coarse speckled pattern with anti-RNP or anti-Sm showed thrombocytopenia and renal involvement in JSLE patients, but leukopenia in both groups. JSLE patients with fine-coarse speckled pattern and anti-RNP, anti-Sm, anti-Ro-52 or anti-SSA developed leukopenia, thrombocytopenia and renal involvement, whilst hemolytic anemia and serositis were commonly found in those with anti-Ro-52. Median SLEDAI score was higher in JSLE than ASLE patients.
Conclusion: Detailed ANA-staining patterns with specific autoantibodies show particular clinical manifestations and hence prompt further clinical investigations in both JSLE and ASLE patients. Therefore, this study demonstrates that distinct patterns of ANA staining and specific autoantibodies are clinically important in both children and adults with SLE.
Key words: antinuclear antibodies, systemic lupus erythematosus, autoantibodies, autoimmune diseases, anti-double stranded DNA