Journal
RHEUMATOLOGY
Volume 54, Issue 3, Pages 449-457Publisher
OXFORD UNIV PRESS
DOI: 10.1093/rheumatology/keu326
Keywords
systemic lupus erythematosus; anti-nucleosome antibodies; biomarkers; disease activity
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Funding
- New Emerging Team grant from the Canadian Institutes of Health Research (CIHR) [QNT 78341]
- Ontario Institute for Cancer Research through Government of Ontario
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Objective. The aim of this study was to determine whether anti-nucleosome antibodies function as activity-specific biomarkers in SLE. Methods. Fifty-one patients were recruited and followed prospectively with periodic clinical and biochemical assessments over a 14-month period. Disease activity was determined by the SLEDAI-2K. Anti-nucleosome antibody levels were measured by an ELISA and its utility as an activity-specific biomarker as compared with that of anti-dsDNA antibodies and C3 was assessed both at baseline and in longitudinal analysis. Results. Anti-nucleosome antibodies were significantly elevated in SLE patients vs controls and showed a moderate positive correlation with disease activity. The utility of anti-nucleosome antibodies in identifying patients with active disease in a cross-sectional analysis was comparable to that of anti-dsDNA antibodies and C3. Analysis of variance demonstrated that the level of anti-nucleosome antibodies and C3 varied significantly with changes in disease activity over time. Changes in clinical state were not mirrored by changes in anti-dsDNA antibodies. In time-dependent analysis, anti-nucleosome antibodies showed a better fit over time than anti-dsDNA antibodies and C3. In pairwise comparisons, C3 and anti-nucleosome antibodies outperformed other models, including the conventional pairing of C3 and anti-dsDNA antibodies, however, no biomarker alone or as a group accurately predicted impending remissions or exacerbations. Conclusion. Anti-nucleosome antibodies demonstrate greater fidelity as a biomarker for changes in SLE disease activity than traditional biomarkers, supporting the routine monitoring of this antibody in clinical practice.
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