Anti-dsDNA antibodies: still a useful criterion for patients with systemic lupus erythematosus?

The presence of antibodies to dsDNA has been a criterion for systemic lupus erythematosus (SLE) in each of three attempts to classify the disease that have been undertaken by the American College of Rheumatology. The generally good specificity of the test, the fact that it is widely available and often undertaken by an enzyme linked immunosorbent assay (ELISA) which is relatively cheap and easy to perform have encouraged its continued presence in the list of lupus criteria. The detection of anti-dsDNA antibodies is not, however, straightforward and the real significance of the presence of these antibodies, their true specificity (or otherwise), the question of whether they are truly linked to disease pathogenicity and how accurately they reflect disease activity are all questions that have been posed in the past 20 years.