Heinlen Latisha D, McClain Micah T, Merrill Joan, Akbarali Yasmin W, Edgerton Colin C, Harley John B, James Judith A
Oklahoma Medical Research Foundation, Oklahoma City, OK 73104, USA.
Arthritis Rheum. 2007 Jul;56(7):2344-51. doi: 10.1002/art.22665.
Specific events that occur during the development of systemic lupus erythematosus (SLE) can be quite variable among individual patients. The aim of this study was to identify patterns that distinguish early clinical events in SLE and to assess whether the presence of associated autoantibodies precedes the fulfillment of clinical criteria.
Through a retrospective chart review of military medical records, 130 patients who met the American College of Rheumatology (ACR) criteria for the classification of SLE were identified. The initial time at which each criterion was fulfilled was recorded. Autoantibody analysis was performed on serum samples, using enzyme-linked immunosorbent assays or immunofluorescence.
The clinical features that were observed earliest were discoid rash and seizures, which developed a mean 1.74 and 1.70 years, respectively, before the diagnosis of SLE; however, arthritis was the criterion that was most commonly observed before diagnosis. The presence of IgG rheumatoid factor (IgG-RF) preceded the development of arthritis in 15 (94%) of the 16 patients who were positive for IgG-RF and in whom arthritis developed (Z = 10.2, P < 0.0001). Analogously, IgM-RF appeared before the development of arthritis in 13 (76%) of 17 patients. Anti-double-stranded DNA antibodies were associated with renal disease and appeared before evidence of nephritis in most patients (92%) (Z = 13.3, P < 0.0001). An analysis of the appearance of autoantibodies compared with the appearance of clinical criteria not associated with them revealed no significant temporal relationship.
Symptoms associated with the ACR criteria for classification of SLE are commonly present before the diagnosis of SLE, and development of organ-associated autoantibodies generally precedes the appearance of their associated clinical features.
系统性红斑狼疮（SLE）发病过程中出现的特定事件在个体患者间差异较大。本研究旨在确定区分SLE早期临床事件的模式，并评估相关自身抗体的出现是否先于临床标准的满足。
通过回顾军事医疗记录，确定了130例符合美国风湿病学会（ACR）SLE分类标准的患者。记录每个标准首次满足的时间。使用酶联免疫吸附测定或免疫荧光对血清样本进行自身抗体分析。
最早观察到的临床特征是盘状红斑和癫痫发作，分别在SLE诊断前平均1.74年和1.70年出现；然而，关节炎是诊断前最常观察到的标准。在16例IgG类风湿因子（IgG-RF）阳性且出现关节炎的患者中，有15例（94%）IgG-RF的出现先于关节炎的发生（Z = 10.2，P < 0.0001）。类似地，在17例患者中的13例（76%）中，IgM-RF在关节炎发生之前出现。抗双链DNA抗体与肾脏疾病相关，并且在大多数患者（92%）中在肾炎证据出现之前出现（Z = 13.3，P < 0.0001）。将自身抗体的出现与与其不相关的临床标准的出现进行分析，未发现明显的时间关系。
与ACR SLE分类标准相关的症状在SLE诊断之前通常已经存在，器官相关自身抗体的产生通常先于其相关临床特征的出现。
