School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Victoria, Australia.
Department of Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Rheumatology (Oxford). 2024 Feb 1;63(2):525-533. doi: 10.1093/rheumatology/kead231.
Disease activity monitoring in SLE includes serial measurement of anti-double stranded-DNA (dsDNA) antibodies, but in patients who are persistently anti-dsDNA positive, the utility of repeated measurement is unclear. We investigated the usefulness of serial anti-dsDNA testing in predicting flare in SLE patients who are persistently anti-dsDNA positive.
Data were analysed from patients in a multinational longitudinal cohort with known anti-dsDNA results from 2013 to 2021. Patients were categorized based on their anti-dsDNA results as persistently negative, fluctuating or persistently positive. Cox regression models were used to examine longitudinal associations of anti-dsDNA results with flare.
Data from 37 582 visits of 3484 patients were analysed. Of the patients 1029 (29.5%) had persistently positive anti-dsDNA and 1195 (34.3%) had fluctuating results. Anti-dsDNA expressed as a ratio to the normal cut-off was associated with the risk of subsequent flare, including in the persistently positive cohort (adjusted hazard ratio [HR] 1.56; 95% CI: 1.30, 1.87; P < 0.001) and fluctuating cohort (adjusted HR 1.46; 95% CI: 1.28, 1.66), both for a ratio >3. Both increases and decreases in anti-dsDNA more than 2-fold compared with the previous visit were associated with increased risk of flare in the fluctuating cohort (adjusted HR 1.33; 95% CI: 1.08, 1.65; P = 0.008) and the persistently positive cohort (adjusted HR 1.36; 95% CI: 1.08, 1.71; P = 0.009).
Absolute value and change in anti-dsDNA titres predict flares, including in persistently anti-dsDNA positive patients. This indicates that repeat monitoring of dsDNA has value in routine testing.
在系统性红斑狼疮（SLE）中，疾病活动监测包括对双链 DNA（dsDNA）抗体的连续测量，但对于持续 dsDNA 阳性的患者，重复测量的效用尚不清楚。我们研究了连续抗 dsDNA 检测在预测持续抗 dsDNA 阳性的 SLE 患者疾病发作中的作用。
对来自一个具有 2013 年至 2021 年已知抗 dsDNA 结果的多国纵向队列的患者进行数据分析。根据抗 dsDNA 结果将患者分为持续阴性、波动或持续阳性。使用 Cox 回归模型来研究抗 dsDNA 结果与疾病发作的纵向关联。
对 3484 名患者的 37582 次就诊数据进行了分析。患者中 1029 名（29.5%）持续抗 dsDNA 阳性，1195 名（34.3%）抗 dsDNA 结果波动。抗 dsDNA 与正常截断值的比值与随后疾病发作的风险相关，包括在持续阳性组（调整后的危险比[HR] 1.56；95%CI：1.30，1.87；P<0.001）和波动组（调整后的 HR 1.46；95%CI：1.28，1.66），比值均大于 3。与前一次就诊相比，抗 dsDNA 增加或减少超过 2 倍均与波动组（调整后的 HR 1.33；95%CI：1.08，1.65；P=0.008）和持续阳性组（调整后的 HR 1.36；95%CI：1.08，1.71；P=0.009）疾病发作风险增加相关。
抗 dsDNA 滴度的绝对值和变化预测疾病发作，包括持续抗 dsDNA 阳性的患者。这表明重复监测 dsDNA 在常规检测中有价值。
