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Rheumatic Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Autoantibodies: Autoantibodies to nuclear and cytoplasmic antigens may be present (see Table 4.1). The antinuclear antibody (ANA) test is the best screening test for lupus as it is usually positive. Anti-dsDNA antibodies are specific for lupus and may reflect disease activity, while RF is found in 30–50% of patients. Anti-Smith RNA antibodies are also virtually confined to individuals with lupus but are present in less than 20% of such patients.
Systemic Lupus Erythematosus (SLE)
Published in K. Gupta, P. Carmichael, A. Zumla, 100 Short Cases for the MRCP, 2020
K. Gupta, P. Carmichael, A. Zumla
Clinically, most patients with this syndrome suffer from polyarthralgias and systemic symptoms. They do not experience renal and CNS involvement. Their pattern of auto-antibodies is distinctive in that they are all ANA positive with anti-histone antibodies present in the majority (95%). Anti-dsDNA antibodies are absent.
Anti-L3T4 Antibody Therapy in Systemic Lupus Erythematosus
Published in Thomas F. Kresina, Monoclonal Antibodies, Cytokines, and Arthritis, 2020
Nancy L. Carteron, Wofsy David
Despite the delay in target cell clearance, treatment with anti-L3T4 had an immediate effect on autoimmunity. Before starting therapy, the concentration of anti-dsDNA antibodies had been increasing in both experimental groups (Fig. 6). During the treatment course, the mean titer continued to rise in the saline control group, but in the group that received anti-L3T4, the concentration of anti-dsDNA antibodies immediately plateaued and then dramatically fell. After 2 months of therapy, the mean anti-dsDNA titer in the control group was 1:1300, compared to 1:250 in the anti-L3T4-treated group (p < 0.02).
Clinical features and outcomes of patients with antineutrophil cytoplasmic antibody-positive systemic lupus erythematosus
Published in Renal Failure, 2023
Ying Wang, Xiaoyang Yu, Xinfang Xie, Huixian Li, Wei Yang, Yu Liang, Wanhong Lu
Activated neutrophils effectively capture and eliminate pathogens by releasing neutrophil extracellular traps (NETs), a cell capture net composed of decondensed chromatin and intracellular granule proteins. Current evidence suggests that neutrophils, NETosis, and complement activation contribute to tissue damage in SLE. Patients with SLE exhibit significantly abnormal neutrophil phenotype and function, and their neutrophils are more prone to undergo apoptosis and NETosis [18]. ANCA has been shown to induce endothelial cell injury by triggering the release of granules from neutrophils and monocytes; it is also involved in the acceleration of neutrophil apoptosis [4]. These findings suggest a potential pathogenic role of ANCA in SLE. Numerous clinical retrospective studies have explored the role of ANCA in SLE. Some studies have found associations between ANCA titers, disease activity, and the presence of anti-dsDNA antibodies in patients with newly diagnosed SLE [9]. ANCAs can be detected in the serum of patients with SLE, and some ANCA subtypes have been associated with particular clinical manifestations [19]. Patients with both active and inactive SLE have been found to have high defensin and cathepsin G-ANCA levels [20]. However, most of these studies have concentrated on the relationship between ANCA detected in the serum and disease activity in patients with SLE.
Patients with laboratory criteria of anti-phospholipid syndrome and ‘non-criteria’ manifestations: a multicenter cohort
Published in Scandinavian Journal of Rheumatology, 2023
G Pires da Rosa, E Ferreira, B Sousa-Pinto, P Bettencourt, G Espinosa, R Cervera
Seventy-five patients with APS laboratory criteria but only non-criteria manifestations and 75 definite APS controls were included in the analysis. Patient characteristics, demographic data, and aPL profiles are summarized in Table 2. Thirty-seven patients (49%) exhibited only non-obstetric manifestations, 26 (35%) only obstetric manifestations, and 12 (16%) both obstetric and non-obstetric manifestations. The most common non-obstetric manifestations were thrombocytopenia (n = 34), Coombs’ positivity (n = 11), migraine (n = 11), haemolytic anaemia (n = 5), brain white-matter lesions on magnetic resonance imaging (MRI) (n = 5), and Raynaud’s phenomenon (n = 5). The most common obstetric manifestations were two spontaneous abortions before 10 weeks of gestation (n = 16), infertility (n = 14), two or more in vitro fertilization (IVF) failures (n = 11), intrauterine growth restriction (IUGR) after 34 weeks (n = 7), and prematurity between 34 and 37 weeks (n = 7). A description of all non-criteria manifestations is available in Table 3. The median time span from the date when the non-criteria manifestations were first reported/diagnosed to the last patient visit was 12 years (IQR 8–18 years). Anti-dsDNA antibodies were present in 11 (16%) and hypocomplementemia in 18 (26%) of the non-SLE patients. A suspicion of progression towards SLE was considered plausible in 13 (19%) of the non-SLE individuals.
Mitochondria as a key player in systemic lupus erythematosus
Published in Autoimmunity, 2022
Diana C. Quintero-González, Marcela Muñoz-Urbano, G. Vásquez
Since the last decade, NETosis has been recognized as a pathway involved in multiple autoimmune diseases, including SLE. Neutrophile extracellular traps (NET) from patients with SLE are produced faster and at higher magnitudes than those from healthy controls. The lower degradation of NET due to less effective nuclease function also allows persistent exposure of modified autoantigens, which perpetuates the autoimmune response [82,83]. As previously mentioned, ox-mDNA is highly immunogenic and is associated with NETosis [84]. In a study on neutrophils from patients with lupus, exposure to RNP immunocomplexes induced ox-mDNA, drove NETosis in low-density granulocytes, and released IFN I through the STING pathway [60]. Likewise, enhanced expression of the mtDNA immunocomplex is more potent in stimulating pDCs than the dsDNA immunocomplex by binding to Fcvia toll like receptor 9. A better correlation was observed between anti‐mtDNA antibodies and the severity of lupus nephritis compared to that with anti-dsDNA antibodies. Recently, a SNP in the NCF1 gene (NCF-339) was reported to decrease nicotinamide adenine dinucleotide phosphate oxidase (NADPH) isoform 2 and reduce the quantity of NET, confirming the significant dependence of mROS on this immune mechanism in patients with lupus [85].