A surge in anti-dsDNA titer predicts a severe lupus flare within six months

N. Pan, I. Amigues, Leonard Lyman Stephen, R. Duculan, F. Aziz, M. K. Crow, K. A. Kirou

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Objective: Rising anti-double-stranded (ds) DNA titers have been shown by some, but not all, studies to be predictive of disease flares in systemic lupus erythematosus (SLE). We hypothesized that a rapid and substantial rise in anti-dsDNA titer (anti-dsDNA surge) would be a good predictor of a clinically important SLE flare. Methods: A matched case-control study was conducted in an academic rheumatology practice setting. Our primary endpoint was the occurrence of a severe SELENA-SLEDAI (SS) flare within six months of an anti-dsDNA surge, and secondary endpoints were mild/moderate SS flares, as well as BILAG A and B renal flares. Cases were identified as those patients whose disease course included a surge of anti-dsDNA, defined as an increase of anti-dsDNA titer by the Crithidia luciliae immunofluorescence (CLIF) assay from 0 to 3+/4+, or from 1+ to 4+, within a period of less than 12 months. The date of the anti-dsDNA surge was defined as Day 0. Two control SLE patients were identified for each case and were matched for age, sex, race, and visit date closest to case Day 0, but without an anti-dsDNA surge. Logistic regression models were used to detect associations between anti-dsDNA surges and severe SS flares. Result: A higher proportion of cases, compared to controls, experienced a severe SS flare within six months of Day 0 (OR 6.3 (95% confidence intervals 2.0-19.9), p=0.02). Associations with all flares and hospitalizations for flares were also observed. However, an anti-dsDNA surge was not predictive of a renal flare. Conclusion: An anti-dsDNA surge predicts the subsequent development of a severe SS flare within six months. Physicians should closely monitor such patients and treat promptly at the first sign of clinical activity.

Original languageEnglish
Pages (from-to)293-298
Number of pages6
JournalLupus
Volume23
Issue number3
DOIs
Publication statusPublished - Mar 1 2014

Fingerprint

Systemic Lupus Erythematosus
Logistic Models
Crithidia
Kidney
Rheumatology
Fluorescent Antibody Technique
Case-Control Studies
Hospitalization
Confidence Intervals
Physicians
DNA

All Science Journal Classification (ASJC) codes

  • Rheumatology

Cite this

Pan, N., Amigues, I., Lyman Stephen, L., Duculan, R., Aziz, F., Crow, M. K., & Kirou, K. A. (2014). A surge in anti-dsDNA titer predicts a severe lupus flare within six months. Lupus, 23(3), 293-298. https://doi.org/10.1177/0961203313515763

A surge in anti-dsDNA titer predicts a severe lupus flare within six months. / Pan, N.; Amigues, I.; Lyman Stephen, Leonard; Duculan, R.; Aziz, F.; Crow, M. K.; Kirou, K. A.

In: Lupus, Vol. 23, No. 3, 01.03.2014, p. 293-298.

Research output: Contribution to journalArticle

Pan, N, Amigues, I, Lyman Stephen, L, Duculan, R, Aziz, F, Crow, MK & Kirou, KA 2014, 'A surge in anti-dsDNA titer predicts a severe lupus flare within six months', Lupus, vol. 23, no. 3, pp. 293-298. https://doi.org/10.1177/0961203313515763
Pan, N. ; Amigues, I. ; Lyman Stephen, Leonard ; Duculan, R. ; Aziz, F. ; Crow, M. K. ; Kirou, K. A. / A surge in anti-dsDNA titer predicts a severe lupus flare within six months. In: Lupus. 2014 ; Vol. 23, No. 3. pp. 293-298.
@article{6799ff56ece949b997401432f753eff5,
title = "A surge in anti-dsDNA titer predicts a severe lupus flare within six months",
abstract = "Objective: Rising anti-double-stranded (ds) DNA titers have been shown by some, but not all, studies to be predictive of disease flares in systemic lupus erythematosus (SLE). We hypothesized that a rapid and substantial rise in anti-dsDNA titer (anti-dsDNA surge) would be a good predictor of a clinically important SLE flare. Methods: A matched case-control study was conducted in an academic rheumatology practice setting. Our primary endpoint was the occurrence of a severe SELENA-SLEDAI (SS) flare within six months of an anti-dsDNA surge, and secondary endpoints were mild/moderate SS flares, as well as BILAG A and B renal flares. Cases were identified as those patients whose disease course included a surge of anti-dsDNA, defined as an increase of anti-dsDNA titer by the Crithidia luciliae immunofluorescence (CLIF) assay from 0 to 3+/4+, or from 1+ to 4+, within a period of less than 12 months. The date of the anti-dsDNA surge was defined as Day 0. Two control SLE patients were identified for each case and were matched for age, sex, race, and visit date closest to case Day 0, but without an anti-dsDNA surge. Logistic regression models were used to detect associations between anti-dsDNA surges and severe SS flares. Result: A higher proportion of cases, compared to controls, experienced a severe SS flare within six months of Day 0 (OR 6.3 (95{\%} confidence intervals 2.0-19.9), p=0.02). Associations with all flares and hospitalizations for flares were also observed. However, an anti-dsDNA surge was not predictive of a renal flare. Conclusion: An anti-dsDNA surge predicts the subsequent development of a severe SS flare within six months. Physicians should closely monitor such patients and treat promptly at the first sign of clinical activity.",
author = "N. Pan and I. Amigues and {Lyman Stephen}, Leonard and R. Duculan and F. Aziz and Crow, {M. K.} and Kirou, {K. A.}",
year = "2014",
month = "3",
day = "1",
doi = "10.1177/0961203313515763",
language = "English",
volume = "23",
pages = "293--298",
journal = "Lupus",
issn = "0961-2033",
publisher = "SAGE Publications Ltd",
number = "3",

}

TY - JOUR

T1 - A surge in anti-dsDNA titer predicts a severe lupus flare within six months

AU - Pan, N.

AU - Amigues, I.

AU - Lyman Stephen, Leonard

AU - Duculan, R.

AU - Aziz, F.

AU - Crow, M. K.

AU - Kirou, K. A.

PY - 2014/3/1

Y1 - 2014/3/1

N2 - Objective: Rising anti-double-stranded (ds) DNA titers have been shown by some, but not all, studies to be predictive of disease flares in systemic lupus erythematosus (SLE). We hypothesized that a rapid and substantial rise in anti-dsDNA titer (anti-dsDNA surge) would be a good predictor of a clinically important SLE flare. Methods: A matched case-control study was conducted in an academic rheumatology practice setting. Our primary endpoint was the occurrence of a severe SELENA-SLEDAI (SS) flare within six months of an anti-dsDNA surge, and secondary endpoints were mild/moderate SS flares, as well as BILAG A and B renal flares. Cases were identified as those patients whose disease course included a surge of anti-dsDNA, defined as an increase of anti-dsDNA titer by the Crithidia luciliae immunofluorescence (CLIF) assay from 0 to 3+/4+, or from 1+ to 4+, within a period of less than 12 months. The date of the anti-dsDNA surge was defined as Day 0. Two control SLE patients were identified for each case and were matched for age, sex, race, and visit date closest to case Day 0, but without an anti-dsDNA surge. Logistic regression models were used to detect associations between anti-dsDNA surges and severe SS flares. Result: A higher proportion of cases, compared to controls, experienced a severe SS flare within six months of Day 0 (OR 6.3 (95% confidence intervals 2.0-19.9), p=0.02). Associations with all flares and hospitalizations for flares were also observed. However, an anti-dsDNA surge was not predictive of a renal flare. Conclusion: An anti-dsDNA surge predicts the subsequent development of a severe SS flare within six months. Physicians should closely monitor such patients and treat promptly at the first sign of clinical activity.

AB - Objective: Rising anti-double-stranded (ds) DNA titers have been shown by some, but not all, studies to be predictive of disease flares in systemic lupus erythematosus (SLE). We hypothesized that a rapid and substantial rise in anti-dsDNA titer (anti-dsDNA surge) would be a good predictor of a clinically important SLE flare. Methods: A matched case-control study was conducted in an academic rheumatology practice setting. Our primary endpoint was the occurrence of a severe SELENA-SLEDAI (SS) flare within six months of an anti-dsDNA surge, and secondary endpoints were mild/moderate SS flares, as well as BILAG A and B renal flares. Cases were identified as those patients whose disease course included a surge of anti-dsDNA, defined as an increase of anti-dsDNA titer by the Crithidia luciliae immunofluorescence (CLIF) assay from 0 to 3+/4+, or from 1+ to 4+, within a period of less than 12 months. The date of the anti-dsDNA surge was defined as Day 0. Two control SLE patients were identified for each case and were matched for age, sex, race, and visit date closest to case Day 0, but without an anti-dsDNA surge. Logistic regression models were used to detect associations between anti-dsDNA surges and severe SS flares. Result: A higher proportion of cases, compared to controls, experienced a severe SS flare within six months of Day 0 (OR 6.3 (95% confidence intervals 2.0-19.9), p=0.02). Associations with all flares and hospitalizations for flares were also observed. However, an anti-dsDNA surge was not predictive of a renal flare. Conclusion: An anti-dsDNA surge predicts the subsequent development of a severe SS flare within six months. Physicians should closely monitor such patients and treat promptly at the first sign of clinical activity.

UR - http://www.scopus.com/inward/record.url?scp=84894085865&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84894085865&partnerID=8YFLogxK

U2 - 10.1177/0961203313515763

DO - 10.1177/0961203313515763

M3 - Article

VL - 23

SP - 293

EP - 298

JO - Lupus

JF - Lupus

SN - 0961-2033

IS - 3

ER -