Anti-nucleosome antibodies outperform traditional biomarkers as longitudinal indicators of disease activity in systemic lupus erythematosus

Rheumatology (Oxford). 2015 Mar;54(3):449-57. doi: 10.1093/rheumatology/keu326. Epub 2014 Sep 5.

Abstract

Objective: The aim of this study was to determine whether anti-nucleosome antibodies function as activity-specific biomarkers in SLE.

Methods: Fifty-one patients were recruited and followed prospectively with periodic clinical and biochemical assessments over a 14-month period. Disease activity was determined by the SLEDAI-2K. Anti-nucleosome antibody levels were measured by an ELISA and its utility as an activity-specific biomarker as compared with that of anti-dsDNA antibodies and C3 was assessed both at baseline and in longitudinal analysis.

Results: Anti-nucleosome antibodies were significantly elevated in SLE patients vs controls and showed a moderate positive correlation with disease activity. The utility of anti-nucleosome antibodies in identifying patients with active disease in a cross-sectional analysis was comparable to that of anti-dsDNA antibodies and C3. Analysis of variance demonstrated that the level of anti-nucleosome antibodies and C3 varied significantly with changes in disease activity over time. Changes in clinical state were not mirrored by changes in anti-dsDNA antibodies. In time-dependent analysis, anti-nucleosome antibodies showed a better fit over time than anti-dsDNA antibodies and C3. In pairwise comparisons, C3 and anti-nucleosome antibodies outperformed other models, including the conventional pairing of C3 and anti-dsDNA antibodies, however, no biomarker alone or as a group accurately predicted impending remissions or exacerbations.

Conclusion: Anti-nucleosome antibodies demonstrate greater fidelity as a biomarker for changes in SLE disease activity than traditional biomarkers, supporting the routine monitoring of this antibody in clinical practice.

Keywords: anti-nucleosome antibodies; biomarkers; disease activity; systemic lupus erythematosus.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Antibodies, Anti-Idiotypic / blood*
  • Biomarkers / blood
  • Complement C3 / metabolism
  • Cross-Sectional Studies
  • DNA / immunology
  • Female
  • Humans
  • Longitudinal Studies
  • Lupus Erythematosus, Systemic / blood*
  • Lupus Erythematosus, Systemic / diagnosis*
  • Male
  • Middle Aged
  • Nucleosomes / immunology*
  • Prospective Studies
  • Sensitivity and Specificity
  • Severity of Illness Index*
  • Time Factors
  • Young Adult

Substances

  • Antibodies, Anti-Idiotypic
  • Biomarkers
  • Complement C3
  • Nucleosomes
  • DNA