BASELINE AUTOANTIBODY PROFILE AS A RISK FACTOR FOR DAMAGE DEVELOPMENT IN SYSTEMIC LUPUS ERYTHEMATOSUS

Background: Organ damage development in SLE patients is mediated through a complex mechanism, in which chronic and/or recurrent inflammation and autoantibodies play a central role.Objectives: To determine the relation between the baseline autoantibody profile, inflammatory parameters and the risk of subsequent damage development in an homogenous Caucasian SLE inception cohort.Methods: The baseline autoantibody profile was determined for 124 patients (84% females, mean age 39,4 years) seen at this hospital from 1980 onwards and who were followed for at least 6 months. All patients fulfilled >3 ACR SLE classification criteria. Autoantibodies against dsDNA (tested by both ELISA and Crithidia Luciliae immunofluorescence (CLIFT)), SS-A/SS-B, RNP, Sm and cardiolipin (IgG and IgM subtype) were studied. A positive baseline autoantibody profile was defined as the presence of that autoantibody during the first two years of disease. Mean levels of ESR, CRP and SLEDAI scores during the disease course were used as markers for the inflammatory response. Damage development at the last visit was scored according to the SLICC-Damage Index (DI). Correlations between antibody profiles and damage were analyzed by means of variance and logistic regression analysis.Results: Overall 62 patients (50%) remained free of damage (SLICC DI = 0)after a mean follow up of 66 months; in the remaining patients median damage score at last follow-up was 2.3 (range 1-8). Damage development (SLICC-DI =>1) was associated with the baseline presence of the IgG ACL and the absence of antibodies against RNP, SS-A, SS-B, p=0,05), lower age at diagnosis (37 versus 43 years, p=0.03) as well higher mean CRP levels (13,1 versus 7,5, p=0.03) during follow- up. No association was present between the presence of anti-dsDNA antibodies or the mean SLEDAI scores and overall damage. Also, damage in the renal domain of SLICC-DI was not associated with anti-dsDNA antibodies. Twenty-one patients died; median SLICC DI score at death was 2,1 versus 0,9 for SLICC DI at last visit in survivors, p= 0,001).Conclusion: These findings indicate a role for IgG ACL and CRP levels only in the baseline risk stratification and therapeutic efforts to limit damage development (and thereby possibly mortality), especially in younger lupus patients. Serum antibodies against dsDNA are unrelated to damage, while antibodies SS-A, SS-B and RNP confer a decreased risk of damage.Citation: , volume , supplement , year 2004, page Session: SLE – Clinical aspects