Female patients with systemic lupus erythematosus (SLE), especially those with active disease who had musculoskeletal symptoms or positive antiphospholipid (aPL) antibodies, demonstrated higher titers of anti-double-stranded DNA (anti-dsDNA) antibodies, according to findings published in Lupus. In contrast, patients displaying neuropsychiatric manifestations or taking cyclophosphamide (CYC) had lower anti-dsDNA titers compared with controls.

The pathogenicity of SLE is complex and remains unclear, but anti-dsDNA antibodies are recognized as important disease-specific biomarkers. If implicated in SLE pathogenesis, they could prove to be a useful target, guiding pharmacotherapy. The researchers sought to evaluate correlations between anti-dsDNA titer levels and a host of clinical and laboratory disease parameters.

Researchers enrolled 70 patients with SLE (mean age, 27.5 years; mean disease duration, 7.7 years) and 35 age- and sex-matched healthy controls (mean age, 26.4 years). Serum anti-dsDNA titers and aPL status were measured in all participants, and patients’ Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and Systemic Lupus International Collaborative Clinics/American College of Rheumatology Damage Index (SLICC/ACR-DI) scores were calculated.

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The SLEDAI and SLICC/ACR-DI patient scores were 6.80 ± 8.04 and 1.20 ± 1.30, respectively, with 61.4% displaying anti-dsDNA positivity. The mean patient anti-dsDNA titer was 133.20 ± 100.50 IU/mL, which was significantly higher compared with the control group (22.03 ± 17.20 IU/mL; P <.0001).

There was a positive association between anti-dsDNA levels and musculoskeletal manifestations, as well as the presence of anti-β glycoprotein (anti-β2GP) antibodies, with significantly increased titers in those with arthralgia/arthritis (P =.007) and anti-β2GP (P =.037). An inverse relationship existed between anti-dsDNA levels and neuropsychiatric symptoms (P =.004) as well as CYC therapy (P = .013).

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Additional significant positive correlations were seen between anti-dsDNA levels and erythrocyte sedimentation rate (P=.001), anti-β2GP immunoglobulin (Ig)A (P = .002) and IgG (P =.03), and anticardiolipin IgA and IgG (P =.008 for both). Negative correlations were found between anti-dsDNA titers and SLICC/ACR-DI scores (P =.001) as well as total leukocyte count (P <.0001).

The presence of aPL antibodies and musculoskeletal manifestations was related to increased anti-dsDNA antibody titers, while CYC treatment and neuropsychiatric manifestations were associated with decreased anti-dsDNA levels. Future large-scale longitudinal trials were recommended, and the authors speculated, “A protective role of anti-dsDNA seems likely in those with neuropsychiatric manifestations and those receiving CYC and may form a shield against disease tissue damage.”

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Gheita TA, Abaza NM, Hammam N, Mohamed AAA, El-Gazzar II, Eissa AH. Anti-dsDNA titre in female systemic lupus erythematosus patients: relation to disease manifestations, damage and antiphospholipid antibodies. Lupus. 2018;27(7):1081-1087.