Can Autoantibodies Be Used as Biomarkers for the Diagnosis of Neuropsychiatric Systemic Lupus Erythematosus?

Autoantibodies may be used as biomarkers for the differential diagnosis of neuropsychiatric systemic lupus erythematosus (NPSLE), according to a review published in Clinical Reviews in Allergy & Immunology.

NPSLE may be difficult to diagnose because the disease symptoms, such as headache and cognitive impairment, often with those of other neurologic conditions. Autoantibodies are currently the most powerful diagnostic tool for NPSLE; however, not all of them have the required sensitivity and specificity for NPSLE.

Antibodies, such as anti-Sjögren-syndrome-related antigen A (SSA)/Ro, anti- Sjögren-syndrome-related antigen B (SSB)/La, anti-Smith (Sm), and anti-ribonucleoprotein (RNP), vary in frequency among patients with NPSLE. Although the lupus anticoagulant is frequently observed among patients with NPSLE, it may also be present in other diseases. Biomarkers, such as anti-N-methyl-d-aspartate (NMDA) receptor antibodies, which are restricted to the brain and present only among patients with neuropsychiatric manifestations are the gold standard for differential diagnosis of NPSLE. However, these biomarkers are also not equally distributed among patients with diffuse and focal symptomology. Anti-NMDA antibodies among patients with NPSLE are often associated with diffuse symptoms, but there are studies that contradict the association of anti-NMDA receptor antibodies with NPSLE.

The review indicated one promising biomarker not restricted to brain-antigens is the anti-ribosomal protein (ribP), which is able to predict the flare of disease along with anti-dsDNA antibodies. However, these are only associated with diffuse symptoms, with several studies showing contradictory results regarding the role of these antibodies as a biomarker for NPSLE.

According to the study author, “There is no exclusive biomarker able to predict the development of neuropsychiatric manifestation among patients with SLE. However, several autoantibodies can be currently tested in order to establish a completer and more representative clinical situation of the patient.”

The study author also recommended that further research be conducted on the role of autoantibodies in the pathogenesis of NPSLE.

Reference

Manca E. Autoantibodies in neuropsychiatric systemic lupus erythematosus (NPSLE): Can they be used as biomarkers for the differential diagnosis of this disease? Clin Rev Allerg Immunol. Published online June 11, 2021. doi:10.1007/s12016-021-08865-2