Rheumatology International

, Volume 39, Issue 11, pp 1937–1944 | Cite as

Anti-Smith antibody is associated with disease activity in patients with new-onset systemic lupus erythematosus

  • Sung Soo Ahn
  • Seung Min JungEmail author
  • Juyoung Yoo
  • Sang-Won Lee
  • Jason Jungsik Song
  • Yong-Beom Park


Although anti-Smith (Sm) antibody is a highly specific antibody for systemic lupus erythematosus (SLE), the significance of anti-Sm antibody in patients with SLE is unclear. This study aimed to evaluate the association between anti-Sm antibodies and disease activity in patients with new-onset SLE. We included patients who were tested for anti-Sm antibodies at SLE diagnosis and within 12 months after diagnosis. SLE disease activity index (SLEDAI) was obtained at the time of the anti-Sm antibody test. The baseline disease activity was compared between patients with and without anti-Sm antibodies. The longitudinal association between disease activity and anti-Sm antibodies was also evaluated in total patients and in those with anti-Sm antibodies. Among 92 patients who were tested for anti-Sm antibodies at SLE diagnosis, 67 and another 67 patients were followed up for the presence of anti-Sm antibodies at 6 and 12 months, respectively. Although the baseline SLEDAI was comparable in patients with and without anti-Sm antibodies, the serum level of anti-Sm antibody was significantly correlated with SLEDAI (P = 0.003). At 12 months, anti-Sm antibody positivity was associated with higher SLEDAI and anti-dsDNA titer (P = 0.002, both). In addition, the changes in anti-Sm antibody titer over 12 months were correlated with the alterations in SLEDAI (P = 0.029).Anti-Sm antibody was associated with the baseline disease activity and the alteration of disease activity in patients with new-onset SLE. Monitoring of anti-Sm antibody titer may help assess the disease activity in SLE.


Systemic lupus erythematosus Anti-Smith antibody Disease activity Systemic lupus erythematosus disease activity index 



This study was supported for English editing service from Editage by Cactus.

Author contributions

SS Ahn and SM Jung conceived and designed the work; SS Ahn, J Yoo, and SM Jung acquired and analyzed the data; SS Ahn, S-W Lee, JJ Song, Y-B Park, and SM Jung interpreted the data; all authors contributed to drafting and revising the work, and approved the final version of the manuscript; all authors agreed to all aspects of the work.



Compliance with ethical standards

Conflict of interest

The authors declare no conflicts of interest.


  1. 1.
    Kaul A, Gordon C, Crow MK, Touma Z, Urowitz MB, van Vollenhoven R, Ruiz-Irastorza G, Hughes G (2016) Systemic lupus erythematosus. Nat Rev Dis Primers 2:16039CrossRefGoogle Scholar
  2. 2.
    Zharkova O, Celhar T, Cravens PD, Satterthwaite AB, Fairhurst AM, Davis LS (2017) Pathways leading to an immunological disease: systemic lupus erythematosus. Rheumatology (Oxford) 56((suppl_1)):i55–i66CrossRefGoogle Scholar
  3. 3.
    Phan TG, Wong RC (2002) Adelstein S (2002) Autoantibodies to extractable nuclear antigens: making detection and interpretation more meaningful. Clin Diagn Lab Immunol 9(1):1–7PubMedPubMedCentralGoogle Scholar
  4. 4.
    Hochberg MC (1997) Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 40(9):1725CrossRefGoogle Scholar
  5. 5.
    Petri M, Orbai AM, Alarcon GS et al (2012) Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus. Arthritis Rheum 64(8):2677–2686CrossRefGoogle Scholar
  6. 6.
    Pisetsky DS (2016) Anti-DNA antibodies–quintessential biomarkers of SLE. Nat Rev Rheumatol 12(2):102–110CrossRefGoogle Scholar
  7. 7.
    Hahn BH (1998) Antibodies to DNA. N Engl J Med 338(19):1359–1368CrossRefGoogle Scholar
  8. 8.
    Rekvig OP (2015) The anti-DNA antibody: origin and impact, dogmas and controversies. Nat Rev Rheumatol 11(9):530–540CrossRefGoogle Scholar
  9. 9.
    Linnik MD, Hu JZ, Heilbrunn KR, Strand V, Hurley FL, Joh T (2005) Relationship between anti-double-stranded DNA antibodies and exacerbation of renal disease in patients with systemic lupus erythematosus. Arthritis Rheum 52(4):1129–1137CrossRefGoogle Scholar
  10. 10.
    Migliorini P, Baldini C, Rocchi V, Bombardieri S (2005) Anti-Sm and anti-RNP antibodies. Autoimmunity 38(1):47–54CrossRefGoogle Scholar
  11. 11.
    Pan LT, Tin SK, Boey ML, Fong KY (1998) The sensitivity and specificity of autoantibodies to the Sm antigen in the diagnosis of systemic lupus erythematosus. Ann Acad Med Singapore 27(1):21–23PubMedGoogle Scholar
  12. 12.
    Boey ML, Peebles CL, Tsay G, Feng PH, Tan EM (1988) Clinical and autoantibody correlations in Orientals with systemic lupus erythematosus. Ann Rheum Dis 47(11):918–923CrossRefGoogle Scholar
  13. 13.
    Arroyo-Avila M, Santiago-Casas Y, McGwin G Jr et al (2015) Clinical associations of anti-Smith antibodies in PROFILE: a multi-ethnic lupus cohort. Clin Rheumatol 34(7):1217–1223CrossRefGoogle Scholar
  14. 14.
    Alba P, Bento L, Cuadrado MJ, Karim Y, Tungekar MF, Abbs I, Khamashta MA, D’Cruz D, Hughes GR (2003) Anti-dsDNA, anti-Sm antibodies, and the lupus anticoagulant: significant factors associated with lupus nephritis. Ann Rheum Dis 62(6):556–560CrossRefGoogle Scholar
  15. 15.
    Gladman DD, Ibanez D, Urowitz MB (2002) Systemic lupus erythematosus disease activity index 2000. J Rheumatol 29(2):288–291PubMedGoogle Scholar
  16. 16.
    Flechsig A, Rose T, Barkhudarova F et al (2017) What is the clinical significance of anti-Sm antibodies in systemic lupus erythematosus? A comparison with anti-dsDNA antibodies and C3. Clin Exp Rheumatol 35(4):598–606PubMedGoogle Scholar
  17. 17.
    Morais SA, Isenberg DA (2017) A study of the influence of ethnicity on serology and clinical features in lupus. Lupus 26(1):17–26CrossRefGoogle Scholar
  18. 18.
    Lewis MJ, Jawad AS (2017) The effect of ethnicity and genetic ancestry on the epidemiology, clinical features and outcome of systemic lupus erythematosus. Rheumatology 56((supp_1)):i67–i77PubMedGoogle Scholar
  19. 19.
    Budhoo A, Mody GM, Dubula T, Patel N, Mody PG (2017) Comparison of ethnicity, gender, age of onset and outcome in South Africans with systemic lupus erythematosus. Lupus 26(4):438–446CrossRefGoogle Scholar
  20. 20.
    Tikly M, Burgin S, Mohanlal P, Bellingan A, George J (1996) Autoantibodies in black South Africans with systemic lupus erythematosus: spectrum and clinical associations. Clin Rheumatol 15(3):261–265CrossRefGoogle Scholar
  21. 21.
    Agarwal S, Harper J, Kiely PD (2009) Concentration of antibodies to extractable nuclear antigens and disease activity in systemic lupus erythematosus. Lupus 18(5):407–412CrossRefGoogle Scholar
  22. 22.
    Emad Y, Gheita T, Darweesh H et al (2018) Antibodies to extractable nuclear antigens (ENAS) in systemic lupus erythematosus patients: correlations with clinical manifestations and disease activity. Reumatismo 70(2):85–91CrossRefGoogle Scholar
  23. 23.
    Sabharwal UK, Fong S, Hoch S, Cook RD, Vaughan JH, Curd JG (1983) Complement activation by antibodies to Sm in systemic lupus erythematosus. Clin Exp Immunol 51(2):317–324PubMedPubMedCentralGoogle Scholar
  24. 24.
    McCarty GA, Rice JR, Bembe ML, Pisetsky DS (1982) Independent expression of autoantibodies in systemic lupus erythematosus. J Rheumatol 9(5):691–695PubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of Rheumatology, Department of Internal MedicineYonsei University College of MedicineSeoulRepublic of Korea

Personalised recommendations