Anti-RNP/Sm antibodies in patients with systemic lupus erythematosus and its role in thrombosis: a case-control study
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To validate the association of thrombotic events with positive lupus anticoagulant (LA) and co-presence of anti-RNP/Sm, as well as the diagnostic accuracy of this combination of antibodies for thrombosis.
Case-control study of patients with systemic lupus erythematosus (SLE) who presented thrombosis after SLE diagnosis and controls with SLE without thrombosis. Comorbidities, traditional risk factors, clinical variables, and treatment were evaluated. Antiphospholipid (aPL) and anti-RNP/Sm antibodies were determined.
Sixty-three cases and 63 controls were studied, 88% women, median age of 40 years, and disease duration of 135 months at study inclusion. No differences were found between groups regarding age, comorbidities, or clinical characteristics at SLE diagnosis. Patients with thrombosis were more frequently positive for anti-RNP/Sm (p = 0.001), IgG aCL (p = 0.02), IgG anti-B2GPI (p = 0.02), IgM anti-B2GPI (p = 0.02), LA (p < 0.001), the combination of anti-RNP/Sm + LA (p < 0.001), and aPL triple marker (p = 0.002), compared to controls. The combination of anti-RNP/Sm + LA, SLEDAI-2 K, and prednisone dose was associated with thrombosis (p < 0.05). The combination of anti-RNP/Sm + LA showed 56% sensitivity, 79% specificity, 73% positive predictive value, 64% negative predictive value, positive likelihood ratio (LR) 2.69, and negative LR 0.56 for predicting thrombosis. No difference was found in the comparison of area under the curve between LA alone and the combination of anti-RNP/Sm + LA (p = 0.73).
Thrombosis was associated with disease activity, dose of prednisone, and the combination of anti-RNP/Sm antibodies and LA. This combination of antibodies could be useful in the identification of SLE patients at risk of thrombosis.
KeywordsDiagnostic accuracy Lupus anticoagulant Anti-RNP/Sm Systemic lupus erythematosus Thrombosis
We thank Darinel Hernández Hernández, Andrés Valencia Martínez, Ariadna Jiménez González, and Luis Ángel Mendoza Vargas for their assistance in the blood sample collection and lupus anticoagulant detection.
MCZM, AHA, and JRD designed the study; MCZM, CANA, and AGVR participated in acquisition of data; AHA and JRD analyzed and interpreted data; MCZM, AHA, and JRD drafted the manuscript; MCZM, AHA, JRD, CANA, and AGVR revised the manuscript.
This work was supported by the National Institute of Medical Science and Nutrition S.Z. Grants [INCMNSZ-AI-024 (JRD)], the National Council of Science and Technology [CONACYT SALUD-214395 (JRD)].
Compliance with ethical standards
Research was conducted in compliance with the Helsinki Declaration. Informed consent and approval by the local ethical committee was obtained.
Ethical standards statement
The manuscript does not contain clinical studies or patient data.
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