Clinical Rheumatology

, Volume 9, Supplement 1, pp 100–110 | Cite as

Antibodies to DNA in patients with systemic lupus erythematosus. Their role in the diagnosis, the follow-up and the pathogenesis of the disease

  • R. Smeenk
  • K. Brinkman
  • H. Van Den Brink
  • R. -M. Termaat
  • J. Berden
  • H. Nossent
  • T. Swaak
Article

Summary

In this paper an overview of the present knowledge on antibodies against DNA will be presented. Diagnostic, prognostic and pathogenic aspects of anti-DNA will be highlighted. Detection of antibodies to DNA in the circulation of a patient by an assay selective for high avidity anti-DNA is highly diagnostic for SLE. Anti-DNA of low avidity occurs in rheumatic diseases other than SLE as well, making detection of such antibodies of less diagnostic value. Furthermore, data will be presented that show that the anti-DNA ELISA in its present form is not suited as a diagnostic tool. Not only disease features of SLE vary from patient to patient, anti-DNA avidity does so too. A relationship between anti-DNA avidity and clinical features can be found: high avidity anti-DNA is more abundant in patients with nephritis, low avidity anti-DNA in patients with CNS involvement. Prognostically, a steady increase of the level of high avidity anti-DNA generally heralds an upcoming exacerbation in a patient. Furthermore, 85% of the patients who do not have SLE at the time (high avidity) anti-DNA is detected in their serum, will develop the disease within the next few years. It is noteworthy, that patients with only low avidity anti-DNA in their circulation develop a more mild form of SLE; the (low) avidity of their anti-DNA seldomly increases during the course of their disease. The relevance of anti-DNA to the pathogenesis of SLE still is a matter of debate. On the one hand, the association of parameters of anti-DNA that determine the size of the complexes formed with DNA is in favour of the classical hypothesis, which states that SLE is primarily an immune complex disease. On the other hand, recent data on crossreactions of anti-DNA with phospholipids, glycosaminoglycans and other (polynegative) structures plead for a role of such crossreactivities in the pathogenesis of SLE.

Key words

Anti-DNA ELISA RIA Crithidia Luciliae Farr Assay PEG Assay SLE Diagnosis Pathogenesis Crossreactivity Longitudinal study 

Abbreviations

ANA

antinuclear antibodies

CNS

central nervous system

dsDNA

doublestranded DNA

ELISA

enzymelinked immunosorbent assay

IFT

indirect immunofluorescence technique

PEG

polyethylene glycol

RIA

radio immunoassay

SLE

systemic lupus erythematosus

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Copyright information

© Springer-Verlag 1990

Authors and Affiliations

  • R. Smeenk
    • 1
  • K. Brinkman
    • 1
  • H. Van Den Brink
    • 1
  • R. -M. Termaat
    • 1
    • 2
  • J. Berden
    • 1
    • 2
  • H. Nossent
    • 1
    • 3
  • T. Swaak
    • 1
    • 3
  1. 1.Central Laboratory of the Netherlands Red Cross Blood Transfusion Service and Laboratory for Experimental and Clinical ImmunologyUniversity of AmsterdamThe Netherlands
  2. 2.Department of NephrologyUniversity Hospital, University of NijmegenThe Netherlands
  3. 3.Department of RheumatologyDr Daniel Den Hoed ClinicRotterdamThe Netherlands

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