PubMed · 4554873
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R C Kitridou. 1972. Synovianalysis.. https://pubmed.ncbi.nlm.nih.gov/4554873/
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In summary, we suggest that the following statements regarding lupus nephritis are best supported by the existing data. 1) Lupus nephritis is an immunologically complex disorder. Autoantibodies directed against multiple epitopes on chromatin, including but not limited to dsDNA, may contribute to nephritis. 2) The presence of charged residues within autoantibody heavy chain CDR regions, particularly CDR3, may be essential to the property of nephritogenicity. 3) Chromatin/antichromatin immune complexes (formed either in the circulation or in situ in the GBM) are likely the proximal cause of lupus nephritis. Cross-reactive autoantibodies or antibodies reacting directly to glomerular antigens are less likely to play a major pathogenic role. 4) The induction of lupus nephritis may relate to the propensity of chromatin or its components to bind to the GBM by virtue of the interactions of histones with type IV collagen and heparan-sulfated glycosaminoglycans. Nonetheless, as indicated above, there are numerous issues that remain to be addressed and clarified with respect to lupus nephritis. Insight into these issues is not only of theoretical interest, but may lead to new approaches to diagnostic testing and more specific therapies to replace currently use nonspecific immunosuppressive drugs, which have substantial toxicities.
OBJECTIVE: To determine the utility of anti-extractable nuclear antigen (anti-ENA) antibodies detected by enzyme-linked immunosorbent assay as a predictor for the diagnosis of systemic lupus erythematosus (SLE). METHODS: Among 2,185 serum samples sent for testing for antinuclear antibodies (ANA) by indirect immunofluorescence, 259 consecutive patients with positive ANA were identified. Medical charts of these patients were reviewed to assess the clinical diagnosis, with the reviewer having no knowledge of the anti-ENA result. Clinical data were abstracted for all patients, and diagnoses established using American College of Rheumatology criteria. The utility of ENA antibodies in the diagnosis of SLE was determined by univariate and multivariate analysis among all patients who were positive for ANA, patients who were positive for ANA and for anti-double-stranded DNA (anti-dsDNA), and patients who were positive for ANA and negative for anti-dsDNA. Clinical differences between SLE patients with and those without anti-ENA antibodies were assessed. RESULTS: Anti-ENA antibodies, especially anti-Ro/SS-A, showed strong predictive diagnostic value among ANA+/anti-dsDNA- patients, but were of no utility among ANA+/anti-dsDNA+ patients. The only clinical manifestations that were more common among anti-ENA+ SLE patients were pleuritis and the use of hydroxychloroquine. CONCLUSION: The presence of anti-ENA antibodies, especially anti-Ro/SS-A, is a useful predictor for the diagnosis of SLE, primarily among patients attending a referral rheumatology center who are positive for ANA and negative for anti-dsDNA. No major clinical differences were noted among ANA+ SLE patients with versus those without ENA.