New insights into the role of antinuclear antibodies in systemic lupus erythematosus.

Journal Article (Journal Article;Review)

Systemic lupus erythematosus (SLE) is a prototypic autoimmune disease characterized by antinuclear antibodies (ANAs) that form immune complexes that mediate pathogenesis by tissue deposition or cytokine induction. Some ANAs bind DNA or associated nucleosome proteins, whereas other ANAs bind protein components of complexes of RNA and RNA-binding proteins (RBPs). Levels of anti-DNA antibodies can fluctuate widely, unlike those of anti-RBP antibodies, which tend to be stable. Because anti-DNA antibody levels can reflect disease activity, repeat testing is common; by contrast, a single anti-RBP antibody determination is thought to suffice for clinical purposes. Experience from clinical trials of novel therapies has provided a new perspective on ANA expression during disease, as many patients with SLE are ANA negative at screening despite previously testing positive. Because trial results suggest that patients who are ANA negative might not respond to certain agents, screening strategies now involve ANA and anti-DNA antibody testing to identify patients with so-called 'active, autoantibody-positive SLE'. Evidence suggests that ANA responses can decrease over time because of the natural history of disease or the effects of therapy. Together, these findings suggest that, during established disease, more regular serological testing could illuminate changes relevant to pathogenesis and disease status.

Full Text

Duke Authors

Cited Authors

  • Pisetsky, DS; Lipsky, PE

Published Date

  • October 2020

Published In

Volume / Issue

  • 16 / 10

Start / End Page

  • 565 - 579

PubMed ID

  • 32884126

Pubmed Central ID

  • PMC8456518

Electronic International Standard Serial Number (EISSN)

  • 1759-4804

Digital Object Identifier (DOI)

  • 10.1038/s41584-020-0480-7


  • eng

Conference Location

  • United States