«INCOMPLETE» SYSTEMIC LUPUS ERYTHEMATOSUS IN REAL CLINICAL PRACTICE: DIFFICULTIES OF DIAGNOSIS


Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

Difficulties in diagnosing of systemic lupus erythematosus (SLE) are due to the fact that often the appearance of advanced clinical signs of the disease is preceded by an asymptomatic period with minimal laboratory manifestations of the disease. If less than 4 2012 SLICC criteria are met, the term «incomplete» SLE is currently used in clinical practice. The presented lecture considers in details autoimmune phenomena in the asymptomatic period of the disease (so-called preclinical SLE), characterizes «incomplete» SLE, its clinical and immunological features, problems of early diagnosis, predictors of the transformation of «incomplete» SLE into «accurate» SLE, presents algorithm for diagnosing and managing that certain category of patients, as well as modern tactics of curation.

Full Text

Restricted Access

About the authors

Victoria A. LILA

I.I. Mechnikov North-Western State Medical University of the Ministry of Healthcare of Russia

Email: liu_lo@mail.ru
postgraduate student of the Department of therapy, rheumatology, examination of temporary disability 95 and quality of medical care named after E.E. Eichwald Saint Petersburg

Vadim I. MAZUROV

I.I. Mechnikov North-Western State Medical University of the Ministry of Healthcare of Russia

Email: maz.nwgmu@yandex.ru
MD, professor, academician of the RAS, head of the Department of therapy, rheumatology, examination of temporary disability and quality of medical care named after E.E. Eichwald Saint Petersburg

Alexander M. LILA

V.A. Nasonova Research Institute of Rheumatology; Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of Russia

Email: amlila@mail.ru
MD, professor, Director of V.A. Nasonova Research Institute of Rheumatology, head of the Department of rheumatology, Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of Russia Moscow

References

  1. Соловьев С.К. Системная красная волчанка. В кн.: Российские клинические рекомендации. Ревматология. Под ред. Е.Л. Насонова. М.: ГЭОТАР-Медиа. 2020; 113-136. [Soloviev S.K. Systemic lupus erythematosus. In: Russian clinical guidelines. Rheumatology. E. by Nasonov E.L. Moscow: GEOTAR-Media. 2020; pp.113-136 (In Russ.)]. ISBN: 978-5-9704-5398-8.
  2. Системная красная волчанка. В кн.: Клиническая ревматология. Под ред. В.И. Мазурова. М.: Е-ното. 2021; 231-252. ISBN: 978-5-906023-26-1.
  3. Lim S., Drenkard C., McCune W. et al. Population-based lupus registries: Advancing our epidemiologic understanding. Arthritis and 93 rheumatism. 2009; 61(10): 1462-66. https://dx.doi.org/10.1002/art.24835.
  4. Robertson J., James J. Preclinical systemic lupus erythematosus. Rheum Dis Clin North Am. 2014; 40(4): 621-35. https://dx.doi.org/10.1016/j.rdc.2014.07.004.
  5. Allen M., Rus V., Szeto G. Leveraging heterogeneity in systemic lupus erythematosus for new therapies. Trends Mol Med. 2021; 27(2): 152-71. https://dx.doi.org/10.1016/j.molmed.2020.09.009.
  6. Lockshin M., Barbhaiya M., Izmirly P. et al. SLE: Reconciling heterogeneity. Lupus Sci Med. 2019; 6(1): e000280. https://dx.doi.org/10.1136/lupus-2018-000280.
  7. Costenbader K., Schur P. We need better classification and terminology for «people at high-risk of or in the process of developing lupus». Arthritis Care Res (Hoboken). 2015; 67(5): 593-96. https://dx.doi.org/10.1002/acr.22484.
  8. Deane K., El-Gabalawy H. Pathogenesis and prevention of rheumatic disease: focus on preclinical RA and SLE. Nat Rev Rheumatol. 2014; 10(4): 212-28. https://dx.doi.org/10.1038/nrrheum.2014.6.
  9. Kuo C., Grainge M., Valdes A. et al. Familial aggregation of systemic lupus erythematosus and coaggregation of autoimmune diseases in affected families. JAMA Intern Med. 2015; 175(9):1518-26. https://dx.doi.org/10.1001/jamainternmed.2015.3528.
  10. Насонов Е.Л., Авдеева А.С. Иммуновоспалительные ревматические заболевания, связанные с интерфероном типа I: новые данные. Научно-практическая ревматология. 2019; 4: 452-461. https://dx.doi.org/10.14412/1995-4484-2019-452-461.
  11. Manderson A., Botto M., Walport M. The role of complement in the development of systemic lupus erythematosus. Annu Rev Immunol. 2004; 22: 431-56. https://dx.doi.org/10.1146/annurev.immunol.22.012703.104549.
  12. Bengtsson A., Ronnblom L. Role of interferons in SLE. Best Pract Res Clin Rheumatol. 2017; 31(3): 415-28. https://dx.doi.org/10.1016/j.berh.2017.10.003.
  13. Fu S., Wang H., Gaskin F. et al. Pathogenesis of proliferative lupus nephritis from a historical and personal perspective. Clin Immunol. 2017; 185: 51-58. https://dx.doi.org/10.1016/j.clim.2016.07.024.
  14. Choi J., Kim S., Craft J. The pathogenesis of systemic lupus erythematosus-an update. Curr Opin Immunol. 2012; 24(6): 651-57. https://dx.doi.org/10.1016/j.coi.2012.10.004.
  15. Aringer M., Johnson S. Classifying and diagnosing systemic lupus erythematosus in the 21st century. Rheumatology (Oxford). 2020; 59(Suppl 5): v4-v11. https://dx.doi.org/10.1093/rheumatology/keaa379.
  16. Fanouriakis A., Tziolos N., Bertsias G. et al. Update оп the diagnosis and management of systemic lupus erythematosus. Ann Rheum Dis. 2021; 80(1): 14-25. https://dx.doi.org/10.1136/annrheumdis-2020-218272.
  17. Панафидина Т.А., Попкова Т.В., Асеева Е.А., Лила А.М. Современный подход в диагностике и лечении системной красной волчанки. Доктор.Ру. 2021; 7: 40-50. https://dx.doi.org/10.31550/1727-2378-2021-20-7-40-50.
  18. Fanouriakis A., Kostopoulou M., Alunno A. et al. 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus. Ann Rheum Dis. 2019; 78(6): 736-45. https://dx.doi.org/10.1136/annrheumdis-2019-215089.
  19. Leuchten N., Hoyer A., Brinks R. et al. Performance of antinuclear antibodies for classifying systemic lupus erythematosus: a systematic literature review and meta-regression of diagnostic data. Arthritis Care Res (Hoboken). 2018; 70(3): 428-38. https://dx.doi.org/10.1002/acr.23292.
  20. Tedeschi S., Johnson S., Boumpas D. et al. Developing and refining new candidate criteria for systemic lupus erythematosus classification: an international collaboration. Arthritis Care Res (Hoboken). 2018; 70(4): 571-81. https://dx.doi.org/10.1002/acr.23317.
  21. Pisetsky D.S. Antinuclear antibody testing - misunderstood or misbegotten? Nat Rev Rheumatol. 2017; 13(8): 495-502. https://dx.doi.org/10.1038/nrrheum.2017.74.
  22. Abeles A., Abeles M. The clinical utility of a positive antinuclear antibody test result. Am J Med. 2013; 126(4): 342-48. https://dx.doi.org/10.1016/j.amjmed.2012.09.014.
  23. Tan E., Feltkamp E., Smolen J. et al. Range of antinuclear antibodies in «healthy» individuals. Arthritis Rheum. 1997; 40(9): 1601-11. https://dx.doi.org/10.1002/art.1780400909.
  24. Wandstrat A., Carr-Johnson F., Branch V. et al. Autoantibody profiling to identify individuals at risk for systemic lupus erythematosus. J Autoimmun. 2006; 27(3): 153-60. https://dx.doi.org/10.1016/j.jaut.2006.09.001.
  25. Choi M., Clarke A., St Pierre Y. et al. The prevalence and determinants of anti-DFS70 autoantibodies in an international inception cohort of systemic lupus erythematosus patients. Lupus. 2017; 26(10): 1051-59. https://dx.doi.org/10.1177/0961203317692437.
  26. Gundin S., Irure-Ventura J., Asensio E. et al. Measurement of anti-DFS70 antibodies in patients with ANA-associated autoimmune rheumatic diseases suspicion is cost-effective. Auto Immun Highlights. 2016; 7(1): 10. https://dx.doi.org/10.1007/s13317-016-0082-1.
  27. Conrad K., Rober N., Andrade L.E., Mahler M. The clinical relevance of anti- DFS70 autoantibodies. Clin Rev Allergy Immunol. 2017; 52(2): 202-16. https://dx.doi.org/10.1007/s12016-016-8564-5.
  28. Ochs R.L., Mahler M., Basu A. et al. The significance of autoantibodies to DFS70/LEDGFp75 in health and disease: Integrating basic science with clinical understanding. Clin Exp Med. 2016; 16(3): 273-93. https://dx.doi.org/10.1007/s10238-015-0367-0.
  29. Pashnina I.A., Krivolapova I.M., Fedotkina T.V. et al. Antinuclear autoantibodies in health: Autoimmunity is not a synonym of autoimmune disease. Antibodies (Basel). 2021; 10(1): 9. https://dx.doi.org/10.3390/antib10010009.
  30. Moroni L., Restovic G., Cervera R. et al. Economic Analysis of the use of anti-DFS70 antibody test in patients with undifferentiated systemic autoimmune disease symptoms. J Rheumatol. 2020; 47(8): 1275-84. https://dx.doi.org/10.3899/jrheum.190533.
  31. Лила В.А. Клинико-лабораторные взаимосвязи у пациентов с различными вариантами течения системной красной волчанки. Современная ревматология. 2020; 1: 26-31. https://dx.doi.org/10.14412/1996-7012-2020-1-26-31.
  32. Лила В.А., Мазуров В.И. Профиль иммунологических маркеров в биоптатах кожи у пациентов с вероятной и достоверной системной красной волчанкой. Вестник Северо-Западного государственного медицинского университета им. И.И. Мечникова. 2021; 1: 39-48. https://dx.doi.org/10.17816/mechnikov63358.
  33. Choi M., Barber M., Clarke C. et al. Preventing the development of SLE: Identifying risk factors and proposing pathways for clinical care. Lupus. 2016; 25 (8): 838-49. https://dx.doi.org/10.1177/0961203316640367.
  34. Scofield R.H. Autoantibodies as predictors of disease. Lancet. 2004; 363(9420): 1544-46. https://dx.doi.org/10.1016/S0140-6736(04)16154-0.
  35. Leuchten N., Hoyer A., Brinks R. et al. Performance of antinuclear antibodies for classifying systemic lupus erythematosus: A systematic literature review and meta-regression of diagnostic data. Arthritis Care Res (Hoboken). 2018; 70(3): 428-38. https://dx.doi.org/10.1002/acr.23292.
  36. Bourn R., James J. Preclinical lupus. Curr Opin Rheumatol. 2015; 27(5): 433-39. https://dx.doi.org/10.1097/BOR.0000000000000199.
  37. Rua-Figueroa I., Richi P., Lopez-Longo F.Comprehensive description of clinical characteristics of a large systemic lupus erythematosus cohort from the Spanish Rheumatology Society Lupus Registry (RELESSER) with emphasis on complete versus incomplete lupus differences. Medicine (Baltimore). 2015; 94(1): e267. https://dx.doi.org/10.1097/MD.0000000000000267.
  38. Stahl H., Nived O., Sturfelt G. Outcome of incomplete systemic lupus erythematosus after 10 years. Lupus. 2004; 13(2): 85-88. https://dx.doi.org/10.1191/0961203304lu477oa.
  39. Al Daabil M., Massarotti E., Fine A. Development of SLE among «potential SLE» patients seen in consultation: Long-term follow-up.Int J Clin Pract. 2014; 68(12): 1508-13. https://dx.doi.org/10.1111/ijcp.12466.
  40. Bertoli A., Vila L., Reveille J. et al. Systemic lupus erythematosus in a multiethnic US cohort (LUMINA) LIII: disease expression and outcome in acute onset lupus. Ann Rheum Dis. 2008; 67(4): 500-4. https://dx.doi.org/10.1136/ard.2007.076059.
  41. Lambers W., Westra J., Jonkman M. et al. Incomplete systemic lupus erythematosus - what remains after application of ACR and SLICC criteria? Arthritis Care Res (Hoboken). 2020; 72(5): 607-14. https://dx.doi.org/10.1002/acr.23894.
  42. Gatto M., Saccon F., Zen M. et al. Preclinical and early systemic lupus erythematosus. Best Pract Res Clin Rheumatol. 2019; 33(4): 101422. https://dx.doi.org/10.1016/j.berh.2019.06.004.
  43. Aberle T., Bourn R., Munroe M. et al. Clinical and serological features distinguish patients with incomplete lupus classification from systemic lupus erythematosus patients and controls. Arthritis Care Res (Hoboken). 2017; 69(12): 1780-88. https://dx.doi.org/10.1002/acr.23201.
  44. Olsen N., Li Q., Quan J. et al. Autoantibody profiling to follow evolution of lupus syndromes. Arthritis Res Ther. 2012; 14(4): R174. https://dx.doi.org/10.1186/ar3927.
  45. Vila L., Mayor A., Valentin A. et al. Clinical outcome and predictors of disease evolution in patients with incomplete lupus erythematosus. Lupus. 2000; 9(2):110-15. https://dx.doi.org/10.1191/096120300678828073.
  46. Li Q., Zhou J., Lian Y. et al.Interferon signature gene expression is correlated with autoantibody profiles in patients with incomplete lupus syndromes. Clin Exp Immunol. 2010; 159(3): 281-91. https://dx.doi.org/10.1111/j.1365-2249.2009.04057.x.
  47. Morimoto A., Flesher D., Yang J. et al. Association of endogenous anti-interferon-a autoantibodies with decreased interferonpathway and disease activity in patients with systemic lupus erythematosus. Arthritis Rheum. 2011; 63(8): 2407-15. https://dx.doi.org/10.1002/art.30399.
  48. Соловьев С.К., Лила А.М., Мазуров В.И. с соавт. Системная красная волчанка: новые горизонты диагностики и терапии. Научно-практическая ревматология. 2020; 1: 5-14.
  49. Mosca M., Costenbader K., Johnson S. et al. Brief report: How do patients with newly diagnosed systemic lupus erythematosus present? A multicenter cohort of early systemic lupus erythematosus to inform the development of new classification. Arthritis Rheumatol. 2018; 71(1): 91-98. https://dx.doi.org/10.1002/art.40674.
  50. Costedoat-Chalumeau N., Dunogue B., Morel N. et al. Hydroxychloroquine: A multifaceted treatment in lupus. Presse Med. 2014; 43(6 Pt 2): e167-e180. https://dx.doi.org/10.1016/j.lpm.2014.03.007.
  51. Лила В.А. Клинико-морфологические взаимосвязи при различных вариантах течения системной красной волчанки. Автореф. дис.. канд. мед. наук. СПб. 2021; 24 с.
  52. Gatto M., Zen M., laccarino L., Doria A. New therapeutic strategies in systemic lupus erythematosus management. Nat Rev Rheumatol. 2019; 15(1): 30-48. https://dx.doi.org/10.1038/s41584-018-0133-2.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2022 Bionika Media

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies