Can autoantibodies be used as biomarkers for the diagnosis of neuropsychiatric systemic lupus erythematosus?

According to a review published in Clinical Reviews in Allergy & Immunology, autoantibodies can be used as biomarkers for the differential diagnosis of neuropsychiatric systemic lupus erythematosus (NPSLE).

NPSLE can be difficult to diagnose because symptoms of the disease, such as headache and cognitive impairment, are often associated with those of other neurological disorders. Autoantibodies are currently the most powerful diagnostic tool for NPSLE; however, not all of them have the required sensitivity and specificity for NPSLE.

Antibodies such as anti-Sjogren’s syndrome-related antigen A (SSA) / Ro, anti-Sjogren’s syndrome-related antigen B (SSB) / La, anti-Smith (Sm), and anti-ribonucleoprotein (RNP) vary in frequency Patients with NPSLE. Although the lupus anticoagulant is commonly seen in patients with NPSLE, it can also be present in other conditions. Biomarkers such as anti-N-methyl-d-aspartate (NMDA) receptor antibodies, which are restricted to the brain and only occur in patients with neuropsychiatric manifestations, are the gold standard for the differential diagnosis of NPSLE. However, these biomarkers are not evenly distributed in patients with diffuse and focal symptoms. Anti-NMDA antibodies in patients with NPSLE are often associated with diffuse symptoms, but there are studies contradicting the association of anti-NMDA receptor antibodies with NPSLE.

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The review found that a promising biomarker, not limited to brain antigens, is anti-ribosomal protein (ribP), which, along with anti-dsDNA antibodies, can predict disease flare-ups. However, these are only associated with diffuse symptoms, with several studies showing conflicting results on the role of these antibodies as biomarkers for NPSLE.

The study author says, “There is no exclusive biomarker that can predict the development of a neuropsychiatric manifestation in patients with SLE. However, several autoantibodies can currently be tested in order to determine a more complete and representative clinical situation of the patient. “

The study author also recommended that further studies be carried out on the role of autoantibodies in the pathogenesis of NPSLE.

reference

Manca E. Autoantibodies in Neuropsychiatric Systemic Lupus Erythematosus (NPSLE): Can They Be Used as Biomarkers for the Differential Diagnosis of This Disease? Clin Rev Allerg Immunol. Published online June 11, 2021. doi: 10.1007 / s12016-021-08865-2

This article originally appeared on Rheumatology Advisor