Background/Purpose: A significant number of studies have identified a correlation between anti-nucleosome antibodies (AN-ab) and disease activity in SLE; nevertheless, there is a lack of prospective cohort studies performed in clinically quiescent SLE directed to evaluate if these antibodies are associated with the increase in risk for relapses. The purpose of this study was to evaluate if serum anti-nucleosome antibodies (AN-ab) are predictor factor for the development of short-term relapses in patients with clinically quiescent systemic lupus erythematosus (SLE).

Methods: Patients with clinically quiescent SLE according to modified-SLEDAI (m-SLEDAI) and prednisone doses ≤15 mg/d were included. Baseline serum levels of (AN-ab), anti-DNA, C3 and C4 were determined. Patients were assessed at fixed times during 6 months by researchers blinded to serum levels of antibodies. A relapse was identified when the m-SLEDAI score increased to 3 or more points. Statistical analysis included Hazard risk (HR) and 95% confidence intervals (95%CI) for the development of relapses in presence of AN-ab. Survival curves were obtained for development of relapses in presence of different risk factors.

Results: Sixty-patients were followed. In patients with clinically quiescent SLE the frequency of AN-ab at the baseline was 15%. At six months 11/60 patients developed at least one relapse, 27% of the relapses achieved a m-SLEDAI store >8 points, involving mainly kidney or central nervous system. At 6-month was observed an increase in the development of relapses in patients with AN-ab at the baseline 4/9 (44%) compared with the relapses observed in SLE without these antibodies 7/51 (14%) HR=3.56 (IC95% 1.14-11.15, p=0.05). After the adjustment in the Cox regression analysis the presence of AN-ab and fewer time for inactive disease remained as predictors for relapses at short-term.

Conclusion: These results indicate that the identification of AN-ab is useful as marker to predict relapses in clinically quiescent patients in SLE, and this determination should be included in the clinical assessment of these patients in order to improve the tools for clinical decision-making.

Founding: This project was supported by Instituto Mexicano del Seguro Social with the no. FIS/IMSS/PROT/G11/986.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/anti-nucleosome-antibodies-as-a-predictor-factor-for-relapses-in-clinically-quiescent-systemic-lupus-erythematosus-results-of-a-prospective-cohort-study/