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Research ArticleArticle

Four Anti-dsDNA Antibody Assays in Relation to Systemic Lupus Erythematosus Disease Specificity and Activity

Helena Enocsson, Christopher Sjöwall, Lina Wirestam, Charlotte Dahle, Alf Kastbom, Johan Rönnelid, Jonas Wetterö and Thomas Skogh
The Journal of Rheumatology May 2015, 42 (5) 817-825; DOI: https://doi.org/10.3899/jrheum.140677
Helena Enocsson
From the Department of Clinical and Experimental Medicine, Linköping University, Linköping, and the Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.
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  • For correspondence: helena.enocsson@liu.se
Christopher Sjöwall
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Lina Wirestam
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Charlotte Dahle
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Alf Kastbom
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Johan Rönnelid
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Jonas Wetterö
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Thomas Skogh
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Abstract

Objective. Analysis of antibodies against dsDNA is an important diagnostic tool for systemic lupus erythematosus (SLE), and changes in anti-dsDNA antibody levels are also used to assess disease activity. Herein, 4 assays were compared with regard to SLE specificity, sensitivity, and association with disease activity variables.

Methods. Cross-sectional sera from 178 patients with SLE, of which 11 were followed consecutively, from a regional Swedish SLE register were analyzed for immunoglobulin G (IgG) anti-dsDNA by bead-based multiplex assay (FIDIS; Theradig), fluoroenzyme-immunoassay (EliA; Phadia/Thermo Fisher Scientific), Crithidia luciliae immunofluorescence test (CLIFT; ImmunoConcepts), and line blot (EUROLINE; Euroimmun). All patients with SLE fulfilled the 1982 American College of Rheumatology and/or the 2012 Systemic Lupus International Collaborating Clinics (SLICC-12) classification criteria. Healthy individuals (n = 100), patients with rheumatoid arthritis (n = 95), and patients with primary Sjögren syndrome (n = 54) served as controls.

Results. CLIFT had the highest SLE specificity (98%) whereas EliA had the highest sensitivity (35%). When cutoff levels for FIDIS, EliA, and EUROLINE were adjusted according to SLICC-12 (i.e., double the reference limit when using ELISA), the specificity and sensitivity of FIDIS was comparable to CLIFT. FIDIS and CLIFT also showed the highest concordance (84%). FIDIS performed best regarding association with disease activity in cross-sectional and consecutive samples. Fisher’s exact test revealed striking differences between methods regarding associations with certain disease phenotypes.

Conclusion. CLIFT remains a good choice for diagnostic purposes, but FIDIS performs equally well when the cutoff is adjusted according to SLICC-12. Based on results from cross-sectional and consecutive analyses, FIDIS can also be recommended to monitor disease activity.

Key Indexing Terms:
  • SYSTEMIC LUPUS ERYTHEMATOSUS
  • DOUBLE-STRANDED DNA
  • IMMUNOASSAY
  • AUTOANTIBODIES
  • INFLAMMATION
  • RHEUMATIC DISEASE

Footnotes

  • Supported by the Swedish Research Council (K2012-69X-14594-10-3 and K2011-68X-20611-04-3), the Swedish Society for Medicine (SLS-331171 and SLS-331171), the Swedish Society Against Rheumatism (R-313701, R-307291), the Swedish Society for Medical Research, the King Gustaf V 80-year Foundation (FAI2013-0066), and the Professor Nanna Svartz foundation.

  • Accepted for publication January 2, 2015.
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The Journal of Rheumatology
Vol. 42, Issue 5
1 May 2015
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Four Anti-dsDNA Antibody Assays in Relation to Systemic Lupus Erythematosus Disease Specificity and Activity
Helena Enocsson, Christopher Sjöwall, Lina Wirestam, Charlotte Dahle, Alf Kastbom, Johan Rönnelid, Jonas Wetterö, Thomas Skogh
The Journal of Rheumatology May 2015, 42 (5) 817-825; DOI: 10.3899/jrheum.140677

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Four Anti-dsDNA Antibody Assays in Relation to Systemic Lupus Erythematosus Disease Specificity and Activity
Helena Enocsson, Christopher Sjöwall, Lina Wirestam, Charlotte Dahle, Alf Kastbom, Johan Rönnelid, Jonas Wetterö, Thomas Skogh
The Journal of Rheumatology May 2015, 42 (5) 817-825; DOI: 10.3899/jrheum.140677
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Keywords

SYSTEMIC LUPUS ERYTHEMATOSUS
DOUBLE-STRANDED DNA
IMMUNOASSAY
AUTOANTIBODIES
INFLAMMATION
RHEUMATIC DISEASE

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Keywords

  • systemic lupus erythematosus
  • DOUBLE-STRANDED DNA
  • IMMUNOASSAY
  • autoantibodies
  • inflammation
  • RHEUMATIC DISEASE

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