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CE-21 The prevalence and determinants of ANTI-DFS70 antibodies in an international inception cohort of systemic lupus erythematosus (SLE) patients
  1. May Choi1,
  2. Ann Clarke1,
  3. John G Hanly2,
  4. Murray Urowitz3,4,
  5. Juanita Romero-Diaz5,
  6. Caroline Gordon6,
  7. Sang-Cheol Bae7,
  8. Sasha Bernatsky8,
  9. Daniel J Wallace9,
  10. Joan T Merrill10,
  11. David A Isenberg11,
  12. Anisur Rahman12,
  13. Ellen M Ginzler13,
  14. Paul R Fortin14,
  15. Dafna Gladman15,
  16. Jorge Sanchez-Guerrero16,
  17. Michelle Petri17,
  18. Ian N Bruce18,
  19. Mary Anne Dooley19,
  20. Rosalind Ramsey-Goldman20,
  21. Cynthia Aranow21,
  22. Graciela S Alarcon22,
  23. Kristján Steinsson23,
  24. Ola Nived24,
  25. Gunnar K Sturfelt25,
  26. Susan Manzi26,
  27. Munther Khamashta27,
  28. Ronald F?van Vollenhoven28,
  29. Asad Zoma29,
  30. Guillermo Ruiz-Irastorza30,
  31. S Sam Lim31,
  32. Thomas Stoll32,
  33. Murat Inanc33,
  34. Kenneth C Kalunian34,
  35. Diane L Kamen35,
  36. Peter Maddison36,
  37. Christine A Peschken37,
  38. Søren Jacobsen38,
  39. Anca Askanase49,
  40. Jill P Buyon40,
  41. W Winn Chatham41,
  42. Manuel Ramos-Casals42,
  43. Yvan St Pierre43 and
  44. Marvin J Fritzler1
  1. 1Medicine, University of Calgary, Calgary, AB, Canada;
  2. 2Rheumatology, Dalhousie University and Nova Scotia Health Authority, Halifax, NS, Canada;
  3. 3Rheumatology, TWH, Toronto, ON, Canada;
  4. 4Rheumatology, U of Toronto, Toronto Western Hospital, Toronto, ON, Canada;
  5. 5Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico;
  6. 6Rheumatology, University of Birmingham, Birmingham, United Kingdom;
  7. 7Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea;
  8. 8Rheumatology/Clinical Epidemiology, McGill University, Montreal, QC, Canada;
  9. 9Cedars-Sinai Medical Centre, West Hollywood, CA, USA;
  10. 10Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA;
  11. 11Rayne Institute, Centre for Rheumatology Research, UCL Division of Medicine, London, United Kingdom;
  12. 12Centre for Rheumatology Research, U College of London, London, United Kingdom;
  13. 13Medicine, SUNY-Downstate, Brooklyn, NY, USA;
  14. 14Rheumatology,University of Laval, Quebec, QC, Canada;
  15. 15Rheumatology, University of Toronto, Toronto Western Hospital, Toronto, ON, Canada;
  16. 16Rheumatology, Toronto Western Hospital, Toronto, ON, Canada;
  17. 17Rheumatology, Johns Hopkins University Hospital, Baltimore, MD, USA;
  18. 18Central Manchester University Hospital and Manchester Academic Health Science Centre, NIHR Manchester, Musculoskeletal Biomedical Research Unit, Manchester, United Kingdom;
  19. 19UNC Kidney Centre, University of North Carolina, Chapel Hill, NC, USA;
  20. 20Rheumatology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA;
  21. 21Feinstein Institute for Medical Research, Mahasset, NY, USA;
  22. 22Medicine, University of Alabama at Birmingham, Birmingham, AL, USA;
  23. 23Rheumatology, University Hospital, Reykjavik, Iceland;
  24. 24Rheumatology, Inst of Clinical sciences, Lund, Sweden;
  25. 25Department of Rheumatology, University Hospital Lund, Lund, Sweden;
  26. 26Rheumatology, Allegheny Health Network, Pittsburgh, PA, USA;
  27. 27Graham Hughes Lupus Research Laboratory, The Rayne Institute, St Thomas’ Hospital, London, United Kingdom;
  28. 28Department of Medicine, Rheumatology Unit, Karolinska Institutet, Stockholm, Sweden;
  29. 29Rheumatology, Hairmyres Hospital, East Kilbride, United Kingdom;
  30. 30Universidad del Pais Vasco, Servicio de Medicina Interna, Hospital de Cruces, Bizkaia, Spain;
  31. 31Medicine/Rheumatology, Emory University, Atlanta, GA, USA;
  32. 32Abteilung Rheumatologie/Rehab, Kantonsspital Schaffhausen, Schaffhausen, Switzerland;
  33. 33Department of Internal Medicine, Division of Rheumatology, Istanbul University, Istanbul, Turkey;
  34. 34Division of Rheumatology, Allergy & Immunology, UCSD School of Medicine Centre for Innovative Therapy, La Jolla, CA, USA;
  35. 35Medicine, Medical University of South Carolina, Charleston, SC, USA;
  36. 36School of Sport, Health and Exercise Sciences, Bangor University, Bangor, United Kingdom;
  37. 37Rheumatology, University of Manitoba, Winnipeg, MB, Canada;
  38. 38Rheumatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark;
  39. 39Columbia University College of Physicians & Surgeons, New York, NY, USA;
  40. 40Medicine, Division of Rheumatology, New York University School of Medicine, New York, NY, USA;
  41. 41Medicine/Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA;
  42. 42Department of Autoimmune Diseases, CELLEX-IDIBAPS, Hospital Clínic, Barcelona, Barcelona, Spain;
  43. 43Clinical Epidemiology, Research Institute of the McGill University Health Centre, Montreal, QC, Canada

Abstract

Background When found in the absence of antibodies to extractable nuclear antigens (ENA) or anti-double-stranded DNA (dsDNA) (i.e., monospecific), autoantibodies to the nuclear autoantigen dense fine speckles 70 (DFS70) are purported to rule out SLE. The reported frequency of anti-DFS70 by chemiluminescence (CIA) in SLE is low compared to healthy individuals (0–5.7% vs. 1.3–23.2%), while the frequency of monospecific anti-DFS70 in SLE is even lower at 0–0.4%. There are no studies examining the frequency of anti-DFS70 in an early inception SLE cohort. This study determined the prevalence of anti-DFS70 in a multi-national, multi-ethnic early inception SLE cohort and examined demographic, clinical, and autoantibody associations.

Materials and methods Patients fulfilling ACR Classification Criteria for SLE were enrolled in the Systemic Lupus International Collaborating Clinics (SLICC) inception cohort within 15 months of diagnosis. Demographic and clinical data were collected at enrollment. ANAs were detected by indirect immunofluorescence on HEp-2 cells (ImmunoConcepts, Sacramento) and ENAs and dsDNA by an addressable laser bead immunoassay (FIDIS Connective13, TheraDiag, Paris). Anti-DFS70 antibodies were measured by CIA (Inova Diagnostics, San Diego). The association between anti-DFS70 and baseline demographic, clinical, and autoantibody profiles was assessed using univariate and multivariate logistic regression. For the most informative model, only the remaining statistically significant predictors at the 95% CI: were included, after eliminating other potential predictors individually, starting with the least likely to be associated with the outcome.

Results 1137 patients were included; 89.9% were female and 93.8% were ANA positive (Table 1). The frequency of anti-DFS70 was 7.1% [95% CI: 5.7–8.8%]. 13 of 1137 (1.1%) [95% CI: 0.6–1.9%] were positive for anti-DFS70 only (monospecific). In univariate analysis, patients with musculoskeletal activity (based on SLEDAI items) or anti-β−2 glycoprotein-1 (anti-β2GP1) were more likely to have anti-DFS70, whereas those with anti-dsDNA, anti-SSA/Ro60, anti-SSB/La, or anti-U1RNP were less likely to have anti-DFS70. In multivariate analysis, patients with musculoskeletal activity (Odd Ratio (OR) 1.25 [95% CI: 1.10, 1.41]) or anti-β2GP1 (OR 2.15, 95% CI: 1.21, 3.84) were more likely to have anti-DFS70, while those with anti-dsDNA (OR 0.53, 95% CI: 0.31, 0.92) or anti-SSB/La (OR 0.25, 95% CI:0.08, 0.82) were less likely to have anti-DFS70.

Conclusions The prevalence of anti-DFS70 in newly diagnosed SLE patients was at the high end of the range previously ?published for SLE (7.1% vs. 0–5.7%) and was associated with musculoskeletal activity and anti-β2GP1. However, ‘monospecific’ anti-DFS70 was rare (1.1%) and is potentially useful to discriminate between ANA positive healthy individuals and SLE.

View this table:
Abstract CE-19 Table 1

Baseline demographic, clinical, and autoantibody profiles of anti-DFS 70 negative and positive patients and univariate and multivariate associations with anti-DFS70

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