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Correlation between Systemic Lupus Erythematosus Disease Activity Index, C3, C4
and Anti-dsDNA Antibodies
#MMPMID27365721
Narayanan K
; Marwaha V
; Shanmuganandan K
; Shankar S
Med J Armed Forces India
2010[Apr]; 66
(2
): 102-7
PMID27365721
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BACKGROUND: Therapeutic decisions in systemic lupus erythematosus (SLE) are based
on the disease activity and nature of organ involvement. There are various
clinical and laboratory methods to assess the lupus flares. METHODS: Fifty one
SLE patients with active disease (lupus flare) were studied. Systemic lupus
erythematosus disease activity index (SLEDAI), C3, C4 and anti-double stranded
DNA levels were estimated and repeated monthly till remission. After remission
these tests were done three monthly. Values of serological parameters were then
correlated with SLEDAI score. RESULT: Thirteen (25.4%) patients had predominantly
renal involvement while 38 (74.6%) patients had non-renal affliction.
Musculoskeletal and mucocutaneous symptoms were the commonest features of lupus
flare (90%). It was observed that 12 out of 13 (92.3%) patients with active renal
involvement had low C3 levels and 11 (84.6%) had low C4 levels. The anti-dsDNA
levels were elevated in all patients with predominant renal flare. In non-renal
flare anti-dsDNA titre was raised only in 35% cases. Low C3 and C4 levels were
noticed in 43% and 53% of non-renal flares respectively. Significant positive
correlation was noticed between SLEDAI score and anti-dsDNA levels (0.01 level
two-tailed prediction) and a significant negative correlation was observed with
SLEDAI and C3, C4 levels (0.01 and 0.05 levels, two-tailed prediction) in our
patients. On subgroup analysis it was noticed that this correlation is stronger
for renal lupus. Negative correlation of SLEDAI and complement levels was not
observed in non-renal flares. CONCLUSION: Calculation of SLEDAI is a vital
clinical tool for assessment of SLE patients. Serial estimation of anti-dsDNA
titre, C3 and C4 levels help us diagnose lupus flare and make appropriate
therapeutic decisions in patients with high SLEDAI score.
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