Review Article

Serology of Lupus Erythematosus: Correlation between Immunopathological Features and Clinical Aspects

Table 1

Correlation between antibodies reactivity lupus subtypes and diagnostic utility.

AntibodyTargetDiagnostic utility Associated lupus subtypes (prevalence)Other associated diseases References

ANAsThe cell nucleusHigh sensitivity, but specificity is lowSLE (98%)
LN (100%)
MCTD
Drug-induced lupus
Discoid lupus (35%)
Hepatic diseases (autoimmune hepatitis A), malignancies, chronic infections, thyroid diseases, elderly people, SS, SSc, PM, DM, juvenile chronic arthritis, Felty’s syndrome, relapsing polychondritis, and rheumatoid arthritis[12, 21, 22]

Anti-dsDNADouble strand DNAHigh sensitivity and specificity for SLE. Correlate with disease activitySLE (70–98%)
LN (70%)
NPSLE (44, 4–81, 6%)
RA, HIV and parvovirus B19 infections, myeloma, and type 1 autoimmune hepatitis [12, 21, 2326]

Anti-SmSm1Low sensitivity, but high specificity for SLESLE (20–40%)
LN (14%)
MCTD (8%)
EBV infections[12, 21, 27, 28]

Anti-nucleosomeNuclesome2High sensitivity and specificity for SLE. Correlate with disease activitySLE (61–85%)
LN (60–90%)
MTCD (41%)
RA, SSc, and SS[14, 21, 29, 30]

Anti-histoneHistoneLow IgM
Higher IgG
SLE (70%)
LN (37%)
Anti-H2A and Anti-H2b specific for SLE induced by drugs (96–100%)
Rheumatoid arthritis, SSc, PBC3, Alzheimer’s disease, dementia, and infections[12, 21, 31, 32]

Anti-SSA/RoSSA/Ro (proteins 60/52 kD)4High prognostic value for NLE in pregnant womenSLE (30%)
LN (31%)
NLE (especially CHB) (90%)
SCLE (70–80%)
Discoid Lupus (5–20%)
SSc, IIM5, PBC, RA, and SS[12, 21, 3336]

Anti-SSB/LaSSB/La6ModerateSLE (10%)
LN (14%)
Protective for LN
SCLE (30%)
NLE (90%)
SS[12, 21, 35, 36]

Anti-ribosomal PRibosomes7ModerateSLE (13–40%)
LN (6%)
NPSLE (especially psychosis and depression) (21%)
Hepatic diseases, malignancies, and RA [12, 21, 37, 38]

Anti-phospholipidPhospholipids8 (of cardiolipin, LACs are the most important ones)High if Anti-PL syndrome is suspectedSLE (30–40%)
LN (20–80%)
Anti-PL syndrome: venous thrombosis, arterial thrombosis, recurrent pregnancy loss, thrombocytopenia and haemolytic anaemia, livedo reticularis, and skin ulcers.
Other autoimmune diseases, infections, malignancies, and drug-induced disorders, rheumatoid arthritis[12, 21, 39]

Anti-C1q C1q9Low but useful to monitor evolution of LE nephritisSLE (17–46%)
LN (40–100%)
CLE (44%)
Hypocomplementemic urticarial vasculitis syndrome, rheumatoid arthritis, and renal disease[21, 40, 41]

Anti-RNPRNP10UnclearSLE (20–30%)
MCTD (100%)
Sharp’s syndrome
scleroderma, polymyositis,
rheumatoid arthritis,
SSc, Sj gren’s syndrome
[12, 42, 43]

Anti-PCNAPCNA11LowSLE (5–10%)Chronic hepatitis B and C[44, 45]

In biology, Sm proteins are a family of RNA-binding proteins found in virtually every cellular organism.
2A nucleosome is the basic unit of DNA packaging in eukaryotes, consisting of a segment of DNA wound in sequence around eight histone protein cores.
3Primary biliary cirrhosis.
4Ro60 is a ribonuclear protein containing small uridine-rich nucleic acids known. Protein 60 KD is located into the nucleus and nucleolus, while protein 52 is located into the cytoplasm.
5Idiopathic inflammatory myopathies.
6SSB/La particle is a 48–50 kDa nuclear phosphoprotein composed of 2 distinct regions of 28 and 23 kDa.
7P0, P1, and P2 of 38, 19, and 17 kDa, respectively, of the 60S subunit.
8Anionic phospholipis including cardiolipin (CL), LA, phophatidylserine (PS), phsphatidylinositol (PI), and phosphatidic acid (PA).
9C1q is a cationic glycoprotein of 410–450 kDa which binds to the Fc portions of immunoglobulins in immune complexes to initiate complement activation via the classical pathway.
103 ribonucleoproteins: of 70 kDa (U1), 33 kDa (protein A), and 22 kDa (protein C), respectively.
11Anti-proliferating cell nuclear antigen.