Abstract
Objective: Serologically active clinically quiescent (SACQ)-SLE is a subtype of systemic lupus erythematosus (SLE); most SACQ-SLE patients relapse. Although complement and/or anti-dsDNA level fluctuations during SACQ status are reportedly not useful for predicting relapse, they might be useful in specific clinical settings. We aimed to assess the correlation between future relapse and progressive reductions in serum complement levels following remission in patients with hypocomplementemia. Methods: We retrospectively reviewed patients aged ≥15 years who were treated with ≥20 mg/day of prednisolone for remission induction. After achieving remission, the patients treated with prednisolone tapered to ≤15 mg/day without relapse and followed by hypocomplementemia (first hypocomplementemia point) were analyzed. The primary outcome was the relapse during the first 24 months. Results: Seventy-six patients were enrolled; 31 (40.8%) relapsed. A ≥10% reduction after the first hypocomplementemia point in serum C3, C4, and CH50 levels was found in 10, 21, and 16 patients, respectively. Hazard ratios (95% confidence intervals) for relapse were 2.32 (0.92–5.12) for serum C3 levels and 2.46 (1.18–5.01) for serum C4 levels. Progressive reductions in serum C3 and C4 levels had relatively high specificity (93.3% and 82.2%) but limited sensitivity (22.6% and 41.9%) for predicting relapse. However, simultaneous progressive reduction in C3 levels and increase in anti-dsDNA antibody levels had the highest specificity (97.8%), and simultaneous progressive reduction in C4 levels or increase in anti-dsDNA antibody levels had the highest sensitivity (71.0%). Conclusion: Simultaneous progressive reductions in complement levels and increases in anti-dsDNA antibody levels may indicate future relapse SACQ-SLE patients.
| Original language | English |
|---|---|
| Pages (from-to) | 2093-2100 |
| Number of pages | 8 |
| Journal | Lupus |
| Volume | 27 |
| Issue number | 13 |
| DOIs | |
| Publication status | Published - Nov 1 2018 |
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Keywords
- anti-dsDNA antibodies
- hypocomplementemia
- progressive reduction
- relapse
- Systemic lupus erythematosus
ASJC Scopus subject areas
- Rheumatology
Cite this
Progressive reduction of serum complement levels : a risk factor for relapse in patients with hypocomplementemia in systemic lupus erythematosus. / Miyawaki, Y.; Sada, Kenei; Asano, Y.; Hayashi, K.; Yamamura, Y.; Hiramatsu, S.; Ohashi, K.; Morishita, Michiko; Watanabe, Haruki; Matsumoto, Yoshinori; Kawabata, T.; Wada, Jun.
In: Lupus, Vol. 27, No. 13, 01.11.2018, p. 2093-2100.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Progressive reduction of serum complement levels
T2 - a risk factor for relapse in patients with hypocomplementemia in systemic lupus erythematosus
AU - Miyawaki, Y.
AU - Sada, Kenei
AU - Asano, Y.
AU - Hayashi, K.
AU - Yamamura, Y.
AU - Hiramatsu, S.
AU - Ohashi, K.
AU - Morishita, Michiko
AU - Watanabe, Haruki
AU - Matsumoto, Yoshinori
AU - Kawabata, T.
AU - Wada, Jun
PY - 2018/11/1
Y1 - 2018/11/1
N2 - Objective: Serologically active clinically quiescent (SACQ)-SLE is a subtype of systemic lupus erythematosus (SLE); most SACQ-SLE patients relapse. Although complement and/or anti-dsDNA level fluctuations during SACQ status are reportedly not useful for predicting relapse, they might be useful in specific clinical settings. We aimed to assess the correlation between future relapse and progressive reductions in serum complement levels following remission in patients with hypocomplementemia. Methods: We retrospectively reviewed patients aged ≥15 years who were treated with ≥20 mg/day of prednisolone for remission induction. After achieving remission, the patients treated with prednisolone tapered to ≤15 mg/day without relapse and followed by hypocomplementemia (first hypocomplementemia point) were analyzed. The primary outcome was the relapse during the first 24 months. Results: Seventy-six patients were enrolled; 31 (40.8%) relapsed. A ≥10% reduction after the first hypocomplementemia point in serum C3, C4, and CH50 levels was found in 10, 21, and 16 patients, respectively. Hazard ratios (95% confidence intervals) for relapse were 2.32 (0.92–5.12) for serum C3 levels and 2.46 (1.18–5.01) for serum C4 levels. Progressive reductions in serum C3 and C4 levels had relatively high specificity (93.3% and 82.2%) but limited sensitivity (22.6% and 41.9%) for predicting relapse. However, simultaneous progressive reduction in C3 levels and increase in anti-dsDNA antibody levels had the highest specificity (97.8%), and simultaneous progressive reduction in C4 levels or increase in anti-dsDNA antibody levels had the highest sensitivity (71.0%). Conclusion: Simultaneous progressive reductions in complement levels and increases in anti-dsDNA antibody levels may indicate future relapse SACQ-SLE patients.
AB - Objective: Serologically active clinically quiescent (SACQ)-SLE is a subtype of systemic lupus erythematosus (SLE); most SACQ-SLE patients relapse. Although complement and/or anti-dsDNA level fluctuations during SACQ status are reportedly not useful for predicting relapse, they might be useful in specific clinical settings. We aimed to assess the correlation between future relapse and progressive reductions in serum complement levels following remission in patients with hypocomplementemia. Methods: We retrospectively reviewed patients aged ≥15 years who were treated with ≥20 mg/day of prednisolone for remission induction. After achieving remission, the patients treated with prednisolone tapered to ≤15 mg/day without relapse and followed by hypocomplementemia (first hypocomplementemia point) were analyzed. The primary outcome was the relapse during the first 24 months. Results: Seventy-six patients were enrolled; 31 (40.8%) relapsed. A ≥10% reduction after the first hypocomplementemia point in serum C3, C4, and CH50 levels was found in 10, 21, and 16 patients, respectively. Hazard ratios (95% confidence intervals) for relapse were 2.32 (0.92–5.12) for serum C3 levels and 2.46 (1.18–5.01) for serum C4 levels. Progressive reductions in serum C3 and C4 levels had relatively high specificity (93.3% and 82.2%) but limited sensitivity (22.6% and 41.9%) for predicting relapse. However, simultaneous progressive reduction in C3 levels and increase in anti-dsDNA antibody levels had the highest specificity (97.8%), and simultaneous progressive reduction in C4 levels or increase in anti-dsDNA antibody levels had the highest sensitivity (71.0%). Conclusion: Simultaneous progressive reductions in complement levels and increases in anti-dsDNA antibody levels may indicate future relapse SACQ-SLE patients.
KW - anti-dsDNA antibodies
KW - hypocomplementemia
KW - progressive reduction
KW - relapse
KW - Systemic lupus erythematosus
UR - http://www.scopus.com/inward/record.url?scp=85055639688&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85055639688&partnerID=8YFLogxK
U2 - 10.1177/0961203318804892
DO - 10.1177/0961203318804892
M3 - Article
C2 - 30309286
AN - SCOPUS:85055639688
VL - 27
SP - 2093
EP - 2100
JO - Lupus
JF - Lupus
SN - 0961-2033
IS - 13
ER -