Levels of Anti-dsDNA and Complement May Help Predict Flares in People with Lupus
Arthritis & Rheumatism, Volume 54, Issue 11, October 30, 2006, Pages 3623-3632
The effect of moderate-dose corticosteroids in preventing severe flares in patients with serologically active, but clinically stable, systemic lupus erythematosus: Findings of a prospective, randomized, double-blind, placebo-controlled trial
Finding ways to predict the onset of flare in lupus patients, especially among patients who appear to be doing fine until shortly before the flare starts, could be very helpful. Chung E. Tseng, MD, of the Hospital for Joint Diseases and colleagues took up this challenge, looking in particular at whether abnormal levels of anti-dsDNA autoantibodies and complement in patients with lupus who seem well are an indication those patients would flare. If so, they wondered, could short-term treatment with steroids help prevent those flares from occurring?
Their study involved 154 lupus patients who were seen every month for up to 18 months. Measurements of complement (C3a, C3, C4, CH50) and anti-dsDNA levels were taken monthly. Patients who remained well but showed increase of both the anti-dsDNA level and the C3a level were randomly assigned to receive either prednisone or placebo therapy (a pill with no effects). The initial prednisone dosage was 30 mg/day for two weeks, reduced to 20 mg/day for one week, and then 10 mg/day for one week.
Forty-one patients showed these positive tests, which allowed them to enter the study: 21 were randomly assigned (like a throw of the dice) to receive prednisone, and 20 received placebo. Within the next 90 days, six severe flares occurred in patients who were taking placebo while none occurred in patients taking prednisone. Furthermore, those who took prednisone had improvement in disease activity overall, decreased levels of anti-dsDNA antibodies, and improvement in the levels of C4 (a complement test) one month after initiation of prednisone treatment.
These preliminary data lend support to the potential use of C3a and anti-dsDNA in combination as a marker for flare risk, and additional studies could elaborate on that possibility. The study also suggests the possibility that a short-term steroid taper in patients with these blood test results may avert a severe flare in those at high risk; the research team noted that such a recommendation would result in a number of patients receiving exposure to steroids who might not otherwise require them, but they weighed that consideration against the potential serious, even life-threatening complications that could result from a severe flare.
Connect with Us: