Our main findings are elevated levels of CSF-1, TNF-α, IP-10 and MCP-1 in saliva and serum of patients with SLE compared with controls. Furthermore, we observed elevated levels of TNF-α, IP-10 and MCP-1 in urine from patients with SLE with active renal disease as compared with those with non-active renal disease.
C-reactive protein. CRP is the standard marker of inflammation, but in SLE patients, CRP is more of a marker for severe infections (Table 3). It is therefore of interest to analyze the role of CRP in SLE in some detail. CRP is directly driven by IL-6 [32], and IL-6 levels are increased in active SLE [33,34].
Anti-Nuclear Antibody (ANA) Test. Anti-nuclear antibodies (ANA) are autoantibodies to the nuclei of your cells. 98% of all people with systemic lupus have a positive ANA test, making it the most sensitive diagnostic test for confirming diagnosis of the disease.
C-reactive protein (CRP), as the prototypical marker of inflammation in the routine laboratory, is often not greatly elevated in SLE (see below) and in fact should raise suspicion of bacterial infection if highly elevated in an SLE patient. Still, the immune complexes in SLE almost invariably lead to inflammation.
Abstract. CRP levels in 194 serum samples from 43 SLE patients were measured. Patients with inactive disease have levels below 10 micrograms/ml; patients with active SLE have higher levels, but never over 50 micrograms/ml.
It is important to realize, though, that a low CRP value does not necessarily mean that an individual is experiencing no inflammation; a low CRP can be seen in lupus patients with active inflammation. An elevated CRP can also be seen after someone has a heart attack, surgical procedure, or infection.
Since ESR rises both with lupus activity and infection, alone it is too nonspecific to distinguish between lupus flare and infection. CRP values of >6.0 mg/dl in SLE patients have been associated with infectious processes and higher CRP levels have been observed in SLE infection compared to SLE flare without infection.
Furthermore, a combined effect of the CRP-lowering polymorphism of the CRP gene (rs1205) (16) and detectable IFN-α levels resulted in inability of CRP to reflect inflammatory activity among SLE patients (13).
“I have some patients who have very aggressive lupus flares or autoinflammatory flares, and the sedimentation rate can be completely normal,” says Dr. Schulz.
Biomarkers widely used for SLE diagnosis include antinuclear antibodies (ANAs), anti-Smith antibodies, antibodies to double stranded DNA (anti-dsDNA), and levels of complement components C3, C4, CH50. ANAs are highly sensitive but lack specificity and have very little positive predictive value for SLE.
Antinuclear antibodies (ANAs)
If you have a positive ANA test, it may mean you have an autoimmune disease. Autoimmune diseases cause your immune system to attack your healthy cells, tissues, or organs. Most people with lupus have ANA antibodies in their blood.
If your doctor says your ANA test is “positive,” that means you have antinuclear antibodies in your blood — but it doesn't necessarily mean you have lupus. In fact, a large portion of patients with a positive ANA do not have lupus. Diagnosing lupus is like putting together a puzzle.
The initial requirement of the criteria for lupus diagnosis is a positive ANA test with a titer of at least 80. The numerical value of the titer refers to the ratio of blood serum being evaluated to a dilution agent.
Hepatic involvement was reported in 48.55% of total SLE patients. Aspartate aminotransferase (AST), alanine aminotransferase (ALT), and both enzymes higher than normal upper limits were detected in 8.7%, 5%, and 34.7% of lupus patients, respectively.
Patients with systemic lupus erythematosus (SLE) often display modest elevations of C-reactive protein (CRP) despite raised disease activity and increased interleukin (IL-) 6.
Many people with systemic lupus have abnormal CBCs. White blood cell counts can be low (leukopenia) due to lupus, immunosuppressive therapy, or the presence of a virus. High WBC counts may signal infection but also occur when individuals are on corticosteroids such as prednisone.
In our first study, we demonstrated that some patients with SLE were anti-CRP antibody positive on one occasion but negative on another occasion [149].
Lupus can be difficult to diagnose because it has many symptoms that come and go and can mimic symptoms of other disorders or diseases. When speaking to your doctor about your symptoms, be sure to include symptoms that may no longer be present.
A doctor may use the phrase "borderline lupus" when symptoms or blood test results suggest lupus, but there is not enough information for a definite diagnosis.
1.0 to 10.0 mg/dL: Moderate elevation (Systemic inflammation such as RA, SLE, or other autoimmune diseases, malignancies, myocardial infarction, pancreatitis, bronchitis). More than 10.0 mg/dL: Marked elevation (Acute bacterial infections, viral infections, systemic vasculitis, major trauma).
A wide variety of inflammatory conditions can cause elevated CRP levels, including : autoimmune conditions, including rheumatoid arthritis (RA), lupus, and certain types of inflammatory bowel disease (IBD), such as Crohn's disease and ulcerative colitis.
95% of people with lupus test positive for ANA, but a number of other, non-lupus causes can trigger a positive ANA, including infections and other autoimmune diseases. The ANA test simply provides another clue for making an accurate diagnosis.
Anti-nuclear antibody test (ANA) is positive in almost all patients with SLE. Anti-double stranded DNA antibodies are frequently present, may be associated with kidney involvement and the level can fluctuate with disease activity making this a useful test to monitor.
People with lupus are almost always positive for ANA; however, people with RA sometimes test positive as well, as do some healthy people.