Systemic Lupus Erythematosus: Autoantibody Panels and Molecular Diagnostics in SLE
This comprehensive BMJ review covers the genetics, epigenetics, and immunopathogenesis of SLE alongside updates on diagnosis and classification criteria. For clinical laboratories, SLE diagnosis relies heavily on autoantibody testing including ANA, anti-dsDNA, anti-Smith, and antiphospholipid antibodies, while complement levels (C3, C4) serve as disease activity monitors. The review highlights how emerging molecular subtyping based on interferon signatures and other immune pathways may enable personalised treatment selection and more precise laboratory-guided monitoring.
The original study
Advances in the management of systemic lupus erythematosus.
- Authors
- Morand EF, Fernandez-Ruiz R, Blazer A, Niewold TB
- Journal
- BMJ (Clinical research ed.)
- Type
- Journal Article, Review
- PMID
- 37884289
Original abstract
Systemic lupus erythematosus (SLE) is a severe multisystem autoimmune disease that can cause injury in almost every body system. While considered a classic example of autoimmunity, it is still relatively poorly understood. Treatment with immunosuppressive agents is challenging, as many agents are relatively non-specific, and the underlying disease is characterized by unpredictable flares and remissions. This State of The Art Review provides a comprehensive current summary of systemic lupus erythematosus based on recent literature. In basic and translational science, this summary includes the current state of genetics, epigenetics, differences by ancestry, and updates about the molecular and immunological pathogenesis of systemic lupus erythematosus. In clinical science, the summary includes updates in diagnosis and classification, clinical features and subphenotypes, and current guidelines and strategies for treatment. The paper also provides a comprehensive review of the large number of recent clinical trials in systemic lupus erythematosus. Current knowns and unknowns are presented, and potential directions for the future are suggested. Improved knowledge of immunological pathogenesis and the molecular differences that exist between patients should help to personalize treatment, minimize side effects, and achieve better outcomes in this difficult disease.