So the next time you are consulted on a patient with diffuse alveolar hemorrhage and a pulmonary-renal syndrome in the intensive care unit, think of the value of corticosteroids, and the impact their discovery has had on the field of medicine.

All authors are part of the Rheumatology Fellowship Program at the University of Colorado, Anschutz Medical Campus, Aurora.

References

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Autoantibodies Before SLE

Preclinical autoimmunity

BY GUY KATZ, MD, JACQUELYN NESTOR, MD, PHD, STEVE WITTE, MD, PHD, ZANDRA WALTON, MD, PHD, GREG CHALLENER, MD, & MARCY BOLSTER, MD

Base Article

Arbuckle MR, McClain MT, Rubertone MV, et al. Development of autoantibodies before the clinical onset of systemic lupus erythematosus. N Engl J Med. 2003 Oct 16;349(16):1526–1533.¹

Team Overview

Virtually every player with systemic lupus erythematosus (SLE) harbors autoantibodies as part of their offensive strategies. For decades, these autoantibodies have been powerhouses in the workup and long-term management for patients with SLE and many other systemic autoimmune diseases. Indeed, the ability to analyze the meaning of these tests in different clinical contexts is one of the defining skills of a rheumatologist. However, long after they were discovered to be associated with SLE, critical questions surrounding these autoantibodies remained. What is their role in disease pathogenesis? When in the disease process do they develop? How should we counsel patients with positive autoantibodies but no clinical evidence of associated autoimmune disease? In the landmark article by Arbuckle et al., answers to these questions were finally uncovered, providing novel insights into SLE and autoimmunity.

Recruiting players from a powerful database of 30 million prospectively collected serum samples, patients with SLE (n=130) and four matched controls each were identified.¹ These samples were then interrogated for the presence of anti-nuclear antibodies (ANA) at a titer of 1:120 titer or greater, as well as antibodies to Ro (SSA), La (SSB), dsDNA, Smith (Sm), RNP and phospholipids.