Autoantibody-based subgroups and longitudinal seroconversion in juvenile-onset systemic lupus erythematosus

Area of Science:

• Pediatric Rheumatology
• Immunology
• Systemic Lupus Erythematosus (SLE) Research

Background:

• Juvenile-onset SLE (JSLE) presents a complex clinical spectrum.
• Understanding autoantibody profiles is key to stratifying JSLE patients and predicting disease course.

Purpose of the Study:

• To evaluate the clinical utility of an autoantibody-based subgroup framework in JSLE.
• To analyze autoantibody fluctuation trends and their association with disease activity and flares.

Main Methods:

• Retrospective analysis of 87 JSLE patients, categorized into subgroups using a two-step cluster analysis based on nine key autoantibodies.
• Comparison of clinical manifestations, organ involvement (lupus nephritis, neuropsychiatric SLE), disease activity (SLE Disease Activity Index), and flare-free survival rates among subgroups.
• Longitudinal analysis of autoantibody status fluctuations and seroconversion events.

Main Results:

• Two distinct subgroups emerged: positive anti-Sm/RNP and negative anti-Sm/RNP.
• The positive anti-Sm/RNP subgroup showed a higher prevalence of lupus nephritis and neuropsychiatric SLE, along with increased disease activity.
• A progressive decrease in positive autoantibodies (anti-dsDNA, anti-nucleosome, anti-ribosomal P protein) was observed over time.
• Positive seroconversion was significantly associated with lower flare-free survival (p<0.001).

Conclusions:

• Autoantibody profiling effectively differentiates JSLE phenotypes and disease activity, aiding in clinical management.
• Positive anti-Sm/RNP autoantibodies are linked to more severe organ involvement (lupus nephritis, neuropsychiatric SLE).
• Monitoring autoantibody changes, particularly seroconversion, offers valuable insights into predicting and managing disease flares in JSLE.