Unraveling incomplete lupus: search for predictive markers for progression to systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is a rare autoimmune disease that can be serious. There is no cure, but the disease can be slowed down with medication. The aim of this thesis is to gain more insight into the early phase of SLE. If recognized early, targeted treatment can be started in time to prevent organ damage. The researchers looked at the occurrence of early features of autoimmune diseases in the population, both for symptoms and antibodies. It shows that screening for specific autoantibodies in the population is only useful in a selected risk group, possibly on the basis of a questionnaire aimed at systemic diseases. Furthermore, research has been done on patients with features of SLE, without meeting the classification criteria, also known as incomplete SLE (iSLE). The patients were followed for a longer period of time, with the aim of distinguishing which patients have a high risk of progression to SLE. Based on this study and a literature analysis, there are several factors, namely female gender, younger age, increased IFN-type I activity, decreased complement and diversity of autoantibodies, which together suggest a higher risk of SLE. Therefore, we recommend repeat testing for antinuclear antibodies and serum complement concentrations in patients with iSLE. In the future, increased IFN-type I activity could possibly be investigated, using myxovirus resistance protein A as a surrogate marker, but these tests are not yet generally available. When changes in one or more of these factors occur, closer monitoring and considering early treatment is advised.