Future of lupus management may require further disease subdivision
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DESTIN, Fla. — Systemic lupus erythematosus may benefit from being redefined and further subdivided, depending on the autoantibody profile of the patient, according to a speaker at the Congress of Clinical Rheumatology East 2022.
“I think it is very important when you have a newly diagnosed lupus patient that you perform an expanded antibody profile,” Elisabet Svenungsson, MD, PhD, an adjunct professor from the Karolinska Institute, in Sweden, told attendees. “This could help to tailor treatment to create better lives in the future. I believe that in the future, that we will need to redefine SLE and maybe subdivide it or talk about subgroups.”
During a presentation, Svenungsson described four distinct “clusters” of SLE patients. The clusters are distinguished by unique disease manifestations that typically “lump together” but are still found overlapping in specific patients, she said.
“I think it’s a way of thinking that we will need for the future,” Svenungsson said. “SLE is a very heterogeneous disease.”
The first cluster — identified by Svenungsson as the Sjögren cluster — is associated with anti-SSA Ro60/Ro52 and SSB. This group comprised about 29% of the population used in the identifying studies and exhibit more prominent overlap with Sjögren’s syndrome, skin and discoid lupus, and increased photosensitivity, Svenungsson said.
Patients in the second cluster, the anti-phospholipid antibody cluster, made up 24% of the identifying cohort. Disease in this population was associated with anticardiolipin/anti beta2GPI and LA, and was typified by low platelet counts, an increased number of vascular events and a higher cardiovascular risk.
Patients in the nephritis cluster — the third group — made up 29% of the analyzed cohort and were associated with anti-dsDNA, nucleosomes and Sm/RNP antibodies, and were characterized by early disease onset and nephritis.
Meanwhile, the fourth cluster included the 18% of patients who were anti-nuclear antibody positive but showed no ANA sub specificities, Svenungsson said.
“Subgrouping SLE could be a clue to understand underlying mechanisms much better, and maybe determine prognosis,” Svenungsson said. “There really is no strict border separating these patients into these four groups, but nevertheless characteristics lump together, but they still overlap with each other, and I think we need to look at this in much more detail.”
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Svenungsson E. Autoantibodies in SLE — Can they predict disease characteristics, outcomes and treatment needs? Presented at: The Congress of Clinical Rheumatology East; May 12-15, 2022; Destin, Fla.
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