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Updates in Biomarkers for SLE: Aiding Early Diagnosis and Disease Monitoring

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A biomarker is like a signal that shows something happening inside the body, like a normal process. Read the article to know more.

Medically reviewed by

Dr. Basuki Nath Bhagat

Published At February 15, 2024
Reviewed AtMarch 26, 2024

Introduction

Systemic lupus erythematosus (SLE) is an immune disease dysfunction. It is clinically dermatological heterogeneous neuropsychiatric and cardiovascular symptoms. The clinical and immunological biomarkers play a critical role in improving the diagnosis of SLE. The prevalence of SLE is 31.5 per 100,000 per year. However, it is seen that SLE has an increased prevalence. SLE has become an important social and public health problem as it cannot be completely cured; instead, it can stop the progression of the disease. Immunological biomarkers have emerged to diagnose SLE more properly and accurately. The aim is to control the disease. It is really important to get better at finding out if someone has SLE (a disease) early so we can treat it well. That is why scientists are looking at special signs in the body called biomarkers, especially ones related to the immune system. These biomarkers can help us figure out if someone has SLE and understand how the disease works. The goal is to use this information to control the disease better. This study is all about checking out these immune system biomarkers for diagnosing SLE and understanding how the disease works.

What Are Biomarkers?

A biomarker is like a signal that shows something happening inside the body, like a normal process, a sickness, or a reaction to medicine. Recently, the definition of biomarkers has changed a bit. Now, biomarkers have to be something physical or related to cells, chemicals, molecules, or genes. Scientists use them to check and watch biological processes or sickness by doing tests. It can measure biomarkers in blood, urine, or tissues. Lately, they are used a lot in figuring out and managing diseases like SLE, diabetes, heart problems, and cancer. In SLE, biomarkers are super important. They help diagnose it, understand complications, see how active the disease is, and know if treatments are working.

Finding the best biomarker for SLE is hard. It needs to show the sickness or the target for treatment is reliable, valid, and very good at predicting. It should also be great at watching how active SLE is, being easy to measure in tissues or fluids without being affected by other things, and being stable and reproducible. Testing should also be available in most labs at a reasonable cost. Sometimes, mistakes in labs, specific techniques, or how things are stored can affect the results. Since SLE affects different organs, it is complicated, and it happens and shows up in different ways in people; one biomarker might only show one part of SLE and not give the whole picture of the disease.

How Biomarkers Used as SLE Diagnosis?

Doctors identify and categorize SLE (a disease) based on a person's symptoms and signs, as well as special signs in the body called biomarkers that show immune reactions and inflammation in different organs. It is important to have consistent rules for identifying and categorizing SLE for both research and clinical purposes. The commonly used rules were made by the American College of Rheumatology (ACR). These rules include various biomarkers like protein in the urine, certain antibodies, and other things. The rules were changed a bit in 1997 and later in 2012 by another group to make them more relevant.

In 2019, new rules were made by a European and American alliance. These rules focus on a positive result for a specific antibody as a must for SLE. They also include other immune markers and clinical symptoms in the criteria. These new rules are better at catching cases of SLE early compared to the older ones. Some markers are needed in the newer rules but not in the older ones. In the early stages of SLE, the new rules are better at finding cases, and they also have good accuracy. Still, diagnosing SLE can be tricky. The current biomarkers are not perfect, and doctors need a lot of skill and experience. Some people with SLE do not show clear signs early on, making it hard to diagnose, especially if they only have a few features of SLE.

The following are the types of SLE biomarkers:

  • Serum Complement 3 and 4 (C3 and C4) - Complements can be activated by immune complexes. Serums C3 and C4 are used to diagnose the presence of biologically active immune complexes and thus help to monitor disease activity.

  • Anti-nucleosome Antibodies (ANuA) - The presence of AnuA confirms the SLE. The presence of ANuA can be confirmed by other laboratory tests and clinical findings. Additionally, the accuracy of the ANA test for SLE is 61 percent in detecting positive cases, and it is 94 percent in correctly identifying negative cases.

  • Erythrocyte Sedimentation Rate (ESR) and C-reactive Protein (CRP) - In real-world medical situations, elevated ESR values combined with low CRP levels are a significant indicator of inflammation in SLE. They serve as a useful measure to keep track of the activity of SLE in a patient. For a certain group of individuals with SLE who experience serositis and/or arthritis, both ESR and CRP values rise at the same time. An ESR level exceeding 25mm/hour (millimeter per hour) is strongly linked to increased SLE activity.

Conclusion

The study of biomarkers is really challenging. The study of atomic levels in the body is tough. For example, with SLE, some markers have not shown enough accuracy or reliability for doctors to use them confidently. Also, the way to measure these markers is not always super accurate, and it can vary. Plus, sometimes, there are not have enough groups of people to check if these markers really work. To make these studies better, one needs to plan them carefully. It should figure out how many samples are needed based on what basis it has been studied and how it is tested. The details of what has been measured should be really clear, and the right math should be used to analyze the results. Stronger markers related to the immune system are also needed to understand SLE better. These markers should show how the disease is moving in people, both in general and in specific parts of the body. Because no single marker is perfect for SLE, combining a few markers using math might be a good way to check for the disease. Smart computer methods to handle lots of data and find new markers are needed.

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Dr. Basuki Nath Bhagat
Dr. Basuki Nath Bhagat

Family Physician

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