OUTCOME OF UNTREATED AND TREATED PATIENTS WITH SEROLOGICALLY ACTIVE, CLINICALLY QUIESCENT SLE

Abstract

When a patient presents with classical features of systemic lupus such as polyarthritis, rach or glomerulonephritis, associated with abnormal serologic tests, including anti-DNA antibodies and low complement, the therapeutic aim is to control the disease manifestations and to reverse the serology. It can be initially assumed that the patient is clinically and serologically concordant. If the serology converts to normal, when the clinical symptoms come under control, this hypothesis is confirmed.

On the other hand, if the clinical features are reversed by therapeutic intervention and the serology remains abnormal, one may conclude that there is clinical and serologic discordance (Urowitz, 1994).

Occasionally, a patient presents with abnormal serology in the face of no or very minor clinical manifestations. The investigations may be undertaken because of routine follow up in a lupus clinic, because of minor symptoms or because the patient has involved family members and requested investigation in such a case, one faces the dilemma of treating serologic abnormalities alone without clinical features to monitor. More and more, the approach has become to avoid introduction of disease suppressing medications in such patient, but instead to undertake careful, repeated monitoring for signs of clincial activity (Walz et a!., 1991).

Some serologic tests in SLE, such as fluorescent ANA test, and anti-Sm antibody, are helpful in the diagnosis of the disease but are