Frühe Diagnostik des systemischen Lupus erythematodes

Zusammenfassung

Die frühe Diagnose eines systemischen Lupus erythematodes (SLE) fußt noch immer in erster Linie auf einer sorgfältigen klinischen Erfassung typischer ACR-Kriterien ( 4) durch den behandelnden Arzt. Hinzu tritt die anamnestische Eruierung charakteristischer Auslösesituationen wie Jahreszeit (Frühjahr, Sommer), Sonneneinfluss, Virusinfekte, Medikamente und Gewebstraumata. Ergänzend fordern die ACR-Kriterien den Nachweis SLEtypischer Autoantikörper mit Spezifität für Kernantigene (ANA), dsDNA, Sm, rib1, [uni03B2]2GP1. Diagnosestützend sind Befunde eines gesteigerten intravasalen Complement-Umsatzes (niedrige CH50, erhöhtes C3d). Im Validierungsstadium für eine SLE-Frühdiagnose befinden sich Tests zur Erfassung einer Typ-1-IFN-Signatur wie z. B. eine standardisierte qPCR-Reaktion für den Nachweis von sechs durch INF-[uni03B1] induzierte Gene in Blutleukozyten („total IFN score for the diagnosis of SLE“).

Summary

In early diagnosis of SLE careful recording of typical clinical ACR criteria ( 4) by the treating physician remains a mainstay. Anamnestic revelation of characteristic flare inducing circumstances such as spring season, sun exposure, viral infections, certain drugs and tissue damage are supportive of an SLE diagnosis. Detection of SLE-typical autoanti-bodies with specificity for nuclear antigens (ANA), dsDNA, Sm, rib1 and [uni03B2]2-GP1 are requested by the ACR criteria whereas increased intravascular complement turnover (low CH50, elevated C3d) contributes indirect, supportive evidence. Currently measurements of an increased type 1 INF signature, such as a qPCR of six leukocyte genes induced by IFN-[uni03B1] (“total IFN score for the diagnosis of SLE”) are under clinical validation.

Schlüsselwörter

Frühe SLE-Symptome - schubauslösende Situationen und Laborparameter - Typ-1-IFNSignatur

Keywords

Early SLE symptoms - flare-inducing circumstances and laboratory parameters - type 1 IFN signature

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