Serological abnormalities

Antinuclear antibodies, as detected using rat liver or human epithelial cell substrates, are present in over 95% of lupus patients. Antigens within the nucleus which these antibodies recognize include double-stranded DNA (40-90%) single-stranded DNA (up to 70%) poly (ADP ribose) (up to 70%) RNP (35%) and Sm (30% in the USA, 5% in Europe). Antibodies to double-stranded DNA, notably of the immunoglobulin G (IgG) isotype in high titers, are essentially disease specific as are antibodies to Sm. In addition, antibodies to cytoplasmic antigens notably Ro (up to 35%) and La (15%) as well as those binding to cell surfaces of red cells, white cells and platelets are frequently found. Antiphospholipid antibodies, notably anticardiolipin, have been identified in up to half of the patients with lupus, whilst the so-called 'lupus anticoagulant' is probably present in about 20%. Apart from anti-DNA antibodies and those binding poly (ADP) ribose, the remainder seem to fluctuate relatively little with disease activity.

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