Which autoantibody is most specific for systemic lupus erythematosus and is associated with a homogeneous pattern on indirect immunofluorescence?

Question

Accepted Answer

B. Anti-double-stranded DNA (anti-dsDNA) antibodies. ## Anti-dsDNA Antibodies in SLE

**Key Point:** Anti-dsDNA antibodies are the most specific autoantibodies for SLE, present in 60–70% of SLE patients, and their presence is part of the SLE classification criteria.

### Immunofluorescence Pattern
Anti-dsDNA antibodies produce a **homogeneous (diffuse) pattern** on indirect immunofluorescence (IIF) of HEp-2 cells, which is characteristic and helps distinguish SLE from other autoimmune conditions.

### Clinical Significance

| Feature | Anti-dsDNA | Anti-histone | Anti-Ro/SSA | Anti-centromere |
|---------|-----------|-------------|-----------|----------------|
| **Specificity for SLE** | Very high (95%) | Low (seen in drug-induced LE) | Moderate (SLE, Sjögren's) | Low (limited sclerosis) |
| **IIF Pattern** | Homogeneous | Speckled | Homogeneous/speckled | Centromeric |
| **Disease Activity** | Correlates with active lupus nephritis | Not disease-specific | Neonatal lupus risk | Rare in SLE |
| **Prevalence in SLE** | 60–70% | 40–50% | 40–60% | 1–2% |

**High-Yield:** Anti-dsDNA antibodies correlate with lupus nephritis activity and are used to monitor disease progression. Rising titers often precede clinical flares.

**Clinical Pearl:** The combination of anti-dsDNA + low complement (C3, C4) is highly predictive of active lupus nephritis and warrants aggressive immunosuppression.

Answer

A. Anti-Ro/SSA antibodies

Answer

C. Anti-centromere antibodies

Answer

D. Anti-histone antibodies

Which autoantibody is most specific for systemic lupus erythematosus and is associated with a homogeneous pattern on indirect immunofluorescence?

Explanation

Anti-dsDNA Antibodies in SLE

Immunofluorescence Pattern

Clinical Significance

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Feature	Anti-dsDNA	Anti-histone	Anti-Ro/SSA	Anti-centromere
Specificity for SLE	Very high (95%)	Low (seen in drug-induced LE)	Moderate (SLE, Sjögren's)	Low (limited sclerosis)
IIF Pattern	Homogeneous	Speckled	Homogeneous/speckled	Centromeric
Disease Activity	Correlates with active lupus nephritis	Not disease-specific	Neonatal lupus risk	Rare in SLE
Prevalence in SLE	60–70%	40–50%	40–60%	1–2%