Review SLE diagnosis and treatment: When early is early Andrea Doria ⁎, Margherita Zen, Mariagrazia Canova, Silvano Bettio, Nicola Bassi, Linda Nalotto, Mariaelisa Rampudda, Anna Ghirardello, Luca Iaccarino Division of Rheumatology, Department of Clinical and Experimental Medicine, University of Padova, Italy abstract article info Available online 8 September 2010 Around 1980 antinuclear antibody testing became widely used in routine laboratory practice leading to a tapering in the lag time between SLE onset and diagnosis. Since then nothing relevant has been introduced which could help us in making the diagnosis of SLE earlier than now. Notably, there is increasing evidence that early diagnosis and treatment could increase SLE remission rate and improve patient prognosis. Although it has been shown that autoantibodies appear before clinical manifestations in SLE patients, currently we cannot predict which autoantibody positive subjects will eventually develop the disease. Thus, great effort should be made in order to identify new biomarkers able to improve our diagnostic potential. B lymphocyte stimulator (BLyS), anti-ribosomal P protein and anti-C1q antibodies are among the most promising. In recent years, some therapeutic options have emerged as appropriate interventions for early SLE treatment, including antimalarials, vitamin D, statins and vaccination with self-derived peptides. All these immune modulators seem to be particularly useful when introduced in an early stage of the disease. © 2010 Elsevier B.V. All rights reserved. Contents 1. Diagnosis and classification of SLE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 2. Timing of SLE diagnosis over years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 3. When does SLE start? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 4. How can we identify patients with early SLE? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 4.1. Anti-ribosomal P protein antibodies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 4.2. Anti-C1q antibodies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 4.3. B lymphocyte stimulator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 5. What is the importance of early diagnosis? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 6. How should we manage patients with early lupus? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 6.1. Antimalarials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 6.2. Vitamin D. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 6.3. Statins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 6.4. Vaccination with self-derived peptides . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 . Take-home messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 Systemic lupus erythematosus (SLE) is a disease characterized by a broad spectrum of clinical manifestations and a multitude of laboratory abnormalities. The complexity of the disease could also explain why it can be difficult to identify SLE patients in an early stage of the disease. In fact, there are no pathognomonic clinical or serological features which can help clinicians in making SLE diagnosis. 1. Diagnosis and classification of SLE In clinical practice the diagnosis of SLE is usually made in a patient who has developed a combination of clinical and immunologic features specific to SLE. Of course diseases which can mimic SLE have to be concomitantly ruled out. Criteria for the classification of SLE were elaborated by the American College of Rheumatology (ACR) firstly in 1971, then revised in 1982, and then again in 1997. Unfortunately, they are not diagnostic; in fact, they cannot be applied to every individual case, Autoimmunity Reviews 10 (2010) 55–60 ⁎ Corresponding author. Division of Rheumatology, University of Padova, Via Giustiniani, 2, 35128 Padova, Italy. Tel.: + 39 049 8212190; fax: + 39 049 8212191. E-mail address: adoria@unipd.it (A. Doria). 1568-9972/$ – see front matter © 2010 Elsevier B.V. All rights reserved. doi:10.1016/j.autrev.2010.08.014 Contents lists available at ScienceDirect Autoimmunity Reviews journal homepage: www.elsevier.com/locate/autrev