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Diagnostic role of anti-dsDNA antibodies: do not forget autoimmune hepatitis

Nature Reviews Rheumatology volume 17, page 244 (2021)Cite this article

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In their Review (Pisetsky, D. S. & Lipsky, P. E. New insights into the role of antinuclear antibodies in systemic lupus erythematosus. Nat. Rev. Rheumatol. 16, 565–579 (2020))1, Pisetsky and Lipsky highlight the clinical role of antinuclear antibody (ANA) testing in patients with systemic lupus erythematosus (SLE) and properly state that anti-double-stranded DNA (dsDNA) antibodies are highly specific for the diagnosis of SLE; however, they refer to two papers that do not take into account the widely and historically recognized presence of these autoantibodies in individuals with autoimmune hepatitis2,3. In this regard, we would like to point out that knowledge of anti-dsDNA antibody positivity in autoimmune hepatitis dates back to 1956 when, because of the similarities to SLE, Mackay et al. proposed that this chronic liver disease be named ‘lupoid hepatitis’4.

The term lupoid hepatitis was first used to describe patients with chronic active hepatitis and positivity for the lupus erythematosus cell test, suggesting that these individuals have a specific form of liver disease that is often associated with extrahepatic complaints that are typically seen in SLE, including arthralgia and a cutaneous rash. In our opinion, the link between the two autoimmune diseases is of considerable clinical and immunological relevance. Patients with autoimmune hepatitis often have anti-dsDNA antibodies and ANAs with a ‘homogeneous pattern’, a typical feature of SLE, whereas patients with SLE often have a mild hepatic involvement, known as ‘lupic hepatitis’ to distinguish it from lupoid hepatitis (renamed autoimmune hepatitis), which, in turn, includes ANAs in its diagnostic criteria5. In addition, from a genetic perspective, both conditions share a strong association with HLA-DR3, suggesting a further parallel between the two diseases6.

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Fig. 1: Antinuclear and anti-dsDNA antibody immunofluorescence patterns in autoimmune hepatitis.

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Authors and Affiliations

  1. Division of Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy

    Alessandro Granito, Luigi Muratori, Francesco Tovoli & Paolo Muratori

  2. Center for the Study and Treatment of Autoimmune Diseases of the Liver and Biliary System, University of Bologna, Bologna, Italy

    Alessandro Granito, Luigi Muratori & Paolo Muratori

  3. Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy

    Alessandro Granito, Luigi Muratori & Francesco Tovoli

  4. Department of the Science of Quality of Life, Alma Mater Studiorum, University of Bologna, Bologna, Italy

    Paolo Muratori

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  1. Alessandro Granito
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Correspondence to Alessandro Granito.

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Granito, A., Muratori, L., Tovoli, F. et al. Diagnostic role of anti-dsDNA antibodies: do not forget autoimmune hepatitis. Nat Rev Rheumatol 17, 244 (2021). https://doi.org/10.1038/s41584-021-00573-7

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