Nat. Rev. Rheumatol. doi: /nrrheum

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Copyright © 2004 American Medical Association. All rights reserved.

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Systemic Lupus Erythematosus

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Figure 2 A timeline summarizing the development of diagnostic tools in rheumatology Figure 2 | A timeline summarizing the development of diagnostic tools.

Nat. Rev. Rheumatol. doi: /nrrheum

Figure 3 Methods to detect trough levels of therapeutic antibodies

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Nat. Rev. Rheumatol. doi: /nrrheum

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Nat. Rev. Rheumatol. doi: /nrrheum

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Figure 3 Endogenous repair of double-strand DNA breaks

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Figure 4 Approaches to targeting inhibitory immune receptors

Figure 1 Activation and signalling of IL-1

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Figure 2 Cas9 targeting using crRNA (CRISPR

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Figure 1 Treat to target, remission and low disease activity in SLE

Figure 1 The current model of the pathogenesis of SLE

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Figure 1 Patterns of joint and organ involvement in rheumatic disease

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Receiver operating curve of soluble C3, C4, antibodies to double-stranded DNA (anti-dsDNA) compared with complement C4d levels on erythrocytes (EC4d) and.

Positivity rate for antibodies to double-stranded DNA (anti-dsDNA), low complement, high complement C4 activation products (CBCAPS) and two-tiered methodology.

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EULAR Lupus Nephritis Trials Network Study Group

Figure 2 Involvement of plasmacytoid dendritic cells

Presentation transcript:

Nat. Rev. Rheumatol. doi:10.1038/nrrheum.2016.18 Figure 2 The relationship between BAFF, anti-dsDNA antibodies and B-cell numbers in SLE, before and after rituximab therapy Figure 2 | The relationship between BAFF, anti-dsDNA antibodies and B-cell numbers in SLE, before and after rituximab therapy. Relapse of systemic lupus erythematosus (SLE) before rituximab therapy is associated with a modest B-cell lymphopenia and an increased proportion of plasmablasts, compared with the situation in healthy individuals. Those patients who flare after rituximab treatment with elevated levels of antibodies to double-stranded DNA (anti-dsDNA antibodies) also have high levels of B-cell activating factor (BAFF, also known as TNF ligand superfamily member 13B or BLyS), often with very low B-cell numbers, among which autoreactive plasmablasts predominate. This phenomenon can be compounded by repeated rituximab infusions (see also Fig. 3). By contrast, patients who remain in remission after B-cell depletion have moderate-to-low BAFF levels. Understanding the relationship between BAFF levels, B-cell subsets and SLE flare will be crucial for the appropriate selection of therapy in these patients. Ehrenstein, M. R. & Wing, C. (2016) The BAFFling effects of rituximab in lupus: danger ahead? Nat. Rev. Rheumatol. doi:10.1038/nrrheum.2016.18