Preclinical Systemic Lupus Erythematosus

Preclinical lupus encompasses a spectrum from enhanced SLE risk without clinical symptoms to individuals with autoantibodies and some SLE clinical features without meeting ACR classification. Studies have identified antibody and serological biomarkers years before disease onset. Incomplete lupus and undifferentiated connective tissue disease may occur during preclinical disease periods, but only 10–20% of these individuals transition to SLE and many have a mild disease course. Further studies are warranted to characterize biomarkers of early disease, identify individuals in need of close monitoring or preventive interventions, and elucidate mechanisms of disease pathogenesis without confounding factors of immunosuppressive medications or organ damage.

Key points

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Autoantibodies are present and cytokine biomarkers are altered prior to systemic lupus erythematosus (SLE) diagnosis.
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Incomplete lupus erythematosus patients who transition to SLE classification often have mild SLE without major, life-threatening organ involvement.
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Undifferentiated connective tissue disease patients who have multiple autoreactivities, anti-nuclear antibody–homogeneous pattern, anti–double-stranded DNA, anti-samarium, and anti-cardiolipin responses are at higher risk for transitioning to SLE.
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New classification schemes are needed to adequately capture all phases of SLE.
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New preclinical lupus studies are warranted to elucidate mechanisms of disease progression without the confines of advance organ or tissue damage and immunosuppressive medication.