What is the utility of following serologic tests to assess disease activity and predict disease flares?
Hypocomplementemia (low C3) and elevated anti-dsDNA antibodies can correlate with disease activity in most but not all SLE patients. The value of following complement and anti-dsDNA antibody levels serially and increasing the prednisone dose to prevent flares if the patient becomes more serologically active is controversial. Data supports that individual patients act differently but usually fall into one of three patterns:
- 1. Flare without changing their serologies
- 2. Flare only after they become more serologically active
- 3. Always serologically active and may never flare
Therefore, the clinician needs to establish the serologic pattern for each patient and treat accordingly. Only patients who demonstrate that they flare when their serologies become more active should receive prophylactic increases in immunosuppression to prevent a flare.