ABSTRACT
Systemic lupus erythematosus (SLE) is a systemic autoimmune disease characterized by production of autoantibodies against DNA, and immune-complex deposition culminating in visceral organ damage and vasculopathy (1). Although SLE is one of the most commonly encountered clinical problems in rheumatology clinic, the definition of disease has still been evolving (2,3), reflecting its overwhelming degree of diversity of clinical manifestations and outcomes. As such, the lack of “gold standard” poses a major diagnostic challenge in the care for SLE patients. It cannot be overemphasized that the lupus diagnostic criteria were developed to identify patients suitable for clinical trials, and that strict adherence to the criteria may not allow us to thoroughly capture patients who would benefit from lupus-directed interventions. Furthermore, it is important to keep in mind that the reference employed to define the diagnostic power of criteria were experts’ opinions because there are no clinical, serological, or histological findings that definitively define SLE. When it comes to lupus treatment, the currently available drugs do not directly address the underlying mechanisms of the disease. As such, a substantial portion of patients succumb to their illness or toxicities from global immunosuppression. In light of these challenges in the diagnosis and management of SLE, it is abundantly clear that it is critical to define disease mechanisms and develop target-specific therapeutics in order to improve the quality of care for patients with SLE. In this section, we first review biomarkers commonly used in the management of SLE in the current rheumatology practice along with their limitations. This is followed by discussions of emerging biomarkers that are expected to improve the accuracy of our diagnostic assessment and help develop target-selective therapeutics.
