Old and new autoantibodies in systemic lupus erythematosus

INTRODUCTION: Systemic lupus erythematosus (SLE) is a prototypical autoimmune disorder characterized by production of autoantibodies targeting self-antigens. These autoantibodies form immune-complexes that deposit in various tissues, leading to complement activation, inflammation, and, ultimately, organ damage. The detection of specific autoantibodies is crucial for diagnosing SLE and for assessing disease activity. AREAS COVERED: A variety of autoantibodies are employed in clinical practice to assess the risk of different SLE manifestations and other systemic inflammatory diseases. These autoantibody specificities are integral to clinical decision-making procedures. Herein, we examine the most commonly evaluated autoantibodies and their associations with disease phenotypes. In addition, we discuss recent findings of novel autoantibodies in SLE and their clinical relevance and potential utility. EXPERT OPINION: In addition to the well-established autoantibody specificities routinely assessed in clinical practice for patients with a diagnosis of - or clinically suspected - SLE, recent studies have identified several new autoantibodies with potential clinical relevance. If these findings are validated through further research and accessible diagnostic assays are developed, these emerging autoantibodies could narrow the gap between first symptoms and classifiable disease and significantly enhance patient management by providing critical insights into the risk of specific SLE manifestations, thereby facilitating more timely and personalized interventions.