title: Immunologic prediction of relapse in patients with pemphigus vulgaris (PV) in clinical remission.
abstract: BACKGROUND
  Pemphigus vulgaris (PV) is characterized by multiple relapses, occurring especially in patients on minimal therapy or off therapy.
  
  
  OBJECTIVE
  To identify immunologic predictors (anti-desmoglein [Dsg] 1 and 3 antibodies; direct immunofluorescence [DIF]) for relapse in PV patients.
  
  
  METHODS
  Eighty-nine patients in complete clinical remission for at least 6 months and receiving less than or equal to 10 mg prednisolone daily and no immunosuppressive drugs were evaluated using DIF (n=89) and Dsg ELISA (n=46). They were followed until relapse or for at least 18 months.
  
  
  RESULTS
  DIF was positive in 44 of 89 patients (49.5%); anti-Dsg 3 antibodies were detected in 18 of 46 patients (39.1%) and anti-Dsg 1 antibodies were detected in 4 of 46 patients (8.7%). Relapse occurred in 38 patients (42.7%). Mean relapse-free time was significantly shorter in anti-Dsg 3-positive patients compared to anti-Dsg 3- negative patients (P = .015) and in DIF-positive patients compared to DIF-negative patients (P = .047), but not in anti-Dsg 1- positive patients compared to anti-Dsg 1-negative patients (P = .501). Sensitivity and predictive values of neither of these tests were high.
  
  
  CONCLUSIONS
  Small number of anti-Dsg 1-positive patients and use of conventional ELISA.
  
  
  CONCLUSIONS
  Positive anti-Dsg 3 ELISA and, to a lesser degree, positive DIF are predictors of relapse in PV patients in clinical remission. Decision on discontinuing treatment should be based on the results of these tests as well as on clinical findings.
authors.affiliation: Autoimmune Bullous Diseases Research Center, Department of Dermatology, Tehran University of Medical Sciences, Tehran, Iran. Electronic address: daneshpj@tums.ac.ir.
authors.forename: Maryam
authors.initials: M
authors.lastname: Daneshpazhooh
authors.affiliation: Autoimmune Bullous Diseases Research Center, Department of Dermatology, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Vahid
authors.initials: V
authors.lastname: Zafarmand Sedigh
authors.affiliation: Autoimmune Bullous Diseases Research Center, Department of Dermatology, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Kamran
authors.initials: K
authors.lastname: Balighi
authors.affiliation: School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: S Hamed
authors.initials: SH
authors.lastname: Hosseini
authors.affiliation: Autoimmune Bullous Diseases Research Center, Department of Dermatology, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Ali
authors.initials: A
authors.lastname: Ramezani
authors.affiliation: Autoimmune Bullous Diseases Research Center, Department of Dermatology, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Mohammad-Sadegh
authors.initials: MS
authors.lastname: Kalantari
authors.affiliation: Autoimmune Bullous Diseases Research Center, Department of Dermatology, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Narges
authors.initials: N
authors.lastname: Ghandi
authors.affiliation: Autoimmune Bullous Diseases Research Center, Department of Dermatology, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Maryam
authors.initials: M
authors.lastname: Ghiasi
authors.affiliation: Department of Dermatopathology, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Azita
authors.initials: A
authors.lastname: Nikoo
authors.affiliation: Autoimmune Bullous Diseases Research Center, Department of Dermatology, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Cheyda
authors.initials: C
authors.lastname: Chams-Davatchi
mesh_terms: D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001323:Autoantibodies / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D051183:Desmoglein 1 / Q000276:immunology*; D051184:Desmoglein 3 / Q000276:immunology*; D018572:Disease-Free Survival; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D019085:Fluorescent Antibody Technique, Direct; D006801:Humans; D008297:Male; D008875:Middle Aged; D010392:Pemphigus / Q000097:blood / Q000188:drug therapy / Q000276:immunology*; D011237:Predictive Value of Tests; D011239:Prednisolone / Q000627:therapeutic use; D012008:Recurrence; D012074:Remission Induction
chemical_list: D000893:Anti-Inflammatory Agents; D001323:Autoantibodies; D015415:Biomarkers; C495297:DSG1 protein, human; C071894:DSG3 protein, human; D051183:Desmoglein 1; D051184:Desmoglein 3; D011239:Prednisolone
keywords: anti-desmoglein 1; anti-desmoglein 3; clinical remission; direct immunofluorescence; pemphigus vulgaris; relapse; relapse-free time