Assessing the autoantibody levels in relation to disease severity and therapy response in pemphigus patients

In pemphigus, autoantibodies are directed against adhesion molecules, which make the junctions between keratinocytes, and thus determining their level can reflect the disease activity. The purpose of this study is to determine the clinical significance of the autoantibody levels in pemphigus management. The clinical features of 47 pemphigus vulgaris patients were assessed and patients' sera were investigated by indirect immunofluorescence using monkey esophagus as a substrate for autoantibody levels. We found a significant correlation between antibody titers and mucosal severity scores. Initial antibody titers of the patients with at least one mucosal lesion at the end of the first month of the therapy were found significantly higher than the patients who had no mucosal lesion. With the therapy, lesions resolved earlier than the antibody titers. In patients with pemphigus, especially in cases who were not treated before, sera antibody levels are a valuable tool in evaluating disease severity and choosing initial treatment. In patients who had been taking any systemic treatment, it is difficult to make a relationship between antibody levels and disease severity, because therapy improves disease earlier than the antibody titers. However, estimating antibody levels can be helpful for clinicians in disease management, in reducing or ceasing treatment dosage and anticipating recurrence.