Determination of serum free light chains as a marker of systemic lupus flare

  • Ana Belén Rodríguez CambrónEmail author
  • Juana Jiménez Jiménez
  • María Ángeles Blázquez Cañamero
  • Francis Rey Pazos
  • Cristina Macía Villa
  • María Alcalde Villar
  • Paz Collado Ramos
  • Félix Manuel Cabero del Pozo
  • Eva Álvarez Andrés
  • Ana Cruz Valenciano
Original Article



The aim of this study was to explore the usefulness of the determination of free light chains (FLC) in serum as a biomarker of flare in patients with systemic lupus erythematosus (SLE) and to analyze the differences in their discriminatory capacity with complement C3 and C4.


This was a prospective cohort study. The definition of flare was based on the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) Flare Index. The discriminatory capacity of FLC and C3 and C4 levels was compared using receiver operating characteristic (ROC) curves and the area under the curve (AUC).


Forty-six patients were enrolled. Patients with SLE flare showed significantly lower C3 (p = 0.025) and C4 levels (p = 0.028), as well as a higher concentration of lambda light chains (λ-LC) (p = 0.028) compared with the non-flare group. λ-LC, as opposed to kappa light chains and total light chains, demonstrated a discriminatory capacity for detecting the presence of SLE flare (AUC 0.781), with 100% sensitivity, 65% specificity, and 69.6% of patients correctly classified for a cutoff point of ≥ 19.5 mg/L. Complement C3 and C4 also showed a high discriminatory capacity for SLE flare (AUC 0.804 and 0.837, respectively). Comparing λ-LC, C3, and C4, the last one demonstrates better discriminatory capacity for SLE flare with the highest AUC (0.837; 95% CI 0.663–1.000).


λ-LC have good discriminatory capacity for SLE flare and could be useful as a biomarker of SLE exacerbation.

Key Points

The usefulness of free light chains as a biomarker could be compared with complement.

Lambda free light chains have good discriminatory capacity for SLE flare.

Free light chains are a promising marker of SLE activity


Biomarker Flare Free light chains Systemic lupus erythematosus 



The authors want to thank the Spanish Society of Rheumatology for the help in the translation of the manuscript.

Funding information

This work is supported by a grant from Madrid Society of Rheumatology.

Compliance with ethical standards




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Copyright information

© International League of Associations for Rheumatology (ILAR) 2019

Authors and Affiliations

  • Ana Belén Rodríguez Cambrón
    • 1
    Email author
  • Juana Jiménez Jiménez
    • 2
  • María Ángeles Blázquez Cañamero
    • 3
  • Francis Rey Pazos
    • 1
  • Cristina Macía Villa
    • 1
  • María Alcalde Villar
    • 1
  • Paz Collado Ramos
    • 1
  • Félix Manuel Cabero del Pozo
    • 1
  • Eva Álvarez Andrés
    • 1
  • Ana Cruz Valenciano
    • 1
  1. 1.Division of RheumatologyHospital Universitario Severo OchoaMadridSpain
  2. 2.Division of BiochemistryHospital Universitario Severo OchoaMadridSpain
  3. 3.Division of RheumatologyHospital Universitario Ramón y CajalMadridSpain

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