How Biomarkers Are Used in Diagnosis, Monitoring and Lupus Flare Risk
In Part 1, we explored what biomarkers are and why they matter in lupus. But understanding the science is only half the picture. The real question many people with lupus ask is: How does this affect my care?
Biomarkers help clinicians make sense of a complex disease that rarely looks the same from one person to the next—or even from one visit to the next. In this post, we’ll break down how different types of biomarkers are used in lupus care and how they support decisions about monitoring, treatment, and flare risk.
Risk Biomarkers
Risk biomarkers help identify whether someone may be more likely to develop a disease or related health condition in the future. These biomarkers don’t mean a person is sick, but they can signal underlying genetic, immune, or environmental risk factors. In lupus, risk biomarkers are especially challenging because the disease often develops slowly and is difficult to detect before symptoms appear.
But even after a lupus diagnosis, risk biomarkers can still be useful. They may help identify co-morbidities—other health conditions people with lupus are more likely to develop. For example, cardiac troponin T can indicate increased cardiovascular risk, allowing care teams to take preventive steps earlier and tailor treatment plans to reduce long-term complications.
Diagnostic Biomarkers
Biomarkers can also be used to diagnose and classify conditions, including lupus, or narrow down the options for patients. Some commonly used biomarkers in the evaluation of lupus include anti-nuclear antibodies and other autoantibodies. C-reactive protein may also be measured to help assess inflammation or rule out infection. These molecules are a part of how the body deals with viruses, tumors, and other diseases that involve the body’s own cells. When present in high numbers, especially ANAs, this is a sign that an autoimmune disease may be present. ANAs are proteins made by the immune system that mistakenly target the nucleus—the control center—of the body’s own cells.
A good example are Anti-dsDNA tests, a specific type of ANA test that look for antibodies targeting the DNA inside cell nuclei. Because they are highly associated with lupus, anti-dsDNA tests are an important part of diagnosis, and measuring disease and flare activity. High levels of anti-DNA are linked to worse symptoms of lupus. Some lupus treatments target immune pathways associated with anti-dsDNA antibodies to help reduce disease activity.
And because it can take an average of 6 years to get a diagnosis for lupus, it’s exciting that diagnostics companies are working on new digital processes and tools that incorporate biomarker testing, such as the PROACTIVE study from Progentec Diagnostics, to help diagnose lupus earlier!
Prognostic Biomarkers
These biomarkers answer the question of “How are you doing?” Not only do they detect or confirm whether there is disease in the body, but also how bad the disease is getting. With these biomarkers, doctors can track and predict how the disease is progressing and what symptoms might show up later down the line.
For example, Type I interferon (IFN-I) is one of the important regulatory proteins in the immune system. It's both an indicator of how inflammation (and thus lupus disease activity) is going, and, potentially, a way to treat it.
Monitoring Biomarkers
Monitoring biomarkers helps doctors track a patient’s overall health over time and watch for changes in disease activity or treatment effects. These biomarkers are often measured regularly because they are easy to test and provide ongoing insight into what is happening in the body.
In lupus care, common monitoring biomarkers include routine blood tests that look at red and white blood cells, platelets, and markers of inflammation. Changes in these results can help signal when lupus activity is increasing, when a flare may be developing, or when medications may be affecting the body. Because these tests can be repeated safely and frequently, they play an important role in day-to-day lupus management and help guide treatment adjustments before symptoms worsen.
Predictive and Treatment-Response Biomarkers
Predictive biomarkers help doctors anticipate how someone might respond to a specific medication. Because lupus affects people differently, some treatments work well for certain patients but not for others. These biomarkers can offer clues about which therapies are more likely to be effective for an individual.
Treatment-response biomarkers (also called pharmacodynamic biomarkers) are used after treatment begins. They help doctors see whether a medication is working and how the body is responding beneath the surface. While symptoms provide important information, these biomarkers offer a more objective view of treatment effects and can guide adjustments to therapy.
Both types of biomarkers are commonly used in Clinical trials and are increasingly part of routine lupus care, helping doctors fine-tune treatment plans over time.
Safety Biomarkers
Safety biomarkers indicate whether the side effects of medications are causing serious harm. In particular, liver function tests (LFTs) and creatine clearance tests detect whether the organs that neutralize toxins in the body (the liver and kidneys) are overloaded and could potentially be injured. Biomarkers allow doctors to detect these risks before the kidneys and liver become seriously damaged, potentially permanently, and cause possibly life-threatening conditions. Doctors may change the dose of certain medications or overhaul the treatment plan to give these organs time to recover.
Why are biomarkers the key to the future of lupus management?
As researchers learn more about how immune biomarkers behave in lupus, they’re beginning to combine multiple signals into tools that can guide care more precisely. Researchers are now studying cytokines, antibodies, and chemokines closely, not just to understand the disease, but to build new kinds of blood tests that can measure lupus activity and even predict when a flare might be coming.
Building on this research, Progentec Diagnostics and their collaborators have developed two blood tests that analyze panels of these immune mediators: the Lupus Flare Risk Index (LFRI), which predicts the likelihood of a flare in the next 12 weeks, and the Lupus Disease Activity Index (LDAI), which provides an objective measure of current lupus activity. Studies have shown that combinations of specific immune mediators can distinguish between quiet and active disease with high accuracy and can help identify when a flare is about to begin. They are also in the process of validating a third test that assess risk of developing SLE.
This approach (turning immune mediator signals into clinically useful indexes) reflects a broader shift toward precision medicine in lupus. Instead of relying only on symptoms or broad lab values, physicians may soon be able to track diseases more like blood sugar in diabetes: with regular, predictive, biomarker-based tests that guide timely treatment decisions.
A Lupus Warrior’s Takeaway
Biomarkers give medical professionals a detailed look into what is happening in the body. Many equally accurate procedures are invasive (such as endoscopies and biopsies) or relatively expensive and time-consuming methods (such as scans). Many biomarkers can be measured in blood and urine tests, which are less of a burden on people with lupus, easier to do, and can be done regularly. So if you’re looking for more information about your health, check in with a doctor about the latest and greatest in biomarker testing.