In an RA patient with positive RF and CCP abs who is stable on TNFi biologic, how would you approach incidentally found low titer positive DsDNA abs?

ANA and dsDNA antibodies can generally be overlooked in seropositive RA if one is planning to treat (or is treating) with TNF antagonists. There are rare instances of TNFi-induced lupus-like diseases but these are not predicted by pre-existing ANA or dsDNA antibodies.

I have several patients with RA on and off biologics who have some anti-DNA antibodies in the absence of renal disease, skin rashes, thrombocytopenia, hypocomplementemia, etc., in other words, signs and symptoms that would make you think of clinical lupus. Some of these patients go on later to devel...