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Anti-Ro52 antibody testing in?uences the classi?cation and clinical characterisation of primary Sj?gren’s syndrome S. Retamozo1, M. Akasbi1,5, P. Brito-Zerón1, X. Bosch2, A. Bove1, M. Perez-De-Lis5, I. Jimenez7, M.-J. Soto-Cardenas8, M. Gandía8, C. Diaz-Lagares1, O. Vi?as3, A. Siso4,

R. Perez-Alvarez6, J. Yague3, M. Ramos-Casals1

1Sj?gren Syndrome Research Group (AGAUR), Laboratory of Autoimmune Diseases Josep Font, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Autoimmune Diseases, and 2Department of Internal Medicine, ICMiD, and 3Department of Immunology, CDB, Hospital Clínic, Barcelona; 4Primary Care Research Group, IDIBAPS, Centre d’Assistència Primària ABS Les Corts, GESCLINIC, Barcelona; 5Department of Internal Medicine, Hospital Infanta Leonor, Madrid; 6Department of Internal Medicine, Hospital do Meixoeiro, Vigo; 7Department of Internal Medicine, Hospital de Manises, Valencia; 8Department of Internal Medicine, University of Cádiz,

Hospital Puerta del Mar, Cádiz, Spain.

Abstract

Objectives

To evaluate how determination of antibodies against the Ro52 antigen in?uences the classi?cation and clinical characterisation of patients with suspected primary Sj?gren’s syndrome (SS).

The cohort study included 187 patients who ful?lled at least four of the six 1993 SS classi?cation criteria, including positive autoantibodies (antinuclear antibodies [ANA], rheumatoid factor [RF], anti-Ro/SSA and/or anti-La/SS-B antibodies) as mandatory criterium. Anti-Ro/SSA antibodies were tested by qualitative ELISA using a commercial assay.

Anti-Ro52 antibodies were detected by a semiquantitative ELISA.

Anti-Ro52 antibodies were found in 70/187 (37%) patients. A signi?cant percentage of patients with anti-Ro/SSA antibodies were negative for anti-Ro52 antibodies (22%), while 13 patients (12%) were negative for anti-Ro/SSA antibodies but positive for anti-Ro52 antibodies, meaning that they ful?lled the 2002 SS criteria while avoiding the need for a salivary biopsy. Higher mean titers of anti-Ro52 antibodies were associated with severe scintigraphic involvement, positive salivary gland biopsy, parotid enlargement, anaemia, leukopenia and RF. A statistical correlation was found between anti-Ro52 titers and age, gammaglobulin levels, RF titers and serum IgA and IgG. Patients with positive anti-Ro/SSA and anti-Ro52 antibodies had a higher frequency of positive salivary gland biopsy, parotid enlargement and positive RF, and higher levels of serum IgG and IgA levels in comparison with patients with positive anti-Ro/SSA

but negative anti-Ro52 antibodies.

Anti-Ro52 antibodies were closely associated with the main clinical, histopathological and immunological features of primary SS. Anti-Ro52 autoantibody testing may help to identify a speci?c subset of SS patients with more aggressive disease, in whom a closer follow-up and earlier, more robust therapeutic management may be necessary.

Sj?gren’s syndrome, anri-Ro/SSA antibodies, anti-Ro52 antibodies