Department of Rheumatology, Ghent University Hospital; Faculty of Medicine and Health Sciences, Department of Internal Medicine and Paediatrics, Universiteit Gent; and Centre for Inflammation Research, VIB-Ugent, Belgium.
Department of Rheumatology, Ghent University Hospital, and Centre for Inflammation Research, VIB-Ugent, Belgium.
Clin Exp Rheumatol. 2022 Dec;40(12):2310-2317. doi: 10.55563/clinexprheumatol/l70874. Epub 2022 Oct 3.
Autoantibody detection is an essential step in pSS diagnosis. However, the value of separate anti-Ro52, anti-Ro60 and anti-SSB/La detection in pSS diagnosis and phenotyping has not been extensively studied. This study aimed to explore disease characteristics of anti-SSA/Ro positive, suspected and definite pSS patients, in relation to serological profiles based on anti-Ro52, anti-Ro60 and anti-SSB/La reactivity.
Of 187 anti-SSA/Ro positive patients included in the Belgian Sjögren's Syndrome Transition Trial (BeSSTT), 155 were considered definite pSS patients, due to fulfilment of the 2016 ACR-EULAR classification criteria, and 32 suspected, due to reactivity against SSA/Ro without presence of other criteria. None of the patients met any of the ACR-EULAR exclusion criteria for pSS. Patients were grouped based on the presence of anti-Ro52, anti-Ro60 and anti-SSB/La antibodies.
Mono-reactivity against Ro60 or Ro52, double reactivity against Ro52/Ro60 and triple reactivity against Ro52/Ro60 and SSB was detected in respectively 30, 23, 70 and 60 patients. Mono-anti-Ro60 positive patients showed the least pSS features. Mono-anti-Ro52 positive patients reported a significantly higher dryness burden (p=0.016) and tended toward more salivary gland ultrasound (SGUS) abnormalities (p=0.054) than mono-anti-Ro60 positives. Double positive patients showed similar characteristics as mono-anti-Ro52 positive patients, whereas triple positive patients showed lowest unstimulated salivary flow rates (p=0.002) and Schirmer tests (p=0.002), highest ocular staining scores (p<0.001), most positive labial salivary gland biopsies (p=0.039), most laboratory abnormalities compatible with B-cell hyperactivity and highest SGUS scores (p<0.001) compared to other patient groups.
These data indicate that separate detection of anti-Ro52, anti-Ro60 and anti-SSB/La reactivity is not only relevant towards pSS diagnosis, but markedly aids in patient stratification and evaluation of disease burden. Our results suggest a stepwise model in which mono-reactivity against Ro60 displayed the least objective and subjective glandular pSS features, whereas glandular abnormalities and signs of B-cell hyperactivity were most present in patients showing triple reactivity against Ro60, Ro52 and SSB/La.
自身抗体检测是 pSS 诊断的重要步骤。然而，单独检测抗 Ro52、抗 Ro60 和抗 SSB/La 在 pSS 诊断和表型中的价值尚未得到广泛研究。本研究旨在探讨抗 SSA/Ro 阳性、疑似和明确 pSS 患者的疾病特征，以及基于抗 Ro52、抗 Ro60 和抗 SSB/La 反应性的血清学特征。
在比利时干燥综合征转化研究（BeSSTT）中，纳入的 187 例抗 SSA/Ro 阳性患者中，有 155 例被认为是明确的 pSS 患者，因为符合 2016 年 ACR-EULAR 分类标准，32 例被认为是疑似患者，因为对 SSA/Ro 有反应，但不存在其他标准。这些患者均不符合 ACR-EULAR 排除 pSS 的任何标准。根据抗 Ro52、抗 Ro60 和抗 SSB/La 抗体的存在情况对患者进行分组。
在分别 30、23、70 和 60 例患者中检测到单抗 Ro60、单抗 Ro52、双抗 Ro52/Ro60 和三抗 Ro52/Ro60 和 SSB。单抗 Ro60 阳性患者表现出的 pSS 特征最少。与单抗 Ro60 阳性患者相比，单抗 Ro52 阳性患者报告的干燥症状负担明显更高（p=0.016），唾液腺超声（SGUS）异常的趋势更高（p=0.054）。双抗阳性患者表现出与单抗 Ro52 阳性患者相似的特征，而三抗阳性患者的非刺激唾液流量率最低（p=0.002）和 Schirmer 试验（p=0.002），眼部染色评分最高（p<0.001），唇腺活检阳性率最高（p=0.039），实验室异常与 B 细胞过度活跃最相容，SGUS 评分最高（p<0.001）。
这些数据表明，单独检测抗 Ro52、抗 Ro60 和抗 SSB/La 反应性不仅与 pSS 诊断有关，而且明显有助于患者分层和疾病负担评估。我们的结果表明，一种逐步模型，即单抗 Ro60 反应性显示出最少的客观和主观腺体 pSS 特征，而腺体异常和 B 细胞过度活跃的迹象在三抗 Ro60、Ro52 和 SSB/La 反应性的患者中最为明显。
