Anti-Ro antibodies in lupus portend higher disease activity, steroid use
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Key takeaways:
- Anti-Ro antibody positivity was linked to increased disease activity and more frequent glucocorticoid and immunosuppressant use in SLE.
- Anti-Ro-positive patients also had a higher frequency of proteinuria.
Patients with systemic lupus erythematosus who are positive for anti-Ro60 or anti-Ro52 antibodies may face higher disease activity and more intensive treatment needs, according to data published in Rheumatology.
“Anti-Ro60 and anti-Ro52 antibodies are among the most frequently detected autoantibodies and are used for diagnosis and classification for Sjögren’s disease,” Katie Liao, MD, of the department of rheumatology at Monash Health, in Australia, and colleagues wrote. “Apart from Sjögren’s disease, anti-Ro autoantibodies are most frequently associated with SLE.
“While the utility of anti-Ro antibody testing in Sjögren’s disease as a key defining autoantibody is well known, there remains a paucity of data regarding the significance of anti-Ro positivity in SLE,” they added.
To learn more about SLE outcomes associated with anti-Ro antibody positivity, Liao and colleagues analyzed patient data from the Australian Lupus Registry and Biobank. Their study included 409 patients with SLE (83.9% women), 47.2% of whom tested positive for one or both anti-Ro antibodies.
The researchers used linear or logistic regressions to compare patient characteristics with disease outcomes. These outcomes included high disease activity status, defined as having ever scored a 10 or more on the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) 2000, as well as adjusted mean SLEDAI.
According to the researchers, patients with anti-Ro positivity were mostly Asian (OR vs. Caucasian = 2.76; 95% CI, 1.76-4.28), with positive dsDNA (OR = 1.75; 95% CI, 1.05-2.93) and hypocomplementemia, defined as low levels of either C3 or C4 (OR = 3.15; 95% CI, 1.5-6.62). They were also more likely to meet high disease activity status (OR = 1.65; 95% CI, 1.1-2.48) and a mean SLEDAI of four or greater (OR = 1.84; 95% CI, 1.18-2.88).
The researches additionally noted more frequent use of glucocorticoids (OR = 1.87; 95% CI, 1.16-3.03) and immunosuppressants (OR = 2; 95% CI, 1.26-3.17) among those with anti-Ro positivity. Sicca symptoms were present among 24.4% of this population, and there was a significant association with hypergammaglobulinemia (P = .042), the researchers added.
Links between anti-Ro positivity and Asian ethnicity, severe flares, higher adjusted mean SLEDAI, hypocomplementemia, rheumatoid factor, proteinuria, leucopenia and sicca symptoms were confirmed in multivariate analysis, according to the researchers.
“The presence of anti-Ro antibodies in SLE adds prognostic information for the clinicians,” Liao and colleagues wrote. “In addition to the possibility of an overlap syndrome, it is associated with higher disease activity in patients with SLE, with higher frequency of specific target organ associations, such as cutaneous and hematological disease.
“Anti-Ro-positive SLE patients also have high frequency of proteinuria, which should prompt closer examination of renal histopathology,” they added. “The study highlights the significance of examining autoantibody clustering, particularly in patients with overlap features, and to determine optimal treatment strategies.”
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