Background/Purpose: Anti-Ro52 is a myositis-associated antibody increasingly linked to disease features and outcomes in idiopathic inflammatory myopathies (IIMs). Thorough characterisation of these associations is needed to clarify its clinical relevance and to guide future research. We sought to systematically review the literature on clinical associations of anti-Ro52 in IIMs.

Methods: A systematic search of MEDLINE and EMBASE was conducted from inception until April 2025. Studies reporting clinical associations of anti-Ro52 in adult IIM patients were included (See Figure 1 for PRISMA flow diagram).

Results: Of 1953 studies, 227 full-text articles were assessed for eligibility and 105 met inclusion criteria. All included studies were observational, with majority published since 2021 (69%, n=72) and originating from Asia (67%, n=70). Sample sizes ranged from 11-2085 patients. Considerable heterogeneity was observed in the reported clinical associations for anti-Ro52 within adult IIM cohorts (Figure 2). Anti-Ro52 was commonly associated with higher rates of interstitial lung disease (ILD) (57%, n=29/51 studies), including rapidly progressive interstitial lung disease (RP-ILD) (76%, n=19/25 studies), with nonspecific interstitial pneumonia being the predominant lung pattern among studies reporting radiographic findings (50%, n=4/8). Mechanic’s hands (80%, n=8/10 studies) and severe joint involvement (57%, n=8/14 studies) were other commonly reported associations. Among studies examining disease outcomes, anti-Ro52 was frequently associated with increased mortality (65%, n=11/17 studies) and poor prognosis (59%, n=10/17 studies), as indicated by lower cumulative survival or worse functional outcomes. However, anti-Ro52 was rarely linked to malignancy risk (9%, n=1/11 studies). Among 72 studies reporting anti-Ro52 co-positivity with other myositis-specific or myositis-associated antibodies, in a pooled cohort of 4359 patients, the most frequently co-occurring antibodies were anti-MDA5 (55%, n=2393 patients) and anti-aminoacyl-tRNA synthetases (anti-ARS) (35%, n=1537 patients), with the two most common anti-ARS antibodies being anti-Jo1 (15%, n=642 patients) and anti-EJ (5%, n=205 patients) (Figure 3). Antibody co-expression has been linked to a more severe disease phenotype, including RP-ILD, as well as poor treatment response to conventional immunosuppressive therapies, but possibly improved response to rituximab.

Conclusion: Anti-Ro52 is frequently associated with ILD and RP-ILD, poorer prognosis, and increased mortality in adult IIM patients. This review further highlights associations with key extra-muscular manifestations, notably mechanic’s hands and severe joint involvement. Antibody co-positivity with anti-Ro52 may predict high-risk clinical phenotype, enabling risk stratification and early targeted therapies that may improve long-term outcomes. Future research should focus on mechanisms driving these clinical associations and their implications for disease management, including personalised treatments and risk stratification.

Figure 1. PRISMA flow diagram

Figure 2. Common clinical associations of anti-Ro52 antibody in adult IIM patients (p < 0.05 for significance)

Figure 3. Frequency of myositis-specific antibodies (MSA) and myositis-associated antibodies (MAA) co-positive with anti-Ro52 antibody in adult idiopathic inflammatory myopathies (IIM) patients.

* Anti-ARS (anti-aminoacyl-tRNA synthetase) antibodies include anti-Jo1, anti-EJ, anti-OJ, anti-PL7, anti-PL12, anti-KS, and dual anti-ARS antibodies (anti-Jo/anti-PL12, anti-EJ/anti-OJ). Other anti-ARS antibodies include anti-ARS antibodies of lesser frequency and anti-ARS antibody frequency from studies where specific anti-ARS subtypes were not differentiated and the data were reported collectively.

† ≥2 MSA/MMA antibodies: the frequency of two or more MSA/MMA antibodies co-positive with anti-Ro52, excluding any dual anti-ARS antibodies.

¶ Other antibodies include anti-HMGCR, anti-SAE1, anti-Scl-70, anti-Sm and anti-U3RNP.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/clinical-associations-of-anti-ro52-antibodies-in-idiopathic-inflammatory-myopathies-a-scoping-review/