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Abstract Number: 646

A Meta-Analysis of Anti-Ribosomal P Autoantibodies in Systemic Lupus Erythematosus: A Misunderstood Autoantibody

May Choi1, Rachael Brown 2, Katherine Buhler 3, Michael Mahler 4 and Marvin Fritzler 1, 1Cumming School of Medicine, University of Calgary, Calgary, AB, Canada, 2University of Victoria, Victoria, Canada, 3University of Calgary, Calgary, Canada, 4Inova Diagnostics, San Diego, CA

Meeting: 2019 ACR/ARP Annual Meeting

Keywords: anti-ribosomal P, autoantibodies, diagnosis and neuropsychiatric lupus, Systemic lupus erythematosus (SLE)

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Session Information

Date: Sunday, November 10, 2019

Session Title: SLE – Clinical Poster I: Epidemiology & Pathogenesis

Session Type: Poster Session (Sunday)

Session Time: 9:00AM-11:00AM

Background/Purpose: Anti-ribosomal P (Rib-P) antibodies have become known as a highly specific biomarker for the diagnosis of SLE and potentially a biomarker for neuropsychiatric SLE (NPSLE). However, despite comparable specificity in comparison to other SLE autoantibodies such as anti-Sm and anti-dsDNA, anti-Rib-P has not been included in classification criteria for SLE. One limitation has been the wide variation of immunoassays and antigenic targets used to detect anti-Rib-P. Furthermore, the definition of NPSLE encompasses a broad spectrum of neuropsychiatric symptoms. To clarify the clinical associations in SLE, we performed a systematic review and meta-analysis to compare the different anti-Ribo-P assay platforms, antigenic targets, and specific clinical features of SLE and NPSLE.

Methods: PubMed, EMBASE, and Web of Science databases were searched. Associations with clinical features of SLE with attention to specific neuropsychiatric symptoms, type of immunoassays and antigenic targets were extracted. Data were pooled using random effects methods. Associations were expressed as pooled odds ratio (OR) and forest plots to visualize the results.

Results: Our preliminary search identified 21 studies (n=3128) that reported a pooled OR of anti-Rib-P positivity in NPSLE of 2.36 (95% confidence interval (CI): 1.74-3.18) (Figure 1). When stratified by different symptoms of NPSLE, depression had the highest pooled OR of 3.77 (95% CI: 1.19-11.93), followed by psychosis (OR 3.33 (95% CI: 1.97-5.62)), and then central nervous system (CNS) involvement (OR 1.65 (95% CI: 1.11-2.45)) (Figure 2). There were 7 studies (n=1060) that reported a pooled OR for lupus nephritis (LN) of 1.61 (95%CI: 0.93-2.77) and 5 small studies (n=504) that reported a pooled OR for lupus hepatitis of 16.07 (95% CI: 4.30-60.08). Seven studies reported that anti-Rib-P was associated with increased disease activity, however, we were not able to pool the results because different disease activity scores were used (SLEDAI, ECLAM, SLEDAI 2K or MEX-SLEDAI) (Figure 3). There was significant heterogeneity between studies that was at least partly explained by heterogeneity in antigenic targets (C22 peptide, ribosomes, P0/P1/P2, tissue extract, and P individual) and assays (double diffusion, enzyme-linked immunosorbent assay, immunoblot, and/or dot blot) used for these studies.

Conclusion: The addition of anti-Rib-P may improve the specificity of SLE classification criteria in patients presenting with NPSLE symptoms. Anti-Rib-P was also found to be an important biomarker for lupus hepatitis and potentially disease activity. Heterogeneity between studies in this meta-analysis is explained by different assays and antigenic targets.

Figure 1. Pooled odds ratios of NPSLE -combined symptoms-, lupus nephritis, and lupus hepatitis with anti-ribosomal P antibodies stratified by antigenic target -A, C, E- and testing method -B, D, F-. Abbreviations: AB, antigenic target; anti-RibP, anti-ribosomal P; CI, confidence interval; DID, double diffusion; ELISA, enzyme-linked immunosorbent assay; IB, immunoblot; LN, lupus nephritis; NPSLE, neuropsychiatric lupus; OR, odds ratio.

Figure 2. Pooled odds ratios of different symptoms of neuropsychiatric SLE with anti-ribosomal P antibodies stratified by antigenic target -A, C, E- and testing method -B, D, F-. Abbreviations: AB, antigenic target; anti-RibP, anti-ribosomal P; CI, confidence interval; DID, double diffusion; ELISA, enzyme-linked immunosorbent assay; IB, immunoblot; LN, lupus nephritis; NPSLE, neuropsychiatric lupus; OR, odds ratio.

Figure 3. Pooled weighted mean difference of disease activity with anti-ribosomal P antibodies stratified by antigenic target -A-, testing method -B-, and disease activity index -C-. Abbreviations: AB, antigenic target; anti-RibP, anti-ribosomal P; CI, confidence interval; DID, double diffusion; ECLAM, European Consensus Lupus Activity Measurement; ELISA, enzyme-linked immunosorbent assay; IB, immunoblot; LN, lupus nephritis; MEX SLEDAI, Mexican Systemic Lupus Erythematosus Disease Activity Index; NPSLE, neuropsychiatric lupus; OR, odds ratio; SLEDAI, Systemic Lupus Erythematosus Disease Activity Index; SLEDAI-2K, Systemic Lupus Erythematosus Disease Activity Index 2000.


Disclosure: M. Choi, None; R. Brown, None; K. Buhler, None; M. Mahler, Inova Diagnostics, 3; M. Fritzler, Alexion Canada, 7, BioRad, 5, Dr. Fooke Laboratorien GmbH, 5, Euroimmun GmbH, 5, 7, ImmunoConcepts, 7, Inova Diagnostics, 5, 7, 8, Inova Diagnostics Inc. San diego, CA, 5, Inova Dx, Mikrogen GmbH, 5, Werfen International, 5.

To cite this abstract in AMA style:

Choi M, Brown R, Buhler K, Mahler M, Fritzler M. A Meta-Analysis of Anti-Ribosomal P Autoantibodies in Systemic Lupus Erythematosus: A Misunderstood Autoantibody [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/a-meta-analysis-of-anti-ribosomal-p-autoantibodies-in-systemic-lupus-erythematosus-a-misunderstood-autoantibody/. Accessed February 2, 2023.
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