ANTI-RO/SSA and/or ANTI-La/SSB Antibodies: Association with Mild LUPUS Manifestations in 645 Childhood-Onset Systemic LUPUS Erythematosus

Glaucia V. Novak¹, Mariana Marques², Verena Balbi², Natali W. Gormezano², Katia T. Kozu², Ana Paula Sakamoto³, Rosa M R Pereira⁴, Maria Teresa Terreri³, Claudia S. Magalhães⁵, Silvana B. Sacchetti Sr.⁶, Adriana M E Sallum², Roberto Marini Sr.⁷, Virgínia Ferriani⁸, Cássia M. Barbosa⁹, Tânia C M Castro¹⁰, Valéria C. Ramos¹¹, Eloisa Bonfá¹² and Clovis A Silva¹³, ¹Pediatric Rheumatology Unit,, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil, ²Pediatric Rheumatology Unit, University of São Paulo, São Paulo, Brazil, ³Pediatric Rheumatology Unit, Federal University of São Paulo, São Paulo, Brazil, ⁴Rheumatology, University of São Paulo, São Paulo, Brazil, ⁵Pediatric Rheumatology Division, São Paulo State University (UNESP), Botucatu, Brazil, ⁶Pediatric Rheumatology Unit, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil, ⁷Pediatric Rheumatology Unit, State University of Campinas, São Paulo, Brazil, ⁸Department of Pediatrics School of Medicine of Ribeirão Preto, University of São Paulo (USP-RP), Ribeirão Preto, Brazil, ⁹Pediatric Rheumatology Unit, Hospital Infantil Darcy Vargas, São Paulo, Brazil, ¹⁰Pediatric Rheumatology Unit, Hospital Menino Jesus, São Paulo, Brazil, ¹¹Pediatric Rheumatology Unit, Pontifical Catholic University of Sorocaba, São Paulo, Brazil, ¹²Rheumatology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil, ¹³Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: Systemic lupus erythematosus (SLE)

Session Information

Date: Monday, November 14, 2016

Title: Pediatric Rheumatology – Clinical and Therapeutic Aspects - Poster II: Myositis, Systemic Lupus Erythematosus, Sjögren's Syndrome

Session Type: ACR Poster Session B

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

Background/Purpose: Anti-Ro/SSA and anti-La/SSB antibodies were reported in 30-50% and 10-30% of adult SLE patients, associated mainly with cutaneous manifestations. However, to our knowledge there are no studies assessing these autoantibodies in a large population of childhood SLE (cSLE) patients. Therefore, the aim of this multicenter cohort study was to evaluate demographic, clinical and laboratorial features in cSLE patients with and without the presence of anti-Ro/SSA and anti-La/SSB antibodies.

Methods: This was a retrospective multicenter study performed in 10 Pediatric Rheumatology services of São Paulo state, Brazil. Anti-SSA/Ro and anti-SSB/La antibodies were measured by either contraimmunoelectrophoresis or enzyme linked immuno sorbent assay (ELISA) in 645 patients cSLE patients. Other autoantibody analysis was performed according to the routine laboratory of each Center. Demographic data, cumulative clinical and laboratorial features and disease damage (SLICC/ACR-DI) at last visit were evaluated. Juvenile Sjögren’s syndrome was established according to the American-European Consensus Group.

Results: Anti-Ro/SSA and anti-La/SSB antibodies were evidenced in 209/645 (32%) and 102/645 (16%) of cSLE patients, respectively. Analysis of cSLE patients with and without anti-Ro/SSA antibodies revealed higher frequencies of malar rash (79% vs. 71%, p=0.032), photosensitivity (73% vs. 65% p=0.035), cutaneous vasculitis (43% vs. 35%, p=0.046), musculoskeletal involvement (82% vs. 75%, p=0.046) in spite of long and comparable disease duration in both groups (4.25 vs. 4.58 years, p=0.973). Sjögren syndrome was rare and observed in only five patients with this antibody (2.5% vs. 0%, p=0.0035), two of them with concomitant anti-La/SSB. The presence of associated autoantibodies: anti-Sm (50% vs. 30%, p<0.0001), anti-RNP (39% vs. 21%, p<0.0001) and anti-ribossomal P protein (46% vs. 21%, p=0.002) were also significantly higher in patients with the presence of anti-Ro/SAA antibodies. Female gender, multi-organ involvement and SLICC/ACR-DI, including skin damage, were similar in both groups (p>0.05). Further evaluation of cSLE patients with the presence of anti-La/SSB antibodies compared to those without these autoantibodies showed that the frequency of alopecia (70% vs. 51%, p=0.0005) anti-Sm (59% vs. 31%, p<0.0001), anti-RNP (42% vs. 23%, p<0.0001) were significantly higher in the former group. Further evaluation of cSLE patients with and without concomitant anti-Ro/SSA and anti-La/SSB antibodies showed a lower frequency of anti-dsDNA (55% vs. 70%, p=0.009), whereas alopecia (71% vs. 51%, p=0.0008), anti-Sm (59% vs. 29%, p=0.0001) and anti-RNP (45% vs. 21%, p=0.0001) were more frequent in patients with these antibodies.

Conclusion: Our large multicenter study provided novel evidence in cSLE that anti-Ro/SSA and/or anti-La/SSB antibodies were associated with mild manifestations, particularly cutaneous and musculoskeletal. Sjögren syndrome was rarely diagnosed in these patients, in spite of the comparable frequencies of anti-Ro/SSA and/or anti-La/SSB reported for adult SLE.

Disclosure: G. V. Novak, None; M. Marques, None; V. Balbi, None; N. W. Gormezano, None; K. T. Kozu, None; A. P. Sakamoto, None; R. M. R. Pereira, None; M. T. Terreri, None; C. S. Magalhães, None; S. B. Sacchetti Sr., None; A. M. E. Sallum, None; R. Marini Sr., None; V. Ferriani, None; C. M. Barbosa, None; T. C. M. Castro, None; V. C. Ramos, None; E. Bonfá, None; C. A. Silva, CNPq, 2.

To cite this abstract in AMA style:

Novak GV, Marques M, Balbi V, Gormezano NW, Kozu KT, Sakamoto AP, Pereira RMR, Terreri MT, Magalhães CS, Sacchetti SB Sr., Sallum AME, Marini R Sr., Ferriani V, Barbosa CM, Castro TCM, Ramos VC, Bonfá E, Silva CA. ANTI-RO/SSA and/or ANTI-La/SSB Antibodies: Association with Mild LUPUS Manifestations in 645 Childhood-Onset Systemic LUPUS Erythematosus [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/anti-rossa-andor-anti-lassb-antibodies-association-with-mild-lupus-manifestations-in-645-childhood-onset-systemic-lupus-erythematosus/. Accessed .

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