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Abstract Number: 672

Anti-Th/To Antibodies In Various Systemic Rheumatic Diseases Screened By Anti-Rpp25 ELISA

Ann D. Chauffe1, Eric S. Sobel2, Michael R. Bubb1, Westley H. Reeves3, Michael Mahler4, Cristina Gascon5, Jason Y.F. Chan1, S. John Calise6, Edward K.L. Chan6 and Minoru Satoh1, 1Medicine, University of Florida, Gainesville, FL, 2Medicine/Div of Rheumatology, University of Florida, Gainesville, FL, 3Rheumatology & Clinical Imm, University of Florida, Gainesville, FL, 4Research, INOVA Diagnostics, San Diego, CA, 5Research, INOVA Diagnostics, Inc., San Diego, CA, 6Oral Biology, University of Florida, Gainesville, FL

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords: Antibodies and biomarkers

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Session Information

Title: Systemic Sclerosis, Fibrosing Syndromes, and Raynaud’s - Clinical Aspects and Therapeutics I

Session Type: Abstract Submissions (ACR)

Background/Purpose:

Anti-Th/To antibodies (anti-Th) are one of the specificities that show nucleolar staining in indirect immunofluorescence antinuclear antibody test. Anti-Th is associated with systemic sclerosis (SSc), mainly the limited cutaneous variant.  However, cases of anti-Th also have been reported in other diseases. Although known for over 20 years, anti-Th is rarely used in routine testing algorithms because immunoprecipitation (IP) is not widely available. One of the components of the Th-complex, namely Rpp25, has been reported as a major autoantigen, recognized by ~80% of anti-Th positive sera in ELISA.  The goal of the study was to better characterize the clinical features associated with anti-Th in various autoimmune disease cohorts as identified by anti-Rpp25 ELISA followed by confirmation IP.

Methods:

Patients enrolled were seen at Autoimmune Disease Center from 2000 to 2012.  All SSc patients’ sera had previously undergone RNA-IP. Patients with other rheumatic diseases including 462 systemic lupus erythematosus (SLE), 131 autoimmune inflammatory myopathy (AIM), 63 primary Sjogren’s syndrome (SS) and 138 Rheumatoid Arthritis (RA) were screened by anti-Rpp25 ELISA. Borderline and positive cases underwent confirmatory IP. Additionally, anti-nucleolar staining ANA positives were tested by RNA-IP. The clinical characteristics of the anti-Th (+) patients were then more closely evaluated by reviewing database and chart records.

Results:

Overall, anti-Th was confirmed in 17 cases (7 SSc and 10 non-SSc) via Rpp25 ELISA and IP.  Prevalence of anti-Th was 6% (7/125) in SSc, 0.6% (3/462) in SLE, 0.7% (1/131) in AIM, 0% (0/138) in RA, 3% (2/63) in SS and 4 others without a rheumatologic diagnosis. Of the 17 anti-Th patients, 15 were Caucasian and 2 were African American and had SLE.  The anti-Th SSc patients were mainly the limited cutaneous variant (4/7) and none of them had interstitial lung disease (ILD) or pulmonary arterial hypertension (PAH).  Of the non-SSc patients with other rheumatologic diagnoses 3 had SLE, 2 had SS and 1 had AIM but some also had features associated with SSc: 2/6 ILD, 3/6 Raynaud’s (RP), 1/6 telangiectasia (TG), 1/6 pitting scars (PS).  Four other non-SSc patients without a rheumatologic diagnosis had features typical of SSc: 3/4 RP, 1/4 PS, 3/4 TG, 1/4 ILD, 1/4 PAH which may represent sine-SSc variant. 

Conclusion:

Based on anti-Rpp25 ELISA and IP screening, anti-Th is fairly specific for SSc. However, anti-Th was also found in other connective tissue diseases with features associated with SSc and some cases had feature of SSc without sclerodermatous skin changes, thus may be classified sine-SSc.


Systemic Sclerosis

N=7

Other Rheum Diagnosis

SLE (3) Sjogren’s (2) myositis (1)

N= 6

No Rheum Diagnosis

N = 4

Female

100% (7/7)

100% (6/6)

75% (3/4)

Caucasian

100% (7/7)

67% (4/6)

100% (4/4)

Age in Years (mean)

48

50

40

ILD

0% (0/7)

33% (2/6)

25% (1/4)

PAH

0% (0/7)

0% (0/6)

25% (1/4)

Raynaud’s

86% (6/7)

50% (3/6)

75% (3/4)

Telangiectasia

86% (6/7)

17% (1/6)

75% (3/4)

Pitting Scars

0% (0/7)

17% (1/6)

25% (1/4)


Disclosure:

A. D. Chauffe,
None;

E. S. Sobel,
None;

M. R. Bubb,
None;

W. H. Reeves,
None;

M. Mahler,

Inova Diagnostics, Inc.,

3;

C. Gascon,

Inova Diagnostics, Inc.,

3;

J. Y. F. Chan,
None;

S. J. Calise,
None;

E. K. L. Chan,
None;

M. Satoh,
None.

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