Session Information
Session Type: Abstract Submissions (ACR)
Isolated anti-Ro52 antibody – significance and clinical association
Background/Purpose:
Antibodies against Ro-52 (TRIM21) have been described in patients with a broad spectrum of autoimmune diseases. Anti-Ro52 antibodies are the most common immunological markers detected in the idiopathic inflammatory myopathies. The significance and clinical association of isolated anti-Ro52 anti-body is not well known.
Methods:
This is a retrospective study of patients who had isolated Ro52 positivity on ENA screen. Patients were identified from the immunology laboratory records. Search was limited to year 2009 to 2012. Medical records of patients with isolated Ro-52 were reviewed for clinical details.
Results:
Thirty eight patients had isolated anti-Ro52 antibody positivity on ENA screen. The median age was 68 years and 26 were female. ANA was positive in 28 (73%). The prevalence of pulmonary manifestations in presence of anti-Ro52 antibodies was high (9/38, 23%). One patient had an undifferentiated connective tissue disease with interstitial lung disease, 4 had idiopathic pulmonary fibrosis, 2 with malignancy (bronchogenic -1, lung metastases – 1) and remaining 2 patients had suspected malignancy (bronchogenic).
Clinical manifestations of autoimmune diseases were observed only in 21 (55%) patients with Ro 52 positivity (Table 1). A severe form of ITP requiring splenectomy was seen in 2 patients. It was associated with present or past malignancy in 8 (18%) patients and out of these 3 had an underlying auto-immune disease. In another 3 patients malignancy was strongly suspected based on clinical features, imaging findings but histological confirmation could not be obtained due to untimely demise of these patients.
Conclusion:
Ro 52 antibody is commonly seen in non-autoimmune disorders. Presence of isolated anti-Ro52 antibody is associated with pulmonary involvement. It may represent the primary site for loss of tolerance and generation auto-antibodies. It can be seen in conditions other than autoimmune diseases. In our cohort anti-Ro52 was seen in association with malignancy. The role of Ro52 antibody as anti-cancer immune response should be studied further.
Table 1: Disease association with anti-Ro52 antibody
|
Systemic autoimmune disease (N=11) |
Organ specific autoimmune disease (N=6) |
Malignancy (N=9 malignancies in 8 patients) |
Suspected malignancy (N=3)
|
Others (N=13) |
|
Rheumatoid arthritis -2 Scleroderma myositis overlap-1 LcSSc with ITP-1 Primary Sjogren’s -1 Antiphosphilipid syndrome -1 Polymyalgia rheumatica-1 Dermatomyositis-1 UCTD-1 GPA -1 PsA -1 |
AIH-2 Coeliac disease-1 Pernicious anemia-1 PBC-1 ITP-1 Idiopathic pulmonary fibrosis-4
|
Current malignancy Prostate -1 Malignant melanoma-1 Gastric – 1 Colon-1 Bronchogenic -1 Breast -1# Previous malignancy Endometrial -1$ Ovarian -1* Hodgkin’s disease-1* |
Brochogenic -2 Lymphoma -1 |
Stroke-2 Chronic diarrhea-1 General weakness-1 Secondary pulmonary hypertension-1 Sepsis-1 Alcoholic cirrhosis of liver-1 Elevated ALP-1 Generalized tingling-1 |
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# Patient with GPA had previous breast cancer which was treated, now presented with lung metastases.$ Previous history of endometrial cancer, now presented with stroke.* In the patient with PsA, previous history of treated ovarian cancer and Hodgkin’s disease. UCTD – undifferentiated connective tissue disease, GPA – granulomatous polyangiitis, PsA – Psoriatic arthritis, AIH – Autoimmune hepatitis, PBC – Primary biliary cirrhosis, ITP – Idiopathic thrombocytopenia, ALP – Alkaline phosphatase
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Disclosure:
Y. Singh,
None;
P. Patil,
None;
H. Longhurst,
None;
G. Clarke,
None;
B. Dasgupta,
None.
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