Session Information
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose:
A group of murine parotid tissue specific autoantibodies (TSAs) which includes anti-SP1 (salivary protein 1), anti-PSP (parotid secretory protein) and anti-CA6 (carbonic anhydrase) are markers for early disease in the IL-14α transgenic mouse model of Sjogren’s (SS). These TSAs are also found in NOD mice, patients (pts) classified with SSA+ or – Sjogren’s according to the American European Consensus Group criteria and in pts with idiopathic dry eyes.
Methods:
We tested serum for TSAs from 6 patient groups followed in a rheumatology clinic for > 1 year at a university medical center including: 1) SS who met published classification criteria (n=152), 2) non-autoimmune controls (n=36), 3) SLE (n=22), 4) RA (n=17), 5) scleroderma (n=7) and 6) chronic nonspecific sialadenitis (n=16). Saliva samples were also obtained from groups 1,2 & 6. Electronic medical records were reviewed to verify diagnoses & all pts were questioned re: the presence & duration of dry eyes/mouth & medical history. Volunteers with history of dry eyes/mouth, any autoimmune diseases or family history of autoimmune disease were excluded as controls. Serum samples were anonymously coded & assayed by a modified ELISA (Trinity Biotech, Inc., Buffalo, NY). All laboratory personnel were blinded to pts diagnoses. Analyses was performed to determine the sensitivity, specificity & discriminative ability of the presence of > 1 TSAs to differentiate SS from other groups.
Results:
Of the 152 SS pts, 9% had disease duration ≤ 3 years. TSAs were detected in both the serum and saliva of pts with SS. The most frequently detected TSA in SS was anti-PSP IgG (13%) (Table 1). The presence of > 1 TSA was similar in SS (40%), controls (44%), chronic sialadenitis (50%), and patients with other CTD (35%).No particular TSA or isotype was specific for SS. Results suggested a sensitivity and specificity of 40% and 56% respectively for the presence of ≥ 1 TSAs in SS. Prevalence of + ANAs/ RF IgM in each group were as follows: SS (57%/ 44%), controls (14%/ 39%), chronic sialoadenitis (31%/ 31%) and other connective tissue diseases (65%/ 47%) (Table 2). Prevalence of ≥ 1 TSAs did not significantly vary between ANA+ vs. ANA- or between SSA+ vs. SSA- individuals.
Conclusion:
The presence of ≥ 1 TSAs in the serum does not distinguish between established SS and other patient groups. The value of the serum assay, as presently performed, for confirmation of early or undiagnosed SS (≤ 3 years) in humans is doubtful given the lack of assay specificity. Assay of TSAs in saliva or calculation of a saliva/serum TSA ratio may prove to be a more valuable diagnostic test.
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Table 1: Frequency of Positive Murine Parotid Tissue Specific Autoantibodies in Different Patient Groups |
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|
|
Primary Sjogren’s (N = 152) |
Controls (N = 36) |
Chronic Sialadenitis |
CTD (N = 46) |
|
CA6 IgG ≥20 |
7 (4.6%) |
0 (0.0%) |
1 (6.3%) |
0 (0.0%) |
|
CA6 IgM ≥20 |
5 (3.3%) |
4 (11.1%) |
0 (0.0%) |
3 (6.5%) |
|
CA6 IgA ≥20 |
8 (5.3%) |
0 (0.0%) |
2 (12.5%) |
1 (2.2%) |
|
CA6 any ≥20 |
19 (12.5%) |
4 (11.1%) |
2 (12.5%) |
4 (8.7%) |
|
PSP IgG ≥20 |
20 (13.2%) |
5 (13.9%) |
3 (18.8%) |
8 (17.4%) |
|
PSP IgM ≥20 |
13 (8.6%) |
5 (13.9%) |
3 (18.8%) |
5 (10.9%) |
|
PSP IgA ≥20 |
7 (4.6%) |
1 (2.8%) |
3 (18.8%) |
3 (6.5%) |
|
PSP any ≥20 |
38 (25.0%) |
9 (25.0%) |
7 (43.8%) |
11 (23.9%) |
|
SP1 IgG ≥20 |
6 (3.9%) |
3 (8.3%) |
1 (6.3%) |
4 (8.7%) |
|
SP1 IgM ≥20 |
16 (10.5%) |
6 (16.7%) |
0 (0.0%) |
7 (15.2%) |
|
SP1 IgA ≥20 |
12 (7.9%) |
3 (8.3%) |
0 (0.0%) |
2 (4.3%) |
|
SP1 any ≥20 |
31 (20.4%) |
11 (30.6%) |
1 (6.3%) |
10 (21.7%) |
|
Any novel Ab ≥20 |
61 (40.1%) |
16 (44.4%) |
8 (50.0%) |
16 (34.8%) |
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All p > 0.05 in pairwise comparision with primary Sjogren’s with Fisher’s exact test |
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Table 2: Patient Characteristics
|
Primary Sjogren’s |
Controls |
Chronic Sialoadenitis |
CTD* |
|
|
N |
152 |
36 |
16 |
46 |
|
Female |
145 (95.4%) |
22 (61.1%) |
14 (87.5%) |
38 (82.6%) |
|
Age, years |
±13.8 |
±22.3 |
±18.7 |
±12.4 |
|
ANA ≥ 1:160 |
86 (56.6%) |
5 (13.9%) |
5 (31.2%) |
30 (65.2%) |
|
RF IgM ≥ 10) |
67 (44.1%) |
14 (38.9%) |
5 (31.2%) |
21 (46.7%) |
|
SSA ≥ 20 |
92 (60.5%) |
2 (5.6%) |
0 (0%) |
14 (31.1%) |
|
SSB ≥ 20 |
50 (32.9%) |
1 (2.8%) |
2 (12.5%) |
13 (28.9%) |
|
± standard deviation. * 22 lupus, 17 rheumatoid arthritis, 7 scleroderma |
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To cite this abstract in AMA style:
Vivino FB, George MD, Johr C, Sandorfi N, Bunya V, Massaro-Giordano G, Diederich A, Eilberg B, Suresh L, Shen L. Lack of Specificity in Testing for Murine Tissue Specific Autoantibodies for the Diagnosis of Sjogren’s Syndrome [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/lack-of-specificity-in-testing-for-murine-tissue-specific-autoantibodies-for-the-diagnosis-of-sjogrens-syndrome/. Accessed .« Back to 2018 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/lack-of-specificity-in-testing-for-murine-tissue-specific-autoantibodies-for-the-diagnosis-of-sjogrens-syndrome/