Background/Purpose:

Autoantibody production against nuclear components is a characteristic feature of SLE. Autoantibody clustering may provide a valuable tool to differentiate between clinical subsets and to predict lupus disease severity. There is increasing evidence to support the role played by RNA components of Ro and Sm/RNP small ribonucleoproteins as endogenous adjuvants in the pathogenesis of autoimmunity.

 The objectives of this study were to determine the frequency of positivity of the RNA-containing antibody triad of anti-Ro/anti- Sm/anti-RNP in lupus nephritis versus SLE non-nephritis patients. In addition, we examined whether patients with this antibody combination had earlier onset disease, worse renal outcomes or more rapid progression to end-stage renal disease.

Methods:

A retrospective case-control study was undertaken of 180 patients with biopsy-proven lupus nephritis and a control group of 179 ethnically matched SLE patients without nephritis. Data collected included age at disease onset, degree of renal impairment and progression of renal impairment over time based on the KDOQI guidelines (kidney disease outcomes quality initiative) and autoantibody profiles of individual patients.

Results:

SLE patients with nephritis were significantly more likely to have the autoantibody triad of anti-Ro/anti-Sm/anti-RNP than SLE non-nephritis controls (12% versus 6%, p=0.03). There was a trend towards a higher rate of progression to end-stage renal disease in nephritis patients who were antibody triad positive (19% versus 8%, p=0.052).  Mean renal survival was significantly shorter in nephritis patients who were antibody triad positive (14 years versus 21 years, p=0.05). Presence of the antibody triad was not associated with earlier onset disease (24.63 years ± 2.55 versus 26.23 years ± 1.08, p=0.60). 75% of SLE patients with this antibody profile were of African ancestry, 19% were Caucasian and 6% were of South Asian descent.

Conclusion:

This study has shown that the RNA-containing autoantibody combination of anti-Ro/Sm/RNP was significantly more common in lupus nephritis than SLE non-nephritis patients. Progression to advanced renal disease was more common in antibody triad positive patients. Renal survival was significantly shorter in nephritis patients with this autoantibody profile. Based on these findings, we recommend particular vigilance for the detection of nephritis in newly diagnosed SLE patients with this antibody triad. SLE patients with known nephritis and this antibody profile may represent a more aggressive disease subset and thus warrant more intensive clinical monitoring.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/predictive-value-of-the-autoantibody-triad-of-anti-ro-anti-sm-and-anti-rnp-for-the-future-development-of-lupus-nephritis/