Session Title: 3S101: Epidemiology & Public Health II: SLE (892–897)
Session Type: ACR Abstract Session
Session Time: 4:30PM-6:00PM
Background/Purpose: Previous studies have demonstrated that years before clinical onset of auto-immune diseases, auto-antibodies can already be present. However, it is also known that some individuals can have these auto-antibodies and will never develop an auto-immune disease. So far, little information is available on the presence of antibodies to extractable nuclear antigens (anti-ENA) in the general population in relation to the risk of developing an auto-immune disease, with special interest for Systemic Lupus Erythematosus (SLE) and primary Sjögren Syndrome (pSS).
Objectives To estimate the prevalence of anti-ENA and their association with the presence of known risk factors for SLE and pSS in the general Dutch population.
Methods: Methods Lifelines is a prospective population-based cohort study in the Netherlands. Cross-sectional data from 40,135 participants were analyzed. The detection of anti-ENA was performed using the ENA-CTD (connective tissue disease) screen on the Phadia-250 analyzer with a ratio >1.0 considered positive. An extensive questionnaire was taken on demographic and clinical information (e.g. early musculoskeletal symptoms). Furthermore, some general blood parameters were available. SLE and pSS were defined by a combination of self-reported SLE or pSS, specific medication use and visiting a medical specialist within the last year. Characteristics were compared between 3 groups: SLE/pSS patients, anti-ENA positive, and anti-ENA negative participants.
Results: Results Of the total 40,135 consecutive individuals, 41 were detected as having defined SLE or pSS of whom 49% were anti-ENA positive. SLE/pSS patients were older and more often female. Of the remaining individuals (40,094), 1089 (2.7%) were found anti-ENA positive. Anti-ENA positivity was significantly associated with older age, female gender and joint stiffness compared to anti-ENA-negative participants. Interestingly, levels of haemoglobin, leucocytes and lymphocytes were significantly decreased in anti-ENA-positive participants compared to anti-ENA-negative participants. SLE/pSS participants had even significantly lower haemoglobin and reported even more joint stiffness then anti-ENA positive individuals. Lower lymphocyte levels, gender and older age appear as significantly independent predictors of anti-ENA positivity and also for being defined SLE/pSS. Of the anti-ENA positive individuals, 2.3% were positive for anti-dsDNA as well as anti-SSA. These individuals showed significantly lower lymphocyte-, leukocyte-, neutrophilic granulocyte- and monocyte levels compared to other anti-ENA positive participants.
Conclusion: Conclusion In this large population-based study, the prevalence of anti-ENA-positivity was 2.8% for the total group and 2.7% when excluding patients with SLE or pSS. Older age, female gender, joint complaints and lower levels of hemoglobin, leucocytes and lymphocytes were more frequently present in anti-ENA-positive participants. Longitudinal studies are performed up to 15 years to investigate which individuals might develop SLE or pSS to be able to develop prediction models.
To cite this abstract in AMA style:Yntema-Eckenhaussen P, Arends S, Brouwer E, Roozendaal C, Bootsma H, Westra J, de Leeuw K. The Presence of Extractable Nuclear Antigens (ENA) Antibodies in a Large Population-based Cohort from the Netherlands and Their Association with Known Risk Factors for Systemic Lupus Erythematosus and Primary Sjögren Syndrome [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/the-presence-of-extractable-nuclear-antigens-ena-antibodies-in-a-large-population-based-cohort-from-the-netherlands-and-their-association-with-known-risk-factors-for-systemic-lupus-erythematosus-and/. Accessed February 27, 2020.
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