D-penicillamine toxicity in Greek patients with rheumatoid arthritis: anti-Ro(SSA) antibodies and cryoglobulinemia are predictive factors.

Sixty-two consecutive patients, with rheumatoid arthritis (RA) who received D-penicillamine were studied retrospectively to identify predictive risk factors for D-penicillamine toxicity. Thirty-two developed side effects, while 30 did not. The clinical picture in both groups was similar, but the group with D-penicillamine toxicity was characterized by a high incidence of anti-Ro(SSA) antibodies (p less than 0.01) or circulating cryoglobulins (p less than 0.001). The presence of anti-Ro(SSA) antibodies was not correlated with the presence of circulating cryoglobulins (p greater than 0.5), while the coefficient of contingency (C) between anti-Ro(SSA) and cryoglobulins was 0.131. Men were predisposed to express more renal pathology (p less than 0.025), while anti-Ro(SSA) positive patients with RA more often expressed rashes (p less than 0.0001) and acute febrile reactions (p less than 0.05) than anti-Ro(SSA) negative patients. These observations should be considered when making therapeutic decisions at least for Greek patients with RA.     

Anti-CCP in systemic lupus erythematosus patients: a cross sectional study in Brazilian patients

Recently, it has been found that some lupus patients may have anti-cyclic citrullinated peptide antibodies (anti-CCP), although the clinical significance of such finding is not well established. Systemic lupus erythematosus (SLE) patients may have joint complaints that are very similar to those observed in rheumatoid arthritis (RA). In early stages of disease, this form of arthritis can be difficult to differentiate from RA, so it is not rare that some SLE patients are initially misdiagnosed to have this disease. This study aims to investigate the prevalence of anti-CCP in SLE patients from Southern Brazil and its association with clinical and serological profiles. One hundred nine SLE patients were studied for anti-CCP and compared with data of 156 RA patients and 100 healthy volunteers. Comparison of clinical and autoantibody profile of anti-CCP-positive and anti-CCP-negative SLE patients was done. All SLE patients positive of anti-CCP were submitted to hand and feet X-rays. Anti-CCP was positive in 15 of 109 SLE patients, and one of them had confirmed the diagnosis of rhupus. This prevalence was significantly higher than in healthy controls (p?=?0.0004) and lower than in RA patients (p?<?0.0001). No relationship could be found with clinical profile, including joint complaints. SLE patients with anti-CCP had higher prevalence of anti-Ro (p?=?0.02) and anti-La (p?=?0.004) autoantibodies, in comparison with those negative to anti-CCP. We found that 13.7 % of Brazilian patients with SLE have positive anti-CCP. Patients with anti-CCP showed higher prevalence of anti-Ro and anti-La autoantibodies than those negative for anti-CCP. Only a careful and prolonged follow-up will reveal the real clinical value of these markers in each patient individually.     

Genetic studies of anti-Ro (SSA) antibodies in families with rheumatoid arthritis.

Forty-nine members of 4 families with multiple cases of rheumatoid arthritis (RA) were investigated. Nine patients with RA, one patient with primary Sj?gren's syndrome (SS) and one patient with systemic lupus erythematosus (SLE) were detected among them. Anti-Ro (SSA) antibodies were found in 11 members (22%) of the investigated group; 6 suffered from RA, SLE or primary SS, and 5 were healthy first degree relatives. Anti-La (SSB) antibodies were detected in only one family member with primary SS. Secondary SS was evident in 5 patients with RA, 3 of whom had anti-Ro antibodies; HLA-DR4 was present in 7 of 9 patients with RA (78%) but in only 7 of 26 asymptomatic relatives (27%) (p less than 0.05). All patients with RA and their relatives who had anti-Ro antibodies were found to have HLA-DR4. Our results demonstrate that anti-Ro antibodies are present in relatives of patients with RA and are strongly associated with HLA-DR4.     

Anti-Ro(SSA) positive rheumatoid arthritis (RA): a clinicoserological group of patients with high incidence of D-penicillamine side effects.

The clinical, laboratory, histological, and radiological manifestations of 90 Greek patients with anti-Ro(SSA) negative rheumatoid arthritis (RA) were compared with those of 15 Greek patients with anti-Ro(SSA) positive RA. Anti-Ro(SSA) positive RA patients had the same articular and extra-articular manifestations as anti-Ro(SSA) negative patients. However, they were predominantly females with lower rheumatoid factor titres and a high incidence of positive minor salivary gland biopsy specimens for Sjögren''s syndrome. Finally, anti-Ro(SSA) positive RA patients frequently experienced penicillamine side effects.     

Fluctuation of anti-Ro/SS-A antibody levels in patients with systemic lupus erythematosus and Sjögren's syndrome: a prospective study

OBJECTIVE: To determine whether the titers of anti-Ro/SS-A (Ro) antibodies fluctuate during the course of SLE and Sj?gren's syndrome (SS) in parallel with disease activity, and if such fluctuations could be used to predict disease flares. We also evaluated whether the anti-Ro profile (anti-Ro 52, anti-Ro 60) changes over time, since such information could provide new insights into the induction and regulation of anti-Ro autoimmunity. METHODS: Sixteen patients with SLE and 15 patients with SS, all anti-Ro/SS-A antibody positive, were followed up for two years at three-month intervals. Clinical and laboratory parameters of disease activity were examined. Determination of the anti-Ro/SS-A titer was performed by counterimmunoelectrophoresis and the fine anti-Ro antibody specificity was determined by immunoblotting. RESULTS: The titers of anti-Ro antibodies fluctuated during the course of the illness in both SLE and SS patients. In SLE patients these changes were not (except in one case) associated with disease activity nor were they predictive of disease flares. The same was true for the SS patients, with the exception of two patients with skin vasculitis in whom anti-Ro antibody titers fluctuated in parallel with the disease activity. The anti-Ro antibody (anti-Ro 60 kD, anti-Ro 52 kD) specificity did not change in any of the patients during the follow-up period. CONCLUSION: Anti-Ro antibodies could represent a valuable indicator of disease activity in SS patients with cutaneous disorders. They do not, on the other hand, reflect disease activity in patients with SLE. The stable antibody profile in both SLE and SS patients supports the hypothesis that autoantibody production is predominantly genetically regulated.     

PREVALENCE AND CLINICAL SIGNIFICANCE OF ANTIBODIES TO RIBONUCLEOPROTEINS IN SYSTEMIC LUPUS ERYTHEMATOSUS IN MALAYSIA

One hundred and seventy patients with systemic lupus erytbematosus(SLE) were studied for the prevalence of antibodies to the smallRNA-associated proteins Ro/SSA, La/SSB, Sm, UIRNP and Sm. Therelationship of these autoantibodies to different races, sexesand clinical manifestations of SLE was evaluated. Passive immunodiffusionwas employed using human spleen extract as antigen source forRo and rabbit thymus extract for La, Sm and UIRNP. We foundthe prevalence of antibodies to be as follows: anti-Ro/SSA,36%; anti-La/SSB, 8%; anti-Sm, 15%; anti-UIRNP, 21%. Exceptfor a low prevalence of anti-La, the prevalence of these antibodieswas similar to that in Western studies. The prevalence of anti-Ro/SSAis similar to that reported in the Western studies, but lowerthan that reported in other Oriental patients from Singaporeand Hong Kong. Linkages of anti-Ro with anti-La antibodies wereusual; however, although anti-Sm antibodies were usually associatedwith anti-UIRNP, they were more frequently associated with anti-Roantibodies. The Malay patients had a high prevalence of anti-UIRNPcompared to other races. No gender difference was detected.Anti-Sm antibody was associated with scrositis and anti-UIRNPantibodies with Raynaud's phenomenon. No association was foundbetween the presence of skin, renal or cerebral manifestationsand any specific antibodies or combination of antibodies. KEY WORDS: Systemic lupus erythematosus, Racial comparison, Ro/SSA, La/SSB, Sm, UIRNP     

The importance of alpha-fodrin antibodies in the diagnosis of Sjögren’s syndrome

Objective: We wanted to determine the prevalence of IgA and IgG antibodies against alpha-fodrin in the patients with primary and secondary Sjögrens syndrome (SS) and also to compare with anti-Ro and anti-La antibodies in the diagnosis of SS. Methods: We tested the prevalence of anti-alpha-fodrin IgA, IgG, anti-Ro, anti-La antibodies, anti-nuclear antibodies (ANA) and rheumatoid factor (RF) in naive patients with primary (n=20) and secondary SS (n=20) (Rheumatoid Arthritis [RA]+SS, n=10; Systemic Lupus Erythematosus [SLE]+SS, n=10), RA (n=10), SLE (n=10) and in healthy controls (n=20). Salivary gland biopsies were performed in the patients with primary and secondary SS. Results: In primary SS, anti-alpha-fodrin IgA, IgG, anti-Ro and anti-La antibodies were detected as 20, 10, 55 and 20% respectively. In RA+SS, anti-alpha-fodrin IgA was detected to be 10% and IgG was negative; however, anti-Ro antibodies and anti-La antibodies were found to be 40% and 20% respectively. In SLE+SS, anti-alpha-fodrin IgA was found to be 20% and IgG was found to be 10%, but anti-Ro and anti-La antibodies were found to be 90% and 20% respectively. Alpha-fodrin antibodies were not detected in RA, SLE and healthy controls. Conclusion: The detection of anti-alpha-fodrin antibodies by used ELISA does not give much contribution to the diagnosis of SS, and anti-Ro and anti-La are still useful serological markers in the diagnosis of SS.     

Anti-Sm-RNP activity in sera of patients with rheumatic and autoimmune diseases

Summary The sera of various rheumatic and autoimmune diseases were examined for the presence of anti- RNP/Sm activity. An enzymelinked immunosorbent assay (ELISA) was employed. Anti- RNP Ab's were detected in 18%, 20%, 28%, 16% of the sera of SLE, myasthenia gravis (MG), rheumatoid arthritis (RA) and thyroid diseases respectively. The anti- RNP Ab's belonged to the IgG and IgM isotypes. Most of the IgG anti- Sm antibodies were detected in SLE sera, but they were found also in two sera of MG and in one sera of RA patients. IgM anti- Sm antibodies were not found in SLE sera, but they were detected in low titer in MG, RA and autoimmune thyroid diseases. The activity against RNP and/or Sm was further confirmed by employing immunoblotting assays. In none of the patients, except those with SLE, was any clinical manifestation of SLE noted. The mere presence of anti- Sm antibodies of the IgG isotypes is not sufficient for the development of SLE, however, its presence is highly specific for SLE.     

Pregnancy outcome and autoantibodies in connective tissue disease

Pregnancy outcome before and after onset of disease and the association with present levels of anticardiolipin antibodies (aCL) and other autoantibodies were investigated in rheumatoid arthritis (RA) (117 patients), systemic lupus erythematosus (SLE) (74 patients), and systemic sclerosis (28 patients). Although 78% of the 81 pregnancies in patients with systemic sclerosis occurred before disease onset, pregnancy loss rate was highest in this disease (44%) but in RA (17%) and SLE (18%) was similar to a control population (16%). Elevated levels of IgG aCL were present in one of 4 patients with RA, in one of 5 patients with systemic sclerosis and in the only patient with SLE to have recurrent previous pregnancy loss. Congenital heart block occurred in one of 28 pregnancies from 17 anti-Ro (SSA) positive women with SLE.     

IgG subclasses in systemic lupus erythematosus and other autoimmune rheumatic diseases.

In this study the concentration of the different subclasses of IgG in sera from patients with a range of autoimmune rheumatic diseases (ARD) was detected by radial immunodiffusion. In the second part the IgG subclasses of autoantibodies that recognize single-stranded DNA (ssDNA), double-stranded DNA (dsDNA), Ro, La, Sm and RNP in patients with ARD were measured by enzyme-linked immunosorbent assay. We studied 15 patients with lupus, 20 patients each with primary and secondary Sj?gren's syndrome (SS) and 10 each with rheumatoid arthritis (RA), scleroderma and myositis. Twenty healthy controls were also measured. The serum concentration of IgG2 in ARD patients was generally reduced. In contrast, the concentrations of IgG1, IgG3 and IgG4 subclasses were normal or raised. A high degree of correspondence in the IgG1, IgG2 and IgG3 responses to dsDNA and ssDNA in SLE was found. Notable differences in the IgG1 anti-Ro and ssDNA responses compared to the other subclasses were seen in 1 degree and 2 degrees SS. In addition, an unexpected high level of IgG4 antibodies to ssDNA in 1 degree SS (65%) and IgG4 antibodies to Sm/RNP in RA was observed.     

Possible association between anti-Ro antibodies and myocarditis or cardiac conduction defects in adults with systemic lupus erythematosus.

In view of the association of congenital heart block with maternal antibody to cellular antigen Ro (SSA), and one report linking anti-Ro with myocarditis in a patient with myositis an association between anti-Ro antibodies and cardiac disease was sought in adults with systemic lupus erythematosus (SLE). Among 67 patients with SLE, of whom 36 were anti-Ro positive, a significantly higher prevalence of myocarditis and conduction defects was found in the anti-Ro positive group (eight of 36) than in those who were anti-Ro negative (one of 31) and healthy controls (one of 50). Of the 36 anti-Ro positive patients with SLE, three had symptoms diagnostic of myocarditis, and an electrocardiogram showed first degree atrioventricular block and unifascicular block in three cases (including one with myocarditis), right bundle branch block alone (two cases), and first degree atrioventricular block alone (one case). Complete atrioventricular block was not seen. In the anti-Ro negative group there was no myocarditis and only one case of conduction defect (right bundle branch block). Among healthy controls only one of 50 had first degree atrioventricular block. It is concluded that myocarditis and conduction defects are reasonably common in adults with SLE and are associated with anti-Ro antibodies.     

Diagnostic and prognostic significance of different antinuclear antibodies in more than 1000 consecutive Albanian patients with rheumatic diseases.

In an unselected population of 1390 consecutive Albanian patients with rheumatic diseases (RD) and other miscellaneous non-rheumatic diseases (MNRD), for whom antinuclear antibody (ANA) testing was requested, we calculated the diagnostic sensitivity, specificity and positive predictive value (PPV) of ANA positive results, ANA titres over 1:100, anti-native DNA (nDNA), anti-Sm, anti-U1 RNP, anti-SSA (Ro) anti-SSB (La) and anti-non-identified extractable nuclear antigen (NIENA) antibodies. The PPVs of these ANA types were found to be appreciable only for systemic lupus erythematosus (SLE); only the positive predictive value of ANA for SLE (26.4%) was lower than that for RA (34.3%). The anti-snRNP (Sm/U1RNP) positive SLE patients were more likely to have over 4 of the ARA criteria for SLE, ANA titres over 1:100, and anti-nDNA antibodies, in contrast with the anti-snRNP negative subgroup. On the other hand, the anti-ENA positive and anti-nDNA positive SLE patients generally showed higher frequencies of renal disease, over 4 of the criteria for SLE and ANA titres over 1:100, compared to anti-ENA positive and anti-nDNA negative patients. Our data suggest that the association of anti-snRNP antibodies with a more severe form of SLE is not to be attributed to these antibodies themselves, but rather to their close association with the concomitant presence of anti-nDNA antibodies.     

Diagnostic associations in a large and consecutively identified population positive for anti-SSA and/or anti-SSB: the range of associated diseases differs according to the detailed serotype

Objective: To determine the diagnostic distribution in a consecutive anti-SSA and/or anti-SSB positive population. Methods: A total of 15 937 serum samples from 10 550 consecutive patients were analysed for antinuclear antibodies (ANAs) on HEp-2 cells. Serum samples positive for ANAs were analysed by immunodiffusion and line immunoassay with recombinant SSA-Ro52, natural SSA-Ro60, and recombinant SSB. Results: Among ANA positive patients in whom clinical information was available, 181 consecutive patients with anti-SSA and/or anti-SSB antibodies were identified, Disease associations were systemic lupus erythematosus (SLE) (45.3%), primary Sjögren''s syndrome (pSS) (14.4%), scleroderma (8.8%), RA (7.7%), cutaneous lupus (7.7%), and dermatomyositis (2.2%). The ratio of diagnoses differed according to the anti-SSA/anti-SSB serotype. Scleroderma and dermatomyositis were enriched among mono-Ro52 reactive serum samples (34.2% and 10.5% respectively). Single reactivity towards Ro60 or anti-Ro60 with anti-Ro52 predisposed for SLE (80.0% and 52.2% respectively). Triple reactivity towards Ro52, Ro60, and SSB was primarily linked with SLE (55.8%) followed by pSS (20.9%). Anti-SSA on immunodiffusion increased the chance for SLE (62.8%), whereas isolated anti-SSB reactivity on immunodiffusion was less indicative for SLE (14.3%) and predisposed more for cutaneous lupus (23.8%) and pSS (33.3%). Conclusion: The diagnostic range associated with anti-SSA or anti-SSB reactivity differs significantly according to the detailed serotype defined by line immunoassay and immunodiffusion.     

Serologic subsets in systemic lupus erythematosus

A search for anti-Ro or anti-nRNP antibodies by precipitin analysis among a population of 64 patients with systemic lupus erythematosus (SLE) or mixed connective tissue disease was undertaken. The 25% of SLE patients with anti-Ro did not have any distinct clinical features, compared to patients without anti-Ro or to anti-nRNP patients with SLE or mixed connective tissue disease. However, these patients did have a significantly greater frequency of rheumatoid factor (80%). Most importantly however, patients with anti-Ro had a significantly increased frequency of HLA-B8 (81%) and HLA-DRw3 (100%) compared to patients with anti-nRNP (B8—29%; DRw3—33%) or SLE patients without such antibodies (B8—41%; DRw3—25%). These data suggest the existence of a specific immune response gene for Ro close to the D region of the major histocompatibility complex.     

Anti-Ro/SSA antibodies in rheumatoid arthritis: clinical and immunologic associations

OBJECTIVE: To assess the prevalence of anti-Ro/SSA in RA and to analyse clinical and serological features of anti-Ro/SSA positive patients with RA. METHODS: 195 consecutive patients affected by RA were studied by counterimmunoelectrophoresis and ELISA for the detection of anti-Ro/SSA antibodies. Anti-Ro were found in 12 patients, with a prevalence of 6%. These 12 patients were pooled with other 15 patients known to have anti-Ro/SSA antibodies and RA, in order to evaluate their clinical and laboratory features. RESULTS: Anti-Ro positive patients showed a common pattern of joint involvement at onset and a comparable progression of disease compared to anti-Ro negative subjects. In addition, extra-articular manifestations (such as xerophthalmia, xerostomia, scleritis, oral ulcers and amyloidosis) and peculiar autoantibody profile (hypergammaglobulinemia, anti-dsDNA and AMA) were found significantly associated to anti-Ro/SSA positivity. Even though DMARDs withdrawals were more frequently detected in anti-Ro/SSA patients, especially when using gold salts, no statistical difference between the two groups was detected. In addition, anti-TNFalpha treatment did not cause further progression of autoimmunity neither on laboratory nor on clinical ground. CONCLUSION: Anti-Ro/SSA can be detected in about 6% of patients affected by RA. These patients presented a peculiar clinical picture characterised by extra-articular manifestations some of which are known to be anti-Ro/SSA correlated, while others are more disease-specific (amyloidosis, episcleritis). Anti-Ro/SSA are significantly associated with other autoantibodies not specific for RA such as anti-dsDNA and AMA. Treatment with anti-TNF drugs did not cause further progression of autoimmunity neither on laboratory nor on clinical ground.     

Use of anti-citrullinated peptide and anti-RA33 antibodies in distinguishing erosive arthritis in patients with systemic lupus erythematosus and rheumatoid arthritis

OBJECTIVES: Systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) can both present with an erosive arthritis with the small joints of the hands affected. Therefore a serological marker would be useful to distinguish between these two diseases at onset. In this study anti-RA33 antibodies, which are found in patients with SLE and RA, and anti-citrullinated peptide antibodies (anti-CCP), which have recently been described as highly specific for RA, were assessed. METHODS: Two hundred and thirty one patients receiving long term follow up for SLE were evaluated for arthritis and classified as erosive and non-erosive disease. Sixty six patients were tested for anti-RA33 and anti-CCP antibodies. All the patients were tested for rheumatoid factor (RF) and HLA-DR4 status. RESULTS: Ten patients had erosive disease, six of whom were RF positive (60%), and six anti-RA33 positive (60%), whereas only two were anti-CCP positive (20%). Two hundred and twenty one patients had non-erosive disease, 40 of whom were RF positive (18%), 14 were anti-RA33 positive (6%), whereas only one patient was found to be anti-CCP positive (0.5%). CONCLUSION: The presence of anti-CCP antibodies may be useful in distinguishing RA from erosive SLE. Anti-RA33 antibodies and RF are unhelpful.     

HLA alloantigens in Greek patients with systemic lupus erythematosus

The frequency of the HLA-A, -B and -DR alloantigens was studied in 74 unselected, consecutive, unrelated Greek patients with systemic lupus erythematosus (SLE) and the results were compared with those of healthy controls (380 for the class I antigens and 154 for the class II antigens). No statistically significant differences were noted between patients and controls regarding the prevalence of any class II antigen. Furthermore, no such differences were observed between our 36 anti-Ro (SSA) positive and the rest of our SLE patients. However, the coexistence of anti-Ro (SSA) and anti-La (SSB) antibodies (9 patients) correlated significantly with HLA-B8, whereas the haplotype HLA-B8DR3 was more common in the anti-Ro (SSA) positive patients than in the rest-although the difference did not reach statistical significance. The combination of high anti-ds-DNA and low C4 serum levels correlated with absence of HLA-DR5. Our findings, while in agreement with those of certain previous studies, are somewhat different from those of others. The differences may at least partly be related to variations in the control populations employed. On the other hand some of the differences, in accordance with other peculiarities of Greeks with connective tissue disease, emphasize the role of racial and/or ethnic background in the HLA-association of various autoimmune diseases and the fact that the detectable HLA alloantigens in certain diseases modify disease and autoantibody expression rather than being responsible for the autoimmune process itself.     

Pregnancy outcome in 100 women with autoimmune diseases and anti-Ro/SSA antibodies: a prospective controlled study

Anti-Ro/SSA antibodies are associated with neonatal lupus but are also considered a possible cause for unexplained pregnancy loss and adverse pregnancy outcome. In a large multicentres cohort study we have prospectively followed 100 anti-Ro/SSA positive women (53 systemic lupus erythematosus (SLE)) during their 122 pregnancies and 107 anti-Ro/SSA negative women (58 SLE) (140 pregnancies). Anti-Ro/SSA antibodies were tested by immunoblot and counterimunoelectrophoresis. Mean gestational age at delivery (38 vs 37.9 weeks), prevalence of pregnancy loss (9.9 vs 18.6%), preterm birth (21.3 vs 13.9%), cesarean sections (49.2 vs 53.4%), premature rupture of membranes (4.9 vs 8.1%), preeclampsia (6.6 vs 8%), intrauterine growth retardation (0 vs 2.3%)and newborns small for gestational age (11.5 vs 5.8%) were similar in anti-Ro/SSA positive and negative SLE mothers; findings were similar in non-SLE women. Two cases of congenital heart block were observed out of 100 anti-Ro/SSA positive women. In conclusion, anti-Ro/SSA antibodies are responsible for congenital heart block but do not affect other pregnancy outcomes, both in SLE and in non-SLE women. The general outcome of these pregnancies is now very good, ifprospectively followed by multidisciplinary teams with ample experience in this field.     

Distinct antibody profile: a clue to primary antiphospholipid syndrome evolving into systemic lupus erythematosus?

We have performed a retrospective study to determine if patients with antiphospholipid syndrome that developed systemic lupus erythematosus (APS/SLE) had distinct clinical and/or serological features. All 80 primary APS (PAPS) patients followed up at our APS unit were included in the study and divided into two groups: 14 APS/SLE and 66 PAPS. Prior or at onset of lupus manifestations, six patients were uniformly negative for lupus and Sjögren autoantibodies, and the other eight patients had persistent positive. In the first year after diagnosis of SLE, three patients remained with negative antibodies, the other seven patients maintained the same antibodies, and four patients developed other antibodies. APS/SLE group had a significant lower mean age at PAPS diagnosis (26.0?±?8.0 vs. 34.2?±?11.9 years, p?=?0.03) and a longer disease duration (14.0?±?7.0 vs. 6.0?±?5.0 years, p?<?0.0001). The mean time for PAPS to develop SLE was 5.2?±?4.3 years. The typical clinical and laboratorial findings of APS did not discriminate both groups of patients. At lupus onset, antinuclear antibodies were more frequently observed in those who evolved to SLE (100 vs. 51.5 %, p?=?0.0005). Anti-double-stranded DNA (dsDNA), anti-ribosomal P, anti-Ro/SS-A, anti-La/SS-B, and anti-U1RNP antibodies were exclusively found in the APS/SLE patients, whereas anti-Smith (Sm) antibodies were not detected in both groups. The detection of a distinct subgroup of lupus-associated autoantibody in PAPS patients seems to be a hint to overt SLE disease, particularly in those patients with young age at diagnosis.     

Sj?gren's syndrome. Influence of multiple HLA-D region alloantigens on clinical and serologic expression

The relationships of HLA-DR and the newer DS (second D locus) B cell alloantigens (MB and MT) to the clinical and serologic expression of primary and secondary forms of Sj?gren's syndrome (SS) were examined in 102 patients (86 whites and 16 blacks). Although HLA-DR3 was significantly increased in whites (25 of 50, 50%) and blacks (4 of 5, 80%) with primary SS compared with race-matched normal controls, it was not appreciably elevated in those with systemic lupus erythematosus (SLE)-SS, rheumatoid arthritis (RA)-SS, or connective tissue disease-SS. The MT2 specificity, however, was more strongly associated with primary SS (86% of whites and 100% of blacks) and also with SLE-SS and RA-SS compared with race-matched normal controls. Furthermore, MT2 was significantly increased in SLE-SS and RA-SS when compared with non-sicca SLE and RA controls. Although primary and secondary SS were most strongly associated with this DS specificity (MT2), the anti-Ro (SS-A) and anti-La (SS-B) antibody responses were more closely allied to DR antigens. HLA-DR3 was increased in anti-Ro positive patients, both whites and blacks, with primary SS (74%) and in total anti-Ro positive subjects (54%) compared with their anti-Ro negative counterparts (38% and 31%, respectively). Among DR3 negative patients, HLA-DR2 correlated with anti-Ro in both primary SS (83%) and in the total SS group (58%). Thus, 96% of Ro antibody positive patients with primary SS had DR3 and/or DR2, as did 80% of anti-Ro positive subjects in all categories.(ABSTRACT TRUNCATED AT 250 WORDS)