Rheumatoid factor isotype and Ro epitope distribution in primary Sjögren syndrome and rheumatoid arthritis with keratoconjunctivitis sicca
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Primary Sjögren syndrome (pS) is associated with autoantibodies such as rheumatoid factor (RF) and anti-nuclear antibodies such as anti-Ro (SS-A) and/or La (SS-B). Recent developments within autoimmune diagnostics allow quantitation of RF subclasses and anti-Ro epitopes. Will this refinement by autoimmune diagnostics help predicting development of extraglandular manifestations (EGM) in pS patients? A cohort of pS and rheumatoid arthritis (RA) patients with keratoconjunctivitis sicca (n = 35 and 16, resp) was included. Of the pS patients, 54% developed one or more EGM. Antibodies quantitated were IgM-RF, IgA-RF, IgG-RF, anti-Ro52, and anti-Ro60. Upon analysis of RF isotypes, pS patients generally displayed higher IgA-RF concentrations than RA patients (126 versus 49 U/ml, p = 0.015), while the dominant RF isotype in RA patients was IgM-RF (82.5 versus 38 U/ml, p = 0.012). No differences were observed regarding IgG-RF concentrations. In pS without/with EGM, the median RF IgM concentrations were similar, while RF IgA and IgG concentrations tended to be lower in pS patients with EGM > 1. Both Ro epitopes were strongly recognized by almost all pS patients, independent from EGM, while these antibodies were absent in RA patients. Primary Sjögren syndrome and RA patients have distinct serological profiles when analysing RF and Ro-specific antibodies. A longitudinal study of switched RF isotypes in pS patients is worthwhile from an immunological point of view, but its value is limited regarding identification of pS patients prone to developing EGM or RA patients prone to developing secondary sicca symptoms.
KeywordsSjögren Extraglandular manifestations Rheumatoid factor Ro Rheumatoid arthritis Isotype
We thank Anne Thus and Anja van Heugten-Roelink for their technical contributions.
All authors have substantially contributed to the submitted work. BM performed the research, collected and analysed the data, and wrote the manuscript. JK collected and analysed the data and edited the manuscript. AC supervised performance of the study and edited the manuscript. AJvH co-designed the study, provided expertise, co-supervised the project, and edited the manuscript. EJtB designed the study, collected the clinical data, supervised the project, and edited the manuscript.
Compliance with ethical standards
Conflict of interest
No conflicts of interest.
All procedures followed were in accordance with the Declaration of Helsinki. This is a retrospective study with the aim to improve clinical interpretation of routine laboratory diagnostic procedures using clinical data and samples from a published cohort, for which no additional informed consent is required.
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