Association of anti-Ro52, anti-Ro60 and anti-La antibodies with diagnostic, clinical and laboratory features in a referral hospital in Jerez, Spain / Asociación de los anticuerpos anti-Ro52, anti-Ro60 y anti-La con las características diagnósticas, clínicas y de laboratorio en un hospital de referencia en Jerez, España

Objective. Several antibodies have proven to be useful in autoimmune diseases, as markers for diagnosis, prognosis or clinical manifestations. Our objective was to evaluate the diagnosis and manifestations associated for antibodies anti-Ro52, anti-Ro60 and anti-La at a referral hospital in Spain. Methods. We retrospectively analyzed the antigenic specificities of the consecutive samples submitted to the Immunology Unit for antinuclear antibody screening between 2002 and 2012. We included patients with more than one positive sample for some of the autoantibodies anti-Ro52, anti-Ro60 or anti-La. We also reviewed diagnosis, clinical and laboratory features. As dependent variable we evaluated possible combinations of anti-Ro52, anti-Ro60 and anti-La. Results. 322 patients, 91% females, were studied (age 44.3±15.51 years). The most frequent diagnosis was Sjögren's syndrome (40.06%) and systemic lupus erythematosus (SLE) (36.6%). The most prevalent pattern by indirect immunofluorescence was the fine speckled (69.9%). Anti-Ro52+/anti-Ro60+/anti-La+ combination was positively associated with fine speckled pattern (p: 0.001) and negatively with homogeneous (p: 0.016) and cytoplasmic pattern (p: 0.002). Isolated anti-Ro52+ was negatively associated with fine speckled pattern (p<0.001) and positively with the cytoplasmic one (p<0.001). The main positive associations with clinical symptoms were xerostomia and xerophthalmia with anti-Ro52+/anti-Ro60+/anti-La+ (p<0.001), oral ulcers with anti-Ro52+/anti-Ro60+/anti-La− (p: 0.002) and alopecia with anti-Ro52−/anti-Ro60+/anti-La− (p: 0.003). Negative associations were xerophthalmia and photosensitivity with anti-Ro52+/anti-Ro60−/anti-La− (p: 0.003). Laboratory positive associations were hypergammaglobulinemia with anti-Ro52+/anti-Ro60+/anti-La+ (p: 0.003), and hypocomplementemia with anti-Ro52−/anti-Ro60+/anti-La− (p: 0.003). Leucopenia was negatively associated with anti-Ro52+/anti-Ro60−/anti-La− (p: 0.003). Conclusion. Our study found significant relationships between clinical and laboratory manifestations with different patterns of antibodies to anti-Ro52, anti-Ro60 and anti-La. The combination of antibodies might be clinically useful due to prognostic and therapeutic implications (AU)

Objetivo. Varios anticuerpos han demostrado ser útiles en enfermedades autoinmunes, como marcadores de diagnóstico, pronóstico o manifestaciones clínicas. Nuestro objetivo fue evaluar el diagnóstico y las manifestaciones asociadas a anticuerpos anti-Ro52, anti-Ro60 y anti-La en un hospital de referencia en España. Métodos. Se analizaron retrospectivamente las especificidades antigénicas de todas las muestras consecutivas solicitadas a la Unidad de Inmunología para la detección de anticuerpos antinucleares entre 2002 y 2012. Se incluyeron pacientes con más de una muestra positiva para algunos de los autoanticuerpos anti-Ro52, anti-Ro60 o anti-La, y se revisaron sus características diagnósticas, clínicas y de laboratorio. Como variable dependiente se evaluaron las combinaciones de anti-Ro52, anti-Ro60 y anti-La. Resultados. 322 pacientes, 91% mujeres, fueron estudiados (edad 44.3±15.51 años). El diagnóstico más frecuente fue el síndrome de Sjögren (40.06%), y el lupus eritematoso sistémico (LES) (36.6%). El patrón por inmunofluorescencia indirecta más prevalente fue el moteado fino (69.9%). La combinación Anti-Ro52+/anti-Ro60+/anti-La+ se asoció positivamente con el patrón moteado fino (p: 0.001) y negativamente con el homogéneo (p: 0.016) y el citoplasmático (p: 0.002). Anti-Ro52+ aislado se asoció negativamente con el patrón moteado fino (p<0.001) y positivamente con el citoplasmático (p<0.001). La principal asociación con síntomas clínicos fue de xerostomía y xeroftalmia con anti-Ro52+/anti-Ro60+/anti-La+ (p<0.001), úlceras orales con anti-Ro52+/anti-Ro60+/anti-La− (p: 0.002) y alopecia con anti-Ro52−/anti-Ro60+/anti-La−. Asociaciones negativas fueron xeroftalmia y fotosensibilidad con anti-Ro52+/anti-Ro60−/anti-La− (p: 0.003). Asociaciones positivas de laboratorio fueron hipergammaglobulinemia con anti-Ro52+/anti-Ro60+/anti-La+ (p: 0.003) e hipocomplementemia con anti-Ro52−/anti-Ro60+/anti-La− (p: 0.003). Leucopenia se asoció negativamente con anti-Ro52+/anti-Ro60−/anti-La− (p: 0.003). Conclusión. Nuestro estudio encontró una relación significativa entre las manifestaciones clínicas y de laboratorio con diferentes patrones de anticuerpos anti-Ro52, anti-Ro60 y anti-La. La combinación de anticuerpos podría ser clínicamente útil, debido a implicaciones pronósticas y terapéuticas (AU)

Association of anti-Ro52, anti-Ro60 and anti-La antibodies with diagnostic, clinical and laboratory features in a referral hospital in Jerez, Spain.

OBJECTIVE: Several antibodies have proven to be useful in autoimmune diseases, as markers for diagnosis, prognosis or clinical manifestations. Our objective was to evaluate the diagnosis and manifestations associated for antibodies anti-Ro52, anti-Ro60 and anti-La at a referral hospital in Spain. METHODS: We retrospectively analyzed the antigenic specificities of the consecutive samples submitted to the Immunology Unit for antinuclear antibody screening between 2002 and 2012. We included patients with more than one positive sample for some of the autoantibodies anti-Ro52, anti-Ro60 or anti-La. We also reviewed diagnosis, clinical and laboratory features. As dependent variable we evaluated possible combinations of anti-Ro52, anti-Ro60 and anti-La. RESULTS: 322 patients, 91% females, were studied (age 44.3±15.51 years). The most frequent diagnosis was Sjögren's syndrome (40.06%) and systemic lupus erythematosus (SLE) (36.6%). The most prevalent pattern by indirect immunofluorescence was the fine speckled (69.9%). Anti-Ro52+/anti-Ro60+/anti-La+ combination was positively associated with fine speckled pattern (p: 0.001) and negatively with homogeneous (p: 0.016) and cytoplasmic pattern (p: 0.002). Isolated anti-Ro52+ was negatively associated with fine speckled pattern (p<0.001) and positively with the cytoplasmic one (p<0.001). The main positive associations with clinical symptoms were xerostomia and xerophthalmia with anti-Ro52+/anti-Ro60+/anti-La+ (p<0.001), oral ulcers with anti-Ro52+/anti-Ro60+/anti-La- (p: 0.002) and alopecia with anti-Ro52-/anti-Ro60+/anti-La- (p: 0.003). Negative associations were xerophthalmia and photosensitivity with anti-Ro52+/anti-Ro60-/anti-La- (p: 0.003). Laboratory positive associations were hypergammaglobulinemia with anti-Ro52+/anti-Ro60+/anti-La+ (p: 0.003), and hypocomplementemia with anti-Ro52-/anti-Ro60+/anti-La- (p: 0.003). Leucopenia was negatively associated with anti-Ro52+/anti-Ro60-/anti-La- (p: 0.003). CONCLUSION: Our study found significant relationships between clinical and laboratory manifestations with different patterns of antibodies to anti-Ro52, anti-Ro60 and anti-La. The combination of antibodies might be clinically useful due to prognostic and therapeutic implications.

Antagonistas del TNF. Nuevos datos de eficacia / Anti-TNF drugs: new results on efficacy

Los antagonistas del TNF (tumor necrosis factor ‘factor de necrosis tumoral’) han significado un gran avance en el tratamiento de la artritis reumatoide (AR) desde su introducción a finales de la década de 1990. El desarrollo de producto ha sido similar para los 3 anti-TNF licenciados en la actualidad para el tratamiento de la AR: etanercept, infliximab y adalimumab. Los primeros estudios se centraron en los pacientes con enfermedad activa y refractaria a varios tratamientos modificadores de la enfermedad, por lo que se han obtenido diferencias muy significativas frente a placebo o metotrexato (MTX) en los índices de mejoría del American College of Rheumatology (ACR). Los ensayos en los pacientes no tratados con MTX muestran una diferencia menos notable entre los anti-TNF y el MTX, que se hace más significativa para la combinación de MTX con anti-TNF. En este manuscrito se analizan los resultados de los estudios de registro de los anti-TNF así como otros índices de mejoría, como calidad de vida, reducción del riesgo cardiovascular, efectividad mantenida en el tiempo y progresión de lesiones articulares. También se plantea la posibilidad de tratar con dosis menores a las autorizadas para AR y se analiza la afección de mal pronóstico de los pacientes refractarios a MTX, que actualmente es la indicación para el uso de anti-TNF en AR según el consenso de la Sociedad Española de Reumatología (AU)

Anti-TNF drugs have represented a great advancement in the treatment of rheumatoid arthritis since their introduction in the late 1990s. The development of these products has been very similar for etanercept, infliximab and adalimumab, the 3 approved TNF blockers for the treatment of RA. The first studies centered their attention on patients with active disease and refractory to several disease modifying treatments, finding very significant differences when compared to placebo or methotrexate in the ACR improvement scores. Trials in patients who had not been previously treated with methotrexate show less differences between anti-TNF and methotrexate, but becomes more significant when the two drugs are used combined. In this manuscript we analyze the results of the registry of anti-TNF studies with regard to other improvement indexes such as quality of life, reduction in cardiovascular risk, maintained efficacy through time and progression of joint erosions. We also contemplate the possibility of using lower doses than those authorized for rheumatoid arthritis and analyze factors related to a poor prognosis in patients refractory to methotrexate, which is currently the indication for the use of anti-TNF in RA accordiong to the SER consensus (AU)

[Anti-TNF drugs: New results on efficacy]. / Antagonistas del TNF. Nuevos datos de eficacia.

Anti-TNF drugs have represented a great advancement in the treatment of rheumatoid arthritis since their introduction in the late 1990s. The development of these products has been very similar for etanercept, infliximab and adalimumab, the 3 approved TNF blockers for the treatment of RA. The first studies centered their attention on patients with active disease and refractory to several disease modifying treatments, finding very significant differences when compared to placebo or methotrexate in the ACR improvement scores. Trials in patients who had not been previously treated with methotrexate show less differences between anti-TNF and methotrexate, but becomes more significant when the two drugs are used combined. In this manuscript we analyze the results of the registry of anti-TNF studies with regard to other improvement indexes such as quality of life, reduction in cardiovascular risk, maintained efficacy through time and progression of joint erosions. We also contemplate the possibility of using lower doses than those authorized for rheumatoid arthritis and analyze factors related to a poor prognosis in patients refractory to methotrexate, which is currently the indication for the use of anti-TNF in RA accordiong to the SER consensus.