From the Guidelines
A positive Sjögren's syndrome Antinuclear Antibody (ANA) extractable nuclear antigen (ENA) result with a titer of 8.0 is indicative of an autoimmune condition, likely Sjögren's syndrome, and requires further evaluation by a rheumatologist to confirm the diagnosis and initiate management. The presence of this antibody is found in approximately 70-90% of patients with Sjögren's syndrome, an autoimmune disorder that primarily affects moisture-producing glands, causing dry eyes and dry mouth 1. This positive result should be interpreted alongside clinical symptoms and other laboratory findings, as ANA ENA antibodies can also be found in other autoimmune conditions like systemic lupus erythematosus (SLE) and rheumatoid arthritis. Key considerations in the management of Sjögren's syndrome include:
- A multidisciplinary approach involving various health professionals, with a central role for specialists in autoimmune diseases 1
- The first therapeutic approach to dryness should be symptomatic relief using topical therapies, as more than 95% of Sjögren's syndrome patients present with sicca symptoms, which have a significant impact on the health-related quality of life (HRQoL) 1
- Systemic therapies may be considered for the treatment of active systemic disease, with glucocorticoids used at the minimum dose and length of time necessary to control active systemic disease 1
- Treatment of systemic disease should be tailored to organ-specific severity using the ESSDAI definitions, and immunosuppressive agents should be mainly used as GC-sparing agents 1. You should follow up with a rheumatologist who can perform additional tests such as lip biopsy, eye tests, or other antibody tests to confirm the diagnosis, as early diagnosis and management are important to prevent complications like dental problems, eye damage, or involvement of other organs such as lungs, kidneys, or the nervous system.
From the Research
Interpretation of Positive Sjögren's Syndrome Antinuclear Antibody (ANA) Extractable Nuclear Antigen (ENA) Result
- A positive Sjögren's syndrome ANA ENA result with a titer of 8.0 indicates the presence of autoantibodies associated with Sjögren's syndrome, a chronic autoimmune disease characterized by immune-mediated injury of exocrine glands 2.
- The detection of anti-Ro/SSA and anti-La/SSB antibodies is traditional biomarkers for disease classification and diagnosis, while novel autoantibodies such as anti-SP-1, anti-CA6, and anti-PSP may identify specific stages of the disease or clinical phenotypes 2, 3.
- The presence of ENA antibodies, including anti-SS-A (anti-Ro) and anti-SS-B (anti-La), is a key feature of Sjögren's syndrome, leading to chronic inflammation and symptoms such as xerostomia and keratoconjunctivitis sicca 3.
- A titer of 8.0 may indicate a significant level of autoantibody expression, which can be associated with disease activity and severity, although the exact correlation between titer levels and disease severity is not well established 4, 5.
- The interpretation of a positive ANA ENA result should be considered in the context of clinical symptoms, other laboratory tests, and medical history, as Sjögren's syndrome can present with a range of symptoms and may be associated with other autoimmune diseases 6, 5.