From the Guidelines
High anti-SSA levels are a strong indicator of Sjögren's syndrome and other autoimmune conditions, warranting monitoring by a rheumatologist due to the potential for severe clinical manifestations and complications, as seen in the latest classification criteria proposed in the 2024 study 1. The presence of high anti-SSA antibody levels suggests an active immune response against SSA/Ro proteins, which are commonly found in autoimmune conditions such as Sjögren's syndrome, systemic lupus erythematosus (SLE), and certain forms of inflammatory myositis.
- High levels of anti-SSA antibodies may correlate with specific clinical manifestations, including dry eyes, dry mouth, joint pain, and skin rashes.
- In pregnant women, high anti-SSA antibodies are particularly concerning as they can cross the placenta and potentially cause neonatal lupus or congenital heart block in the developing fetus, as noted in the context of autoimmune diseases 1.
- The antibodies target intracellular proteins involved in RNA processing, and their presence reflects a breakdown in the body's ability to distinguish between self and non-self components.
- According to the 2024 study 1, the diagnosis and treatment of underlying systemic immune disorders may decrease morbidity and may even be lifesaving, highlighting the importance of monitoring and management by a rheumatologist.
- The 2020 EULAR recommendations for the management of Sjögren's syndrome 1 emphasize a multidisciplinary approach, with a central role for specialists in autoimmune diseases, and recommend symptomatic relief using topical therapies as the first therapeutic approach to dryness.
From the Research
High Anti-SSA Levels
A high anti-SSA (Sjögren's syndrome antigen) level is associated with several clinical manifestations, including:
- Extraglandular disease, such as vasculitis, purpura, and lymphadenopathy 2
- Hematologic abnormalities, including anemia, leukopenia, and thrombocytopenia 2
- Hyperglobulinemia, increased serologic reactivity, cryoglobulinemia, and hypocomplementemia 2
- A higher risk of developing lymphoma, especially in combination with other factors such as a high ESSDAI score, hypocomplementemia, cytopenia, or evidence of ectopic germinal centers in salivary gland biopsies 3
Disease Activity and Lymphocyte Subpopulations
High anti-SSA levels are also associated with distinct lymphocyte subpopulations, including:
- Increased IL-21+CD4+ and CD8+ T cells 4
- Higher levels of CD24HiCD38Hi B cells, naïve B cells, and IgM-/+CD38++ plasmablasts 4
- Lower levels of memory B cells, including CD24HiCD27+ B cells 4
- Positive correlations between ESSDAI and IL-21+CD4+ and IL-21+CD8+ T cells, suggesting involvement in disease pathogenesis and activity 4
Clinical Significance
The presence of anti-SSA antibodies defines a subset of patients with Sjögren's syndrome who have systemic clinical manifestations, including vasculitis, hematologic abnormalities, and serologic hyperreactivity 2. The identification of anti-SSA antibodies is necessary when corresponding diseases are suspected, and their specificity for the diagnosis of Sjögren's syndrome can be improved when combined with anti-SSB antibodies 5.