From the Guidelines
Positive anti-Ro (SS-A) antibodies are a specific indicator of an autoimmune process, most commonly associated with Sjögren's syndrome, and require comprehensive clinical evaluation and management by a rheumatologist. These antibodies are often found in patients with Sjögren's syndrome, systemic lupus erythematosus (SLE), and other connective tissue disorders 1. The presence of anti-Ro (SS-A) antibodies reflects a breakdown in immune tolerance, leading to autoimmunity against self-antigens. According to the latest guidelines, patients with Sjögren's syndrome should be comanaged with a rheumatologist due to the many possible comorbid systemic conditions 1.
Clinical Evaluation and Management
Patients with positive anti-Ro (SS-A) antibodies should undergo a comprehensive assessment, including:
- Physical examination
- Additional laboratory tests, such as anti-La (SS-B), ANA, and inflammatory markers
- Evaluation of symptoms, including dry eyes, dry mouth, fatigue, and musculoskeletal pain
- Assessment of systemic manifestations, such as arthralgia, myalgia, or lymphoma
Treatment Options
Management depends on the diagnosed condition and may include:
- Hydroxychloroquine (200-400mg daily) for systemic manifestations
- Artificial tears for dry eyes
- Saliva substitutes for dry mouth
- Immunosuppressants for systemic manifestations
- Topical lubricants, topical anti-inflammatory therapy, and tear-conserving strategies for dry eye syndrome 1
Regular Monitoring
Regular monitoring is crucial, especially for pregnant women with these antibodies, as they carry a risk of neonatal lupus and congenital heart block in the fetus. The latest classification criteria for Sjögren's syndrome, based on the weighted sum of five items, including anti-SSA/Ro antibody positivity, should be used to diagnose and classify the condition 1.
From the Research
Positive Anti-Ro (SS-A) Ab
- The presence of anti-Ro (SS-A) antibodies is associated with extraglandular disease, such as vasculitis, purpura, and lymphadenopathy, in patients with Sjögren's syndrome 2.
- Anti-Ro (SS-A) antibodies are also associated with hematologic abnormalities, including anemia, leukopenia, and thrombocytopenia, as well as serologic hyperreactivity 2.
- The anti-Ro (SS-A) antibody is found in approximately 60% of patients with Sjögren's syndrome, but is not a specific marker for the disease 3.
- The antibody is directed against a ribonucleoprotein complex composed of small single-stranded RNAs and one or more peptides, and its function remains unknown 4.
- Anti-Ro (SS-A) antibody positivity has been associated with worse pulmonary outcome and reduced overall survival in patients with systemic sclerosis 5.
- High levels of anti-Ro (SS-A) and anti-La (SS-B) antibodies have been found in patients with purpura, leukopenia, lymphopenia, and increased polyclonal gamma globulins 6.
Clinical Associations
- Anti-Ro (SS-A) antibodies have been associated with:
- Extraglandular disease (vasculitis, purpura, lymphadenopathy) 2
- Hematologic abnormalities (anemia, leukopenia, thrombocytopenia) 2
- Serologic hyperreactivity 2
- Sjögren's syndrome overlap with systemic lupus erythematosus 3
- Congenital heart block in the offspring of anti-Ro (SS-A) and anti-La (SS-B) positive mothers 3
- Worse pulmonary outcome and reduced overall survival in systemic sclerosis 5
Laboratory Findings
- Anti-Ro (SS-A) antibodies can be detected using counter-immunoelectrophoresis, immunoblotting technique, ELISA, or RNA precipitation assays 3.
- The preferred method of screening for anti-Ro (SS-A) antibodies in human sera is counter-immunoelectrophoresis 3.
- High levels of anti-Ro (SS-A) and anti-La (SS-B) antibodies have been found in patients with certain clinical conditions, such as purpura and leukopenia 6.