Autoantibodies to extractable nuclear antigens (ENAs) pattern in rheumatoid arthritis patients: Relevance and clinical implications

Yasser Emad; Yasser Ragab; Nevin Hammam; Nashwa El-Shaarawy; Ossama Ibrahim; Rania M Gamal; Magdy Abd-Elsalam; Reem H A Mohammed; Mona Hawass; Johannes J Rasker

doi:10.1016/j.reuma.2019.10.001

Autoantibodies to extractable nuclear antigens (ENAs) pattern in rheumatoid arthritis patients: Relevance and clinical implications

Reumatol Clin (Engl Ed). 2021 May;17(5):250-257. doi: 10.1016/j.reuma.2019.10.001. Epub 2019 Dec 4.

[Article in English, Spanish]

Authors

Affiliations

¹ Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt; Rheumatology Department, Dr. Erfan and Bagedo General Hospital, Jeddah, Saudi Arabia. Electronic address: [email protected].
² Radiology Department, Faculty of Medicine, Cairo University, Cairo, Egypt; Radiology Department, Dr. Erfan and Bagedo General Hospital, Jeddah, Saudi Arabia.
³ Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada; Rheumatology and Rehabilitation Department, Faculty of Medicine, Assiut University, Assiut, Egypt.
⁴ Rheumatology and Rehabilitation Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.
⁵ Morecambe Bay University Hospitals Lancaster, Lancashire, UK.
⁶ Rheumatology and Rehabilitation Department, Faculty of Medicine, Assiut University, Assiut, Egypt.
⁷ Chest Department, Faculty of Medicine, Ain Shams Faculty of Medicine, Cairo, Egypt.
⁸ Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
⁹ Nephrology Department, Al-Shorta Hospital, Cairo, Egypt.
¹⁰ Faculty of Behavioural, Management and Social Sciences, Department Psychology, Health and Technology, University of Twente, Enschede, The Netherlands.

PMID: 31812441
DOI: 10.1016/j.reuma.2019.10.001

Abstract

Objectives: To study the frequency of different autoantibodies to extractable nuclear antigens (ENAs) in rheumatoid arthritis (RA) patients and to correlate findings with clinical manifestations, disease activity and radiological damage.

Methods: A total of 230 RA patients were included and 75 healthy controls. In all patients rheumatological assessment was done and routine laboratory investigations and immune profile were performed in both patients and controls, including: RF, ACPA, ANA and anti-ENAs (Ro/SSA, La/SSB, U1-RNP, anti-Jo-1 and anti-Sm). Radiological damage was scored using Sharp/van der Heijde, and disease activity was evaluated by DAS28-ESR and DAS28-CRP.

Results: RF was positive in 101 (43.9%), ACPA in 220 (95.7%), ANA in 58 (25.2%), anti Ro in 31 (13.5%), anti-La in 10 (4.3%), anti-Jo1 in 5 (2.2%) and anti-RNP in 2 (0.9%). Anti-Ro/SSA positively correlated with sicca symptoms (p=.02), RF titer (p<.001), ANA (p<.001), DAS28-ESR (p=.026), and DAS28-CRP (p=.003). Anti-La antibodies correlated positively with SJC (p=.001), TJC (p=.001), ANA (p<.001), DAS-28 ESR (p=.007). Anti-Jo-1 correlated positively with interstitial lung disease (ILD) (p≤.001), RF titer (p=.037) and ANA (p≤.001). Anti-RNP antibodies correlated positively with disease duration (p≤.001), ACPA titer (p≤.001) and ANA (p=.014). In the controls ANA was positive in two (2.7%), anti-Ro in three (4%), and none of the controls tested positive for other autoantibodies.

Conclusions: In RA patients, positive ANA is frequent and positively associated with anti-Ro, anti-La and anti-Jo1 autoantibodies. Screening for autoantibodies against other anti-ENAs seems mandatory in RA patients especially when ANA is positive. RA cases with positive Anti-Jo-1 may develop anti synthetase syndrome and ILD.

Keywords: Anti Jo-1 autoantibody; Anti Jo-1 autoanticuerpo; Anti-synthetase syndrome; Anticitrullinated peptide/protein antibodies (ACPA); Anticuerpo antinuclear (ANA); Anticuerpos péptido/proteína anticitrulinados (ACPA); Antinuclear antibody (ANA); Antígenos nucleares extraíbles (ENA) autoanticuerpos; Artritis reumatoide (AR); Artritis reumatoide y superposición de sintetasa; Extractable nuclear antigens (ENAs) autoantibodies; Factor reumatoide (RF); Rheumatoid arthritis (RA); Rheumatoid arthritis and anti-synthetase overlap; Rheumatoid factor (RF); Síndrome anti-sintetasa.