Isolated SS-B Not Associated with Connective Tissue Disease Save
A one-year prospective study of 624 patients undergoing autoantibody testing for anti-SS-A and/or anti-SS-B autoantibodies finds that isolated anti-SS-B autoantibodies was not associated with features or the diagnosis of any specific connective tissue diseases (CTD).
Isolate SS-B autoantibody positivity (SS-B-positive/SS-A negative autoantibody profile) was found in 84 of 624 patients referred for testing (13.5%). Only 20% were diagnosed with a CTD, including 4 systemic lupus erythematosus (5%), 4 rheumatoid arthritis (5%), 2 idiopathic inflammatory myositis (3%), 1 primary Sjögren's syndrome pSS (1%), 1 systemic sclerosis (1%), 2 undefined CTD (3%), and 1 mixed CTD (1%).
A variety of other non-CTD autoimmune diseases and non-autoimmune diseases were seen in the remaining patients.
Arthralgia was the most frequent finding seen in 10 patients (67%), of whom 3 had arthritis.
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Jack: I sure hope that clinicians do not read this abstract and title in a vacuum and assume "isolated SSB is not seen in CTDs!" I certainly have several SLE pts with this (SSB but neg SSA); this study actually had a 20% prevalence of CTD at evaluation. We must remind ourselves that autoantibodies can appear years before dz onset, and Sjogren's syndrome especially can have a slow/gradual onset over many years' time. I would change the wording to "Isolated SSB is seen with CTDs but is not specific for Sjogren's syndrome". Also, my plan for the patient with isolated SSB who does not currently have evidence for a CTD would be: educate the patient about the symptoms of CTD and see me ASAP if any occur, but also, I'd follow the patient clinically over time to see if a CTD does occur in the hopes of catching it at an early, more easily treated stage. (Reference: MR Arbuckle et al. N Engl J Med 2003;349:1526-33)
DT; I posted this as I thought it was thought provoking and your thoughtful comments are appreciated. While only 20% of these isolate SSB patients had a CTD, the smart rheumatologist would and should do as suggest. Counsel, educated, follow and manage Sxs until something more definitive occurs. I beleive we all see such patients, but not much is written about their fate or associations. JJC
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