Friday, 20 Jul 2018

You are here

Isolated SS-B Not Associated with Connective Tissue Disease

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.


The author has no conflicts of interest to disclose related to this subject

Rheumatologists' Comments

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

More Like This

Baricitinib Effective in SLE Trial

Dan Wallace and colleagues report in Lancet the results of a phase II study of the selective baricitinib is an oral selective Janus kinase (JAK1 and JAK2) inhibitor, baricitinib in Patients with systemic lupus erythematosus (SLE), demonstrating the efficacy and safety of JAK1/2 inhibition with baricitinib as a new potential oral therapy for SLE.

Nailfold Capillary Density Predicts Dermatomyositis Lung Involvement

In patients with juvenile dermatomyositis (DM), an association was seen between low nailfold capillary density and pulmonary involvement, European researchers reported.

Systemic Sclerosis: More Common than Expected

Systemic sclerosis is more common in the United Kingdom than previously reported, a nationwide population-based study determined.

Best of 2017: Death Rates from Lupus Remain Disproportionately High

The Annals of Internal Medicine reports that despite improving trends in mortality, death rates from systematic lupus erythematosus (lupus) remain high compared to those in the general population, and disparities persist between subpopulations and geographic regions. Underreporting of lupus on death certificates may have resulted in underestimates of mortality rates. 

Best of 2017: Are ANA Tests Unreliable?

Pisetsky and colleagues have reported in the Annals of Rheumatic Disease that ANA tests done on established SLE patients may yield surprisingly disparate results.

While ANA negative lupus was a problem of old assays and the loss of ANA positivity may be seen with chronicity or age, most rheumatologists believe that ANA positivity is an absolute requirement for the diagnosis of systemic lupus erythematosus.