1. ANTI-Ro/SSA 52 ANTIBODIES IN AUTOIMMUNE DISEASES Coordinator: Monica Copotoiu MD,PhD First author: Gabriela Mihai Coauthors: Isabela Micu, Mihaela Budianu, Andrea Lőrincz

2. Defining criteria for autoimmune diseases Witebsky's postulates ˡ : 1.An autoimmune reaction is identified in the form of autoantibody or cell-mediated immune reaction 2.The corresponding antigen is known 3. An analogous response causes a similar disease in experimental animals ˡ Rose, N. R., C. Bona. 1993. Defining criteria for autoimmune diseases (Witebsky’s postulates revisited). Immunol. Today

3. Anti-Ro/SSA 52 antibodies(aSSA52) aSSA52 are one of the most frequently detected antibodies against Extractable Nuclear Antigen(ENA) ˡ Clinically,the presence of aSSA52 has been reported in various rheumatic diseases but also in other autoimmune diseases. ˡ Ryusule Yoshimi et al. Clinical and Pathological Roles of Ro/SSA Autoantibody System. Clinical and Developmental Immunology Volume 2012 1

4. aSSA52 and Autoimmune diseases association aSSA52 and AD association according to the literature ˡ Polymyositis/Dermatomyositis (PM/DM) Systemic Lupus Erythematosus (SLE) Sjogren syndrome (SjS) Undifferentiated connective tissue disease (UCTD) Systemic Sclerosis (SSc) Rheumatoid Arthritis (RA) Neonatal Lupus Erythematosus (NLE) Primary biliary cirrhosis (PBC) Autoimmune Hepatitis I (AIH I) ˡDefendenti C et al. Clinical and laboratory aspects of Ro/SSA-52 autoantibodies.Autoimmune Rev 2011 Jan

5. aSSA52 detection.Extractable Nuclear Antigen (ENA) panel Anti-Rnp/SmAnti-Cenp B Anti-SmAnti-PCNA Anti-SSA(Ro)Anti-DsDNA Anti-SSA-Ro52 Anti-Nucleosome Anti-SSB(La)Anti-Histone Anti-Scl-70Anti Ribosomal P protein Anti-PM-SclAnti AMA-M2 Anti-Jo-1

6. Objective Our purpose is to study the clinical significance and immunological association in patients displaying aSSA52 in various autoimmune diseases(AD).

7. Material and Method single center Mureș County Emergency Clinical Hospital,Rheumatology Division retrospective and prospective(2013-2015) 41 patients ENA immunoblotting panels analysis

8. Material and method Autoimmune Disease (AD) was defined when a patient displayed one of these: 1.Systemic Lupus Erythematosus(SLE) 2.Polymyositis/Dermatomyositis(PM/DM) 3.Sjogren Syndrome(SjS) 4.Rheumatoid Arthritis(RA) 5.Systemic Sclerosis(SSc ) 6.Unedifferentiated Connective tissue disease(UCTD)

9. Material and method Inclusion criteriaExclusion criteria

10. Results

11. Gender distribution through connective tissue diseases(CTD)

12. Gender distribution

13. Mean age of onset of CTDs between aSSA52- and aSSA52+ groups

14. Distribution of aSSA52 through CTDs P value=0.058

15. Extractable nuclear antigen (ENA) antibodies distribution

16. aSSA52 associated auto-antibodies (p-0.01) (p-0.03)

17. Interstitial pulmonary fibrosis (IFP) prevalence in positive and negative aSSA52 groups 12.2 % 7.3 % 58.5% 22% P-0.059 (ns)

18. Distribution of IPF through Connective tissue diseases (CTDs) in aSSA52+ group

19. Clinical manifestations in CTDs and aSSA52

20. Study limitations In our study, only a few patients had inclusion criteria (n=41) and the small sample size limits the power of the study. Differences between aSSA52+ and aSSA52- groups regarding CTDs features were not significant perhaps due to low absolute numbers which limit the statistical analysis.

21. Conclusions It seems that the presence of aSSA52 are associated with IPF in CTDs. The most prevalent autoimmune diseases associating aSSA52 are PM and SLE. It is recommended to monitor aSSA52 in patiens diagnosed with CTDs in order to predict the outcome.