ArticleInternational journal of rheumatic diseases2026
High Immunological Activity and the Re-Evaluation of Anti-SSA/SSB Antibodies as Prognostic Markers for Major Organ Damage in Systemic Lupus Erythematosus.
Article in International journal of rheumatic diseases, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveAnti-SSA antibodies are among the most prevalent autoantibodies in systemic lupus erythematosus. While their association with cutaneous manifestations and neonatal lupus is established, their prognostic utility regarding long-term survival and major organ damage in adult SLE remains controversial, particularly in Asian populations. Furthermore, the added prognostic value of anti-SSB antibodies in anti-SSA-positive patients is debated. This study aimed to evaluate the impact of anti-SSA status on clinical phenotypes and long-term outcomes and to assess whether double positivity (anti-SSA+/SSB+) confers additional risk compared to single positivity (anti-SSA+/SSB-).
methodsWe conducted a retrospective cohort study of 511 SLE patients at a medical center in Taiwan. Patients were stratified into anti-SSA positive (n = 331) and anti-SSA negative (n = 180) groups. We compared clinical characteristics, serological profiles, disease activity (SLEDAI), and long-term outcomes, including mortality, end-stage renal disease (ESRD), and interstitial lung disease (ILD). A subgroup analysis was performed to compare single positive versus double positive patients.
resultsAnti-SSA positive patients were predominantly female (92.7% vs. 81.7%, p < 0.001) and exhibited significantly higher disease activity (SLEDAI: 13.8 ± 6.5 vs. 12.1 ± 6.0, p = 0.003). Immunologically, the anti-SSA positive group displayed a distinct "multiple autoantibody positivity" profile, characterized by a higher prevalence of anti-dsDNA (74.6% vs. 65.0%, p = 0.028), anti-Sm (44.1% vs. 22.8%, p < 0.001), and anti-RNP (48.3% vs. 31.7%, p < 0.001), along with lower C3 and C4 levels. However, despite this active serological profile, there were no significant differences between anti-SSA positive and negative groups regarding all-cause mortality (16.3% vs. 20.6%, p = 0.282), ESRD (10.0% vs. 8.3%, p = 0.655), or ILD (5.4% vs. 4.4%, p = 0.781). Multivariable regression models confirmed that anti-SSA status was not an independent predictor for mortality (adjusted Hazard Ratio [aHR] 0.82, p = 0.376), ESRD (adjusted Odds Ratio [aOR] 1.17, p = 0.654), or ILD (aOR 1.52, p = 0.369).
conclusionIn this Asian SLE cohort, anti-SSA positivity served as a marker for a phenotype characterized by high immunological activity and multiple autoantibody positivity but was not significantly associated with poor long-term survival or irreversible organ damage in this cohort. However, larger studies are required to definitively exclude modest prognostic effects. The presence of anti-SSB antibodies provided limited additional prognostic value for adult outcomes, suggesting that risk stratification should focus on the primary driver, anti-SSA.
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