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The SSB-positive/SSA-negative antibody profile is not associated with key phenotypic features of Sjögren's syndrome
  1. Alan N Baer1,
  2. Mara McAdams DeMarco1,
  3. Stephen C Shiboski2,
  4. Mi Y Lam2,
  5. Stephen Challacombe3,
  6. Troy E Daniels2,
  7. Yi Dong4,
  8. John S Greenspan2,
  9. Bruce W Kirkham3,
  10. Hector E Lanfranchi5,
  11. Morten Schiødt6,
  12. Muthiah Srinivasan7,
  13. Hisanori Umehara8,
  14. Frederick B Vivino9,
  15. Cristina F Vollenweider5,
  16. Yan Zhao4,
  17. Lindsey A Criswell2,
  18. Caroline H Shiboski2
  19. for the Sjögren's International Collaborative Clinical Alliance (SICCA) Research Groups
    1. 1Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
    2. 2University of California, San Francisco, California, USA
    3. 3King's College, London, UK
    4. 4Peking Union Medical College, Beijing, China
    5. 5University of Buenos Aires and German Hospital, Buenos Aires, Argentina
    6. 6Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
    7. 7Aravind Eye Care System, Madurai, India
    8. 8Kanazawa Medical University, Ishikawa, Japan
    9. 9Penn Presbyterian Medical Center and University of Pennsylvania, Philadelphia, Pennsylvania, USA
    1. Correspondence to Dr Alan N Baer, Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA; alanbaer{at}


    Objective To determine whether the Sjögren's syndrome B (SSB)-positive/Sjögren's syndrome A (SSA)-negative antibody profile is associated with key phenotypic features of SS.

    Methods Among registrants in the Sjögren's International Collaborative Clinical Alliance (SICCA) with possible or established SS, we compared anti-SSA/anti-SSB reactivity profiles against concurrent phenotypic features. We fitted logistic regression models to explore the association between anti-SSA/anti-SSB reactivity profile and each key SS phenotypic feature, controlling for potential confounders.

    Results Among 3297 participants, 2061 (63%) had negative anti-SSA/anti-SSB, 1162 (35%) had anti-SSA with or without anti-SSB, and 74 (2%) anti-SSB alone. Key SS phenotypic features were more prevalent and had measures indicative of greater disease activity in those participants with anti-SSA, either alone or with anti-SSB, than in those with anti-SSB alone or negative SSA/SSB serology. These between-group differences were highly significant and not explained by confounding by age, race/ethnicity or gender. Participants with anti-SSB alone were comparable to those with negative SSA/SSB serology in their association with these key phenotypic features. Among SICCA participants classified with SS on the basis of the American-European Consensus Group or American College of Rheumatology criteria, only 2% required the anti-SSB-alone test result to meet these criteria.

    Conclusions The presence of anti-SSB, without anti-SSA antibodies, had no significant association with SS phenotypic features, relative to seronegative participants. The solitary presence of anti-SSB antibodies does not provide any more support than negative serology for the diagnosis of SS. This serological profile should thus be interpreted cautiously in clinical practice and potentially eliminated from future classification criteria.

    • Sjögren's Syndrome
    • Autoantibodies
    • Systemic Lupus Erythematosus

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