Diagnosis and risk stratification in patients with anti-RNP autoimmunity

Maria F Carpintero, L. Martinez, I. Fernandez, A. C. Garza Romero, C. Mejia, Y. J. Zang, R. W. Hoffman, Eric L Greidinger

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Introduction Anti-RNP autoantibodies occur either in mixed connective tissue disease (MCTD) (with a frequently favorable prognosis), or in systemic lupus erythematosus (SLE) cases with aggressive major organ disease. It is uncertain how to assess for the risk of severe disease in anti-RNP + patients. Methods Following institutional review board-approved protocols, clinical data and blood were collected from patients with known or suspected anti-RNP autoimmunity and normal controls in a cohort study. Samples were screened for parameters of immune activation. Groups were compared based on clinical diagnoses, disease classification criteria, disease activity and specific end-organ clinical manifestations. Results Ninety-seven per cent of patients satisfying Alarcon-Segovia MCTD criteria also met Systemic Lupus International Collaborating Clinic (SLICC) SLE criteria, while 47% of the anti-RNP + SLE patients also met MCTD criteria. Among SLICC SLE patients, MCTD criteria were associated with reduced rates of renal disease (odds ratio (OR) 4.3, 95% confidence interval (CI) 1.3-14.0), increased rates of Raynaud's phenomenon (OR 3.5, 95% CI 1.3-9.5) and increased serum B-cell maturation antigen, transmembrane activator and CAML interactor and TNFα levels. Circulating immune markers and markers of type I interferon activation were not effective at distinguishing clinical subgroups. Conclusions Among anti-RNP patients, the question of MCTD versus SLE is not either/or: most MCTD patients also have lupus. MCTD classification criteria (but not a broad set of immune markers) distinguish a subset of SLE patients at reduced risk for renal disease.

Original languageEnglish (US)
Pages (from-to)1057-1066
Number of pages10
JournalLupus
Volume24
Issue number10
DOIs
StatePublished - Sep 8 2015

Fingerprint

Mixed Connective Tissue Disease
Autoimmunity
Systemic Lupus Erythematosus
B-Cell Maturation Antigen
Biomarkers
Odds Ratio
Confidence Intervals
Kidney
Interferon Type I
Raynaud Disease
Research Ethics Committees
Clinical Protocols
Autoantibodies
Cohort Studies
Serum

Keywords

  • classification criteria
  • inflammation
  • mixed connective tissue disease
  • Systemic lupus erythematosus

ASJC Scopus subject areas

  • Rheumatology

Cite this

Carpintero, M. F., Martinez, L., Fernandez, I., Garza Romero, A. C., Mejia, C., Zang, Y. J., ... Greidinger, E. L. (2015). Diagnosis and risk stratification in patients with anti-RNP autoimmunity. Lupus, 24(10), 1057-1066. https://doi.org/10.1177/0961203315575586

Diagnosis and risk stratification in patients with anti-RNP autoimmunity. / Carpintero, Maria F; Martinez, L.; Fernandez, I.; Garza Romero, A. C.; Mejia, C.; Zang, Y. J.; Hoffman, R. W.; Greidinger, Eric L.

In: Lupus, Vol. 24, No. 10, 08.09.2015, p. 1057-1066.

Research output: Contribution to journalArticle

Carpintero, MF, Martinez, L, Fernandez, I, Garza Romero, AC, Mejia, C, Zang, YJ, Hoffman, RW & Greidinger, EL 2015, 'Diagnosis and risk stratification in patients with anti-RNP autoimmunity', Lupus, vol. 24, no. 10, pp. 1057-1066. https://doi.org/10.1177/0961203315575586
Carpintero MF, Martinez L, Fernandez I, Garza Romero AC, Mejia C, Zang YJ et al. Diagnosis and risk stratification in patients with anti-RNP autoimmunity. Lupus. 2015 Sep 8;24(10):1057-1066. https://doi.org/10.1177/0961203315575586
Carpintero, Maria F ; Martinez, L. ; Fernandez, I. ; Garza Romero, A. C. ; Mejia, C. ; Zang, Y. J. ; Hoffman, R. W. ; Greidinger, Eric L. / Diagnosis and risk stratification in patients with anti-RNP autoimmunity. In: Lupus. 2015 ; Vol. 24, No. 10. pp. 1057-1066.
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abstract = "Introduction Anti-RNP autoantibodies occur either in mixed connective tissue disease (MCTD) (with a frequently favorable prognosis), or in systemic lupus erythematosus (SLE) cases with aggressive major organ disease. It is uncertain how to assess for the risk of severe disease in anti-RNP + patients. Methods Following institutional review board-approved protocols, clinical data and blood were collected from patients with known or suspected anti-RNP autoimmunity and normal controls in a cohort study. Samples were screened for parameters of immune activation. Groups were compared based on clinical diagnoses, disease classification criteria, disease activity and specific end-organ clinical manifestations. Results Ninety-seven per cent of patients satisfying Alarcon-Segovia MCTD criteria also met Systemic Lupus International Collaborating Clinic (SLICC) SLE criteria, while 47{\%} of the anti-RNP + SLE patients also met MCTD criteria. Among SLICC SLE patients, MCTD criteria were associated with reduced rates of renal disease (odds ratio (OR) 4.3, 95{\%} confidence interval (CI) 1.3-14.0), increased rates of Raynaud's phenomenon (OR 3.5, 95{\%} CI 1.3-9.5) and increased serum B-cell maturation antigen, transmembrane activator and CAML interactor and TNFα levels. Circulating immune markers and markers of type I interferon activation were not effective at distinguishing clinical subgroups. Conclusions Among anti-RNP patients, the question of MCTD versus SLE is not either/or: most MCTD patients also have lupus. MCTD classification criteria (but not a broad set of immune markers) distinguish a subset of SLE patients at reduced risk for renal disease.",
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N2 - Introduction Anti-RNP autoantibodies occur either in mixed connective tissue disease (MCTD) (with a frequently favorable prognosis), or in systemic lupus erythematosus (SLE) cases with aggressive major organ disease. It is uncertain how to assess for the risk of severe disease in anti-RNP + patients. Methods Following institutional review board-approved protocols, clinical data and blood were collected from patients with known or suspected anti-RNP autoimmunity and normal controls in a cohort study. Samples were screened for parameters of immune activation. Groups were compared based on clinical diagnoses, disease classification criteria, disease activity and specific end-organ clinical manifestations. Results Ninety-seven per cent of patients satisfying Alarcon-Segovia MCTD criteria also met Systemic Lupus International Collaborating Clinic (SLICC) SLE criteria, while 47% of the anti-RNP + SLE patients also met MCTD criteria. Among SLICC SLE patients, MCTD criteria were associated with reduced rates of renal disease (odds ratio (OR) 4.3, 95% confidence interval (CI) 1.3-14.0), increased rates of Raynaud's phenomenon (OR 3.5, 95% CI 1.3-9.5) and increased serum B-cell maturation antigen, transmembrane activator and CAML interactor and TNFα levels. Circulating immune markers and markers of type I interferon activation were not effective at distinguishing clinical subgroups. Conclusions Among anti-RNP patients, the question of MCTD versus SLE is not either/or: most MCTD patients also have lupus. MCTD classification criteria (but not a broad set of immune markers) distinguish a subset of SLE patients at reduced risk for renal disease.

AB - Introduction Anti-RNP autoantibodies occur either in mixed connective tissue disease (MCTD) (with a frequently favorable prognosis), or in systemic lupus erythematosus (SLE) cases with aggressive major organ disease. It is uncertain how to assess for the risk of severe disease in anti-RNP + patients. Methods Following institutional review board-approved protocols, clinical data and blood were collected from patients with known or suspected anti-RNP autoimmunity and normal controls in a cohort study. Samples were screened for parameters of immune activation. Groups were compared based on clinical diagnoses, disease classification criteria, disease activity and specific end-organ clinical manifestations. Results Ninety-seven per cent of patients satisfying Alarcon-Segovia MCTD criteria also met Systemic Lupus International Collaborating Clinic (SLICC) SLE criteria, while 47% of the anti-RNP + SLE patients also met MCTD criteria. Among SLICC SLE patients, MCTD criteria were associated with reduced rates of renal disease (odds ratio (OR) 4.3, 95% confidence interval (CI) 1.3-14.0), increased rates of Raynaud's phenomenon (OR 3.5, 95% CI 1.3-9.5) and increased serum B-cell maturation antigen, transmembrane activator and CAML interactor and TNFα levels. Circulating immune markers and markers of type I interferon activation were not effective at distinguishing clinical subgroups. Conclusions Among anti-RNP patients, the question of MCTD versus SLE is not either/or: most MCTD patients also have lupus. MCTD classification criteria (but not a broad set of immune markers) distinguish a subset of SLE patients at reduced risk for renal disease.

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