Anti-Ro52 Interpretation — SCE Rheumatology MCQ

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HardAutoimmune SerologyAnti-Ro52 InterpretationSCE Rheumatology

An antigen-specific assay performed after a positive anti-SSA screen shows anti-Ro52/TRIM21 positivity, with anti-Ro60 and anti-La/SSB both negative. Compared with Ro60-containing anti-Ro profiles, in which rheumatic disease context is this isolated anti-Ro52 pattern most characteristically enriched?

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Correct answer: E — Idiopathic inflammatory myopathy

Explanation lettering: B = shown as A · C = shown as B · D = shown as C · A = shown as D

E is correct. Ro52/TRIM21 and Ro60 are distinct antigens, and isolated anti-Ro52 should not be interpreted as equivalent to the conventional Ro52/Ro60 anti-SSA profile. Comparative cohorts show that Ro52-positive/Ro60-negative reactivity is enriched in idiopathic inflammatory myopathy and is associated with myositis-specific antibodies, particularly anti-aminoacyl-tRNA synthetase antibodies such as anti-Jo1. It is also associated with interstitial lung disease and may indicate increased risk of rapidly progressive ILD. Primary Sjögren disease and SLE more typically show anti-Ro60, often with anti-Ro52 and/or anti-La; lupus nephritis has no specific association with isolated Ro52. Anti-Ro52 can occur in rheumatoid arthritis and systemic sclerosis, so it is not diagnostic of myositis, but these are less characteristic associations for this specific antigenic profile.

Reference: Mazeda C et al. Anti-SSA Ro52 and anti-Ro60 autoantibodies: association with clinical phenotypes. Clinical and Experimental Rheumatology. 2024;42:1474-1479. https://pubmed.ncbi.nlm.nih.gov/38530658/