Anti-Ro La Interpretation — SCE Rheumatology MCQ
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Correct answer: E — Sjögren disease
Combined anti-Ro/SSA and anti-La/SSB positivity in a patient with sicca symptoms and parotid swelling points to Sjögren disease; anti-Ro/SSA is the most heavily weighted serological item in the 2016 ACR/EULAR classification criteria used by the BSR Sjögren guideline, and anti-La rarely occurs in isolation. Anti-Ro/La antibodies do occur in SLE, but they are associated with photosensitive and subacute cutaneous phenotypes rather than lupus nephritis, which is signalled by anti-dsDNA, low complement, proteinuria and active urinary sediment (option A). Rheumatoid arthritis is characterised by rheumatoid factor and anti-CCP, not this ENA pattern. Dermatomyositis is linked to myositis-specific antibodies (e.g. anti-Jo-1, anti-Mi-2, anti-TIF1γ) and systemic sclerosis to anti-centromere, anti-Scl-70 or anti-RNA polymerase III — all negative or absent here. Anti-Ro positivity also mandates pregnancy counselling about congenital heart block and neonatal lupus.
Reference: British Society for Rheumatology guideline on management of adult and juvenile onset Sjögren disease (diagnosis/classification and pregnancy sections), Rheumatology, 2024. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12013823/