Autoantibodies Predate Symptoms in Sjögren’s Patients

Autoantibodies may show up years before symptoms do in patients with primary Sjögren syndrome, according to a research letter published in the November 6 issue of the Journal of the American Medical Association. The authors note that autoantibodies are characteristic of primary Sjögren syndrome and they may also be involved in development of the disease, in which immune cells attack and destroy the glands that produce tears and saliva. The researchers investigated the autoantibodies present before symptom onset in this patient population. “These presymptomatic autoantibodies could be used to identify individuals at risk of developing primary Sjögren’s syndrome,” says co-author Gunnel Henriksson, MD, PhD, of Lund University in Malmö, Sweden. “Especially in families with a history of autoimmune disease (not only Sjögren’s syndrome, since several autoimmune diseases may cluster within families), detection of these autoantibodies may be used to identify family members at risk.” Henriksson and his colleagues used data from a registry at Malmö University Hospital, in which all patients with primary Sjögren syndrome had been included since 1984. They randomly selected controls from local biobanks and matched them to each of the cases by sex, age, and date of earliest sampling. Out of the 360 cases in the registry, 41 patients had provided 64 presymptomatic serum samples, which were obtained an average of 7 years before symptom onset. Autoantibodies were detected before symptom onset in two-thirds of these cases (29 patients). In all 29 cases, autoantibodies were present in the earliest available serum samples—as early as 18 years before symptom onset. “It would be good to understand better the time course of converting from laboratory autoimmune state to clinical autoimmune state,” Henriksson says. “[We’d like to figure out] how to find an even better risk marker, maybe combining genetics, autoantibodies, and cytokine assessments in high-risk individuals—those with a family history of autoimmune diseases or possibly those with other already pre-existing autoimmune diseases.” He says another question they’d like to explore is if the presymptomatic autoantibodies may be associated not only with the disease itself but also with its subtypes, severity, rate of progression, and prognosis. He and his colleagues hope to shed light on this and other questions in future research. They intend to do follow-up studies in collaboration with other groups analyzing complementary immunological markers for disease prediction and plan to look at the additive effects of early life events. —Colleen Mullarkey Reference Jonsson R, Theander E, Sjöström, Brokstad K, Henriksson G. Autoantibodies present before symptom onset in primary Sjögren syndrome. JAMA. 2013;310(17):1854-5.