Prognostic value of anti-Ro52 antibodies in Anti-Synthetase Syndrome

Abstract

<bold>Introduction:</bold> Anti-synthetase syndrome (ASS)associates muscle damage with joint and pulmonary damage that can be life-threatening. While the clinical significance of anti-Ro52 antibodies is not fully understood, their positivity may be linked to disease severity and progression. <bold>Aims:</bold> Assess the prognostic interest of anti-Ro52 antibodies in the ASS. <bold>Methods:</bold> Retrospective study focusing on patients treated for ASS, in the respiratory department of the Mongi Slim Hospital, in Tunis-Tunisia, from Jun 2016 to February 2025. The diagnosis of ASS was made according to the ACR/EULAR 2017 recommendations. <bold>Results:</bold> A total of 23 patients with ASS was enrolled (mean age=54 years ; gender ratio H/F= 0.35). ASS was diagnosed before ILD in 6 patients and was associated to rheumatoid arthritis in 2 cases. Extra thoracic symptoms were reported in patients without prior diagnosis of ASS (11/17 cases): polyarthralgia (8/11), palmar-plantar hyperkeratosis (5/11), muscle weakness (3/11). CT patterns were: UIP (n=3), OP (n=2), NSIP(n=18). In the immunological assessment, the antibodies detected were: anti-PL12 (n=1), anti-EJ (n=1), anti-Ku (n=2), anti-PL7 (n=4), anti-JO1 (n=7), anti-OJ (n=5), anti-RO52 (n=9). The average values of FVC, DLCO and SpO2 were 60% ,28% and 92% respectively. The evolution under corticosteroid therapy and immunosuppressive therapy was towards improvement (n=6), stability (n=7), worsening (n=10), chronic respiratory failure and long-term oxygen therapy (n=6) and death (n=7). Anti-Ro52 antibodies were associated to progression into chronic respiratory failure and long-term oxygen therapy (p=0.043) but not to death. <bold>Conclusions:</bold> Anti-Ro52 antibodies in patients with ASS are associated with severe pulmonary involvement.