title: Anti-Ro/SSA antibodies are associated with severe mitral valve regurgitation in patients with systemic lupus erythematosus.
abstract: OBJECTIVE
  To assess whether anti-Ro/SSA antibodies are associated with cardiac valve disease in lupus.
  
  
  METHODS
  A single-center, medical chart review was performed. Lupus patients were divided according to its anti-Ro/SSA status and subgroups were compared for valvular abnormalities and other characteristics. Dependence of anti-Ro/SSA reactivity to anti-Ro52/TRIM21 antibodies was also evaluated.
  
  
  RESULTS
  Eighty-nine lupus patients were analyzed. The most common valvular abnormalities were tricuspid (60%), mitral (41%) and pulmonary (14%) regurgitation. Thirty-six patients were positive and 53 negative for anti-Ro/SSA antibodies. In patients positive to anti-Ro/SSA, a difference was noted for anti-dsDNA (67 versus 45%; p = 0.04) and anti-La/SSB (19 versus 2%; p = 0.004) antibodies. An association between anti-Ro/SSA antibodies and severe mitral regurgitation was observed; indeed, 4/15 patients with anti-Ro/SSA and mitral regurgitation had severe forms of valvulopathy as compared to only 1/22 patients with mitral regurgitation but negative to such antibody (27 versus 5%; p = 0.02). Anti-Ro/SSA antibodies significantly elevated the risk of severe mitral regurgitation (OR = 5). Anti-Ro52/TRIM21 levels (103 ± 29 versus 42 ± 43 U/mL; p = 0.03) and anti-Ro52/TRIM21: anti-Ro/SSA ratios (0.88 ± 0.02 versus 0.35 ± 0.37; p = 0.03) were higher in patients with mitral valve regurgitation than in those with no valvulopathy.
  
  
  CONCLUSIONS
  Anti-Ro/SSA antibodies, mainly against Ro52/TRIM21 antigens, may be pathologically involved in lupus-associated mitral valve regurgitation.
authors.affiliation: a Department of Rheumatology , Instituto Nacional de Cardiología Ignacio Chávez , Mexico City , Mexico.
authors.forename: Violeta
authors.initials: V
authors.lastname: Higuera-Ortiz
authors.affiliation: b Department of Rheumatology , Hospital Ángeles del Pedregal , Mexico City , Mexico.
authors.forename: Tania
authors.initials: T
authors.lastname: Mora-Arias
authors.affiliation: c Department of Dermatology , Hospital General de Zona 32 Villa Coapa, Instituto Mexicano del Seguro Social , Mexico City , Mexico.|d School of Medicine , Universidad Anahuac , Mexico City , Mexico.
authors.forename: Diana
authors.initials: D
authors.lastname: Castillo-Martinez
authors.affiliation: e Department of Immunology , Instituto Nacional de Cardiología Ignacio Chávez , Mexico City , Mexico.|f Department of Health Care , Universidad Autónoma Metropolitana-Xochimilco , Mexico City , Mexico.|g School of Medicine , LaSalle University at Mexico City , Mexico.
authors.forename: Luis M
authors.initials: LM
authors.lastname: Amezcua-Guerra
mesh_terms: D000328:Adult; D000974:Antibodies, Antinuclear / Q000097:blood*; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000097:blood* / Q000150:complications / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000097:blood* / Q000150:complications / Q000000981:diagnostic imaging
chemical_list: D000974:Antibodies, Antinuclear; C035356:SS-A antibodies
keywords: Anti-Ro/SSA antibodies; Mitral valve regurgitation; Systemic lupus erythematosus