Two ro (ss‐a) autoantibody responses in systemic lupus erythematosus

Autoantibodies to Ro (SS‐A), La (SS‐B), and Sm/nuclear RNP were quantitated by enzyme‐linked immunosorbent assay in 106 white patients with systemic lupus erythematosus. Two Ro autoantibody subgroups were identified that differed quantitatively, genetically, and clinically. The subgroup having anti‐Ro only demonstrated significantly lower mean anti‐Ro levels than did the subgroup with concomitant anti‐La and showed a strong association with the linked HLA alleles DR2 and DQw1. The anti‐Ro with anti‐La sub‐group was associated with the linked HLA alleles B8, DR3, DRw52, and DQw2 (DR3 was primary), and this subgroup consisted of patients with older ages at disease onset, sicca complex, and less renal involvement. Overall, the relative risk (RR) for having anti‐Ro was highest in HLA‐DR2/DR3 heterozygotes compared with non‐DR2/DR3 heterozygotes (RR 15) and all other DR combinations (RR 7), suggesting a compound effect of 2 immune responses. Heterozygotes for HLA‐DQw1/DQw2 demonstrated significantly higher mean levels of anti‐Ro, which may be indicative of trans gene interaction at HLA‐DQ. These data suggest the hypothesis that HLA genes exert their major effects on Ro/La autoantibody subsets of systemic lupus erythematosus.