Clinical and Immunological Associations of Anti-Ro52 Antibody Positivity in Primary Sjögren Disease: A Retrospective Cross-Sectional Study

Wanting Hao,1 Yang Zhang,2 Rui Xue,2 Yue Wang,2 Peng Yang,2 Kai Feng21Graduate School of Guizhou University of Traditional Chinese Medicine, Guiyang, 550025, People’s Republic of China; 2Department of Clinical Laboratory, The Second Affiliated Hospital, Guizhou University of Traditional Chinese Medicine, Guiyang, 550001, People’s Republic of ChinaCorrespondence: Peng Yang, The Second Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang, 550001, People’s Republic of China, Email [email protected] Kai Feng, The Second Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang, 550001, People’s Republic of China, Email [email protected]: To characterize the clinical and immunological correlates of anti-Ro52/TRIM21 antibody positivity in primary Sjögren disease (pSjD), focusing on prevalent interstitial lung disease (ILD), hematological abnormalities, and peripheral immune features.Patients and Methods: This single-center retrospective cross-sectional study included 122 adults fulfilling the 2016 ACR/EULAR classification criteria (81 anti-Ro52-positive; 41 anti-Ro52-negative). Prespecified outcomes were prevalent ILD and hematological abnormalities. Anti-Ro52/anti-Ro60 profiles, lymphocyte subsets, absolute lymphocyte counts, and 12 circulating cytokines were assessed. Multiple immune comparisons were controlled using Benjamini-Hochberg false discovery rate (FDR) correction. Firth penalized logistic regression adjusted for age, sex, disease duration, and anti-Ro60 status; modified Poisson models estimated adjusted prevalence ratios (PRs).Results: ILD occurred in 19/81 (23.5%) anti-Ro52-positive and 3/41 (7.3%) anti-Ro52-negative patients (P=0.044); hematological abnormalities occurred in 16/81 (19.8%) and 2/41 (4.9%), respectively (P=0.032). In adjusted Firth models, anti-Ro52 positivity was not statistically associated with ILD (OR 2.95, 95% CI 0.91– 12.26; P=0.074), whereas the association with hematological abnormalities remained evident (OR 5.05, 95% CI 1.28– 30.44; P=0.018). Modified Poisson estimates were directionally similar. Anti-Ro52-positive patients had higher CD19+ B-cell percentages and lower natural killer-cell percentages; both remained significant after FDR correction. Absolute B-cell counts did not differ, whereas absolute natural killer-cell counts were lower. No cytokine remained significant after FDR correction.Conclusion: Anti-Ro52 positivity was associated with distinct clinical and peripheral immune features in hospitalized patients with pSjD. The ILD association was attenuated after adjustment for anti-Ro60 and demographic factors, whereas the hematological association remained statistically evident but imprecise. These findings support interpretation of anti-Ro52 within a broader serological and immunological context.Keywords: primary Sjögren disease, anti-Ro52/TRIM21, anti-Ro60, interstitial lung disease, hematological abnormalities, natural killer cells