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The impact of anti-U1-RNP positivity: systemic lupus erythematosus versus mixed connective tissue disease

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Abstract

Anti-U1-RNP positivity remains mandatory for the mixed connective tissue disease (MCTD) diagnosis, reason for which anti-U1-RNP occurrence in patients with lupus clinical features might determine diagnostic issues. Thus, the prevalence of 25–30% for anti-RNP was reported in John Hopkins and LUMINA lupus cohorts and also 13% prevalence for the anti-U1-RNP in Euro-Lupus cohort. Presence of anti-U1-RNP antibodies in patients fulfilling SLE criteria (but not the MCTD ones) was associated with manifestations such as Raynaud phenomenon, musculoskeletal and lung impairment or nail fold capillaroscopy changes, some clinical features frequently encountered in MCTD patients and only rarely described in lupus population. The use of more specific markers such as 70 kDa anti-U1-RNP or anti-Sm-D was proposed for discriminating between SLE and MCTD. In addition, the IgM serotype of anti-U1-RNP seems more frequently expressed in SLE, while the IgG serotype alone in MCTD. Better acknowledgement of possible clinical involvements in lupus subsets, such as the peculiarities related to the anti-U1-RNP positivity, could provide access to early diagnosis of rather rare but possible severe lupus organ impairments (e.g. pulmonary arterial hypertension).

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Abbreviations

ACR:

American College of Rheumatology

ANA:

Antinuclear antibodies

CL:

Cardiolipin

CTD:

Connective tissue diseases

DCTD:

Diffuse connective tissue disease

DM:

Dermatomyositis

ENA:

Extractable nuclear antigen

IIF:

Indirect immunofluorescence

ILE:

Incomplete lupus erythematosus

LAC:

Lupus anticoagulant

MCTD:

Mixed connective tissue disease

RP:

Raynaud phenomenon

RNP:

Ribonucleoproteins

SLE:

Systemic lupus erythematosus

SLICC:

Systemic Lupus International Collaborative Clinics

SSc:

Systemic sclerosis

U:

Uridin

UCTD:

Undifferentiated connective tissue disease

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Authors and Affiliations

  1. Internal Medicine Department, Carol Davila University of Medicine and Pharmacy, Dionisie Lupu Street 37, 020022, Bucharest S2, Romania

    Alina Dima & Cristian Baicus

  2. Internal Medicine Department, Carol Davila Central University Emergency Military Hospital, Mircea Vulcanescu Street 88, 010825, Bucharest S2, Romania

    Ciprian Jurcut

  3. Internal Medicine Department, Colentina Research Center, Colentina Clinical Hospital, Stefan cel Mare Street 19-21, 020125, Bucharest S2, Romania

    Cristian Baicus

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  1. Alina Dima
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AD, CJ and CB conception and design. AD data acquisition. AD, CJ and CB analyzing and interpretation data. AD and CJ drafting the manuscript. CB revising the manuscript. AD, CJ and CB approval of the manuscript final version.

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Correspondence to Alina Dima.

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Dima, A., Jurcut, C. & Baicus, C. The impact of anti-U1-RNP positivity: systemic lupus erythematosus versus mixed connective tissue disease. Rheumatol Int 38, 1169–1178 (2018). https://doi.org/10.1007/s00296-018-4059-4

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