Abstract
Many literatures reported that neonatal lupus erythematosus and its associated abnormalities mainly, cutaneous lupus lesions, congenital heart block (CHB), hematologic cytopenias, hepatobiliary disease and cardiomyopathy are associated with anti-Ro/SSA and anti-La/SSB antibodies. With skin findings occur in nearly 95% of NLE infants, others reported that 100% of NLE infants with CHB were positive for anti Ro/SSA antibodies and 90.2% of infants with skin NLE were positive for anti Ro/SSA. And long-term follow-up of children with neonatal lupus and their unaffected siblings revealed that 12.24% of NLE children identified definite rheumatic/autoimmune diseases after more than 8 years. <i>Aim of the study:</i> The aim of this study was to determine the incidence of positive anti-Ro/SSA and anti-La/SSB antibodies in infants with recurrent prolonged skin lesions and their mothers to determine asymptomatic mothers at risk to develop autoimmune disease. <i>Subjects and methods:</i> a total of 90 infants with recurrent prolonged skin lesions below the age of 6 months and their mothers attending pediatric screening and follow up clinic at Al Galaa Teaching Hospital in Cairo, Egypt were investigated for positivity of anti Ro/SSA and anti La/SSB antibodies using enzyme linked immunoassay (ELISA). <i>Results:</i> Incidence rate of positive anti Ro/SSA alone and anti La/SSB alone antibodies in infants were 34.4% and 23.3% respectively, and positive both anti Ro/SSA and anti La/SSB antibodies was 21.1%, while in their mothers, positive both anti Ro/SSA and anti La/SSB antibodies was 36.7%. Among the 33 cases with positive antibodies female: male ratio was 2.3:1, and rheumatologic and autoimmune diseases was positive in 14 (42.4%) mothers, while, 19 (57.6%) were asymptomatic mothers, anemia, lymphocytosis, neutropenia with relative lymphocytosis, eosinophilia and thrombocytopenia were found in 6.1%, 9.1%, 3.0%, 9.1% and 12.1% respectively. Liver transaminases were elevated in 4 (12.1%). Positive anti Ro/SSA and anti La/SSB antibodies were statistically significantly correlated with infant age, body weight, body length and head circumference, female sex, infants mothers’ rheumatologic and autoimmune diseases, distribution of skin lesions, positive history of steroid containing cream use, and thrombocytopenia. However, both antibodies showed no statistically significant correlation with infant feeding, rate of recurrent skin lesions, anemia, lymphocytosis, neutropenia with relative lymphocytosis, eosinophilia, positive CRP, and elevated ESR. <i>Conclusion:</i> our infant cases with prolonged skin lesions with positive anti Ro/SSA and anti La/SSB antibodies with their mothers’ especially asymptomatic ones should be investigated and followed up properly for development of NLE and autoimmune diseases.
Highlights
Autoantibodies to deoxy ribonucleic acid enzyme linked immunoassay (ELISA) (DNA) and non-deoxy ribonucleic acid ELISA (DNA) antigens occur in patients with multisystem autoimmune disease e.g., systemic lupus erythematosus [SLE], rheumatoid arthritis, and Sjögren syndrome [SS]
A blood sample of 7 ml was obtained by venipuncture from infants, 2 ml were put on EDTA to perform CBC, erythrocyte sedimentation rate (ESR) and 5ml were left to clot and sera obtained were used for liver profiles, C-reactive protein (CRP), and the rest were stored frozen at -20 until assay of anti Ro/SSA and anti La/SSB
Many literatures reported that neonatal lupus erythematosus and its associated abnormalities mainly, cutaneous lupus lesions, congenital heart block (CHB), hematologic cytopenias, hepatobiliary disease and cardiomyopathy are associated with anti-Ro/SSA and anti-La/SSB antibodies [16 - 19]
Summary
Autoantibodies to DNA and non-DNA antigens occur in patients with multisystem autoimmune disease e.g., systemic lupus erythematosus [SLE], rheumatoid arthritis, and Sjögren syndrome [SS]. Anti-Ro and anti-La autoantibodies targeting fetal and neonatal tissues (Neonatal Lupus Syndromes) are actively transported into the fetal circulation, leading to clinical manifestations that include potentially life-threatening congenital heart block [5 - 7]. In their studied 128 infants born from 124 pregnancies in 112 women with anti-Ro antibodies with or without anti-La antibodies They reported 2 cases (1.6%) of congenital heart block (CHB) and 21 children (16%) developed cutaneous NLE, with laboratory testing showed hematologic abnormalities in 27% of the babies and elevation of liver enzymes in 26% [9]
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