Utilization of the Early Sjögren's Antibody Panel in an Interstitial Lung Disease Clinic

Document Type

Conference Proceeding

Publication Date

5-15-2026

Publication Title

Am J Respir Crit Care Med

Keywords

General & Internal Medicine, Respiratory System

Abstract

Interstitial lung disease (ILD) carries significant morbidity and mortality for patients with Sjögren’s syndrome (SS). While SS diagnosis usually precedes the presentation of ILD by about 5-10 years, lung involvement may be the initial finding. This presents a diagnostic challenge that impacts management, including initiation of immunosuppression. One criterion presented by the 2016 ACR/EULAR Classification Criteria for Primary Sjögren’s Syndrome is the presence of SSA antibodies. However, SSA antibodies are only elevated in about two-thirds of patients. Recent studies have identified a group of antibodies termed the early Sjögren’s antibodies (ESA) - antibodies against salivary protein gland-1 (SP-1), parotid secretory protein (PSP), and carbonic anhydrase IV (CA-6) - and suggest that the ESA may be positive earlier in SS and more sensitive than SSA. Due to limited data on the implications of ESA, no guidelines exist on the use of this test in clinical practice, leaving interpretation up to physician discretion. This study describes the use of ESA in an ILD clinic at an academic medical center, including physician ordering practices and subsequent management. Data from the electronic medical record demonstrated that between 6/1/2024 and 4/24/2025, the ESA panel was ordered on 30 patients with ILD during evaluation in the the ILD clinic or by the inpatient ILD consult service. Physicians primarily ordered ESA when other autoimmune serology did not provide a clear diagnosis (80%). The test was most often ordered when patients complained of xerostomia and xeropthalmia, other rheumatologic symptoms, or both (87%). The radiographic patterns of CT chest of these patients were also identified. Nonspecific interstitial pneumonia was seen in 27%, usual interstitial pneumonia was seen in 10%, with other or multiple patterns noted in 63% of scans. Of the 30 patients with ESA serology, 25 (83%) were positive for at least 1 of the ESA. Of these 25 patients, 13 have had follow-up since the ESA test resulted. Treatment was changed in 9 of these 13 patients including the addition of steroids, steroid-sparing immunosuppression, or IVIG. The high prevalence of positive ESA serology may reflect selection of symptomatic patients and is consistent with positivity rates seen in other studies. This is the first study to discuss the use of ESA in ILD patients. Further studies are needed to understand the significance of the ESA panel to inform incorporation of this panel in diagnostic and phenotypic practice.

Volume

212

Issue

Supplement_1

First Page

1

Find It @ Sladen

Share

COinS