Detection of Anti-Rod and Anti-Ring Autoantibodies in a Patient with Seronegative Rheumatoid Arthritis and Cirrhosis of Liver: A Case Report

Abstract

Present case relates to results of diagnostic autoantibodies reactive against various antigens. Autoantibodies reactive against 16 nuclear antigens (Mi-2, ku, nRNP/Sm, S5-A(nativ), RO-52, SS-B, Scl-70, PM-Scl100, jo-1, CENPB, PCNA, DsDNA, nucleosomes, histones, ribosomal P-protein) and antigen Anti-Mitochondrial M2 Antibody (AMA-M2) were tested by indirect enzyme-linked immunosolvent assay, using a membrane as the solid phase; no colour reaction developed, suggesting absence of antibodies against above antigens. However, autoantibodies against rod and ring-like structures Inosine Monophosphate Dehydrogenase (IMPD) were detected. Presence of high titer autoantibodies against Double stranded (Ds) Deoxyribonucleic Acid (DNA) and Sm nuclear antigens might be diagnostic of Systemic Lupus Erythematosus (SLE). However, low titer antibodies against other nuclear antigens might increase the risk to develop SLE in an asymptomatic patient. Immune complexes might develop and get deposited in synovium. Later, chronic synovitis might develop. In addition, the test for rheumatoid factor was negative with serum of the current patient. Patient was diagnosed as a case of seronegative rheumatoid arthritis. The patient also had cirrhosis of the liver. Rarely, anti-rod and anti-ring autoantibodies might develop in a patient with Hepatitis C Virus (HCV) infection. Further, these antibodies might also be detected in sera of patients with SLE or Hashimoto’s thyroiditis or during treatment with interferon-α/Ribavirin. However, the significance of these autoantibodies in pathogenesis of a autoimmune disease or HCV infection is unknown. High titer antibodies against double stranded (Ds) DNA and Sm antigens might be diagnostic of SLE.

Keywords

• antinuclear antibody
• inosine monophosphate dehydrogenase
• systemic lupus erythematosus