{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T08:00:19Z","timestamp":1790150419628,"version":"4.0.1"},"reference-count":22,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T00:00:00Z","timestamp":1789344000000},"content-version":"vor","delay-in-days":13,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J of Rheum Dis"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Anti\u2010SSA antibodies are among the most prevalent autoantibodies in systemic lupus erythematosus. While their association with cutaneous manifestations and neonatal lupus is established, their prognostic utility regarding long\u2010term survival and major organ damage in adult SLE remains controversial, particularly in Asian populations. Furthermore, the added prognostic value of anti\u2010SSB antibodies in anti\u2010SSA\u2010positive patients is debated. This study aimed to evaluate the impact of anti\u2010SSA status on clinical phenotypes and long\u2010term outcomes and to assess whether double positivity (anti\u2010SSA+\/SSB+) confers additional risk compared to single positivity (anti\u2010SSA+\/SSB\u2010).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted a retrospective cohort study of 511 SLE patients at a medical center in Taiwan. Patients were stratified into anti\u2010SSA positive (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009331) and anti\u2010SSA negative (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009180) groups. We compared clinical characteristics, serological profiles, disease activity (SLEDAI), and long\u2010term outcomes, including mortality, end\u2010stage renal disease (ESRD), and interstitial lung disease (ILD). A subgroup analysis was performed to compare single positive versus double positive patients.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Anti\u2010SSA positive patients were predominantly female (92.7% vs. 81.7%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and exhibited significantly higher disease activity (SLEDAI: 13.8\u2009\u00b1\u20096.5 vs. 12.1\u2009\u00b1\u20096.0,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.003). Immunologically, the anti\u2010SSA positive group displayed a distinct \u201cmultiple autoantibody positivity\u201d profile, characterized by a higher prevalence of anti\u2010dsDNA (74.6% vs. 65.0%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.028), anti\u2010Sm (44.1% vs. 22.8%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), and anti\u2010RNP (48.3% vs. 31.7%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), along with lower C3 and C4 levels. However, despite this active serological profile, there were no significant differences between anti\u2010SSA positive and negative groups regarding all\u2010cause mortality (16.3% vs. 20.6%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.282), ESRD (10.0% vs. 8.3%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.655), or ILD (5.4% vs. 4.4%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.781). Multivariable regression models confirmed that anti\u2010SSA status was not an independent predictor for mortality (adjusted Hazard Ratio [aHR] 0.82,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.376), ESRD (adjusted Odds Ratio [aOR] 1.17,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.654), or ILD (aOR 1.52,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.369).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this Asian SLE cohort, anti\u2010SSA positivity served as a marker for a phenotype characterized by high immunological activity and multiple autoantibody positivity but was not significantly associated with poor long\u2010term survival or irreversible organ damage in this cohort. However, larger studies are required to definitively exclude modest prognostic effects. The presence of anti\u2010SSB antibodies provided limited additional prognostic value for adult outcomes, suggesting that risk stratification should focus on the primary driver, anti\u2010SSA.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1756-185x.70870","type":"journal-article","created":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T21:49:21Z","timestamp":1789422561000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["High Immunological Activity and the Re\u2010Evaluation of Anti\u2010\n                    <scp>SSA<\/scp>\n                    \/\n                    <scp>SSB<\/scp>\n                    Antibodies as Prognostic Markers for Major Organ Damage in Systemic Lupus Erythematosus"],"prefix":"10.1111","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3449-1704","authenticated-orcid":false,"given":"Yao\u2010Fan","family":"Fang","sequence":"first","affiliation":[{"name":"Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine Chang Gung Memorial Hospital  Tao\u2010Yuan Taiwan"},{"name":"School of Medicine Chang Gung University  Tao\u2010Yuan Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8134-9022","authenticated-orcid":false,"given":"Ping\u2010Han","family":"Tsai","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Allergy and Immunology New Taipei Municipal TuCheng Hospital (Built and Operated by Chang Gung Medical Foundation)  New Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-3448-2586","authenticated-orcid":false,"given":"Che\u2010Tzu","family":"Chang","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine Chang Gung Memorial Hospital  Tao\u2010Yuan Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3401-0285","authenticated-orcid":false,"given":"Yen\u2010Fu","family":"Chen","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine Chang Gung Memorial Hospital  Tao\u2010Yuan Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,14]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/s41927\u2010024\u201000387\u20106"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm14165714"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2024.1390642"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10067\u2010022\u201006469\u20105"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1172\/jci110523"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2018.00541"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005792\u2010199505000\u201000001"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1080\/08916930400022954"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/keaf597"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.2174\/0115748871371535250728151758"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.reumae.2025.501816"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.3389\/fepid.2024.1334859"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.1780400928"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.34473"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/1756\u2010185x.13430"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/keae236"},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/resp.14703"},{"key":"e_1_2_13_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.semarthrit.2025.152810"},{"key":"e_1_2_13_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2020.105895"},{"key":"e_1_2_13_21_1","doi-asserted-by":"publisher","DOI":"10.1191\/096120399678847605"},{"key":"e_1_2_13_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.autrev.2016.12.004"},{"key":"e_1_2_13_23_1","doi-asserted-by":"publisher","DOI":"10.1136\/rmdopen\u20102024\u2010005212"}],"container-title":["International 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