{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T00:40:03Z","timestamp":1772498403472,"version":"3.50.1"},"reference-count":31,"publisher":"BMJ","issue":"5","license":[{"start":{"date-parts":[[2023,5,1]],"date-time":"2023-05-01T00:00:00Z","timestamp":1682899200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"John & Anne Leece Family"},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2023,4,18]]},"published-print":{"date-parts":[[2023,5]]},"abstract":"<jats:p>Sj\u00f6gren\u2019s syndrome (SS) is one of the prototypic systemic autoimmune diseases characterised by autoreactive T and B cells, sicca symptoms and various extraglandular manifestations. SS is characterised by autoantibodies (anti-Ro52\/tripartite motif containing-21 [TRIM21], anti-Ro60 and anti-La) that are important diagnostic biomarkers. Patients have typically stable serostatus; that is, patients who are positive for one or more of these autoantibodies tend to remain thus and vice versa. We describe a rare instance where a woman in her 50s was diagnosed with primary SS and developed new autoantibodies subsequently through serological epitope spreading. She demonstrated primarily glandular features only and clinical stability despite serological evolution. In this case report, we discuss the significance of this molecular feature and the clinical implications for our understanding of autoimmunity.<\/jats:p>","DOI":"10.1136\/bcr-2023-254632","type":"journal-article","created":{"date-parts":[[2023,5,2]],"date-time":"2023-05-02T11:09:21Z","timestamp":1683025761000},"page":"e254632","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Serological intermolecular epitope spreading in a patient with primary Sj\u00f6gren\u2019s syndrome"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5179-4803","authenticated-orcid":false,"given":"Adrian Y S","family":"Lee","sequence":"first","affiliation":[{"name":"Centre for Immunology & Allergy Research, Westmead Institute for Medical Research, The University of Sydney, Westmead, New South Wales, Australia"},{"name":"Department of Clinical Immunology & Allergy, Westmead Hospital, Westmead, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ming Wei","family":"Lin","sequence":"additional","affiliation":[{"name":"Centre for Immunology & Allergy Research, Westmead Institute for Medical Research, The University of Sydney, Westmead, New South Wales, Australia"},{"name":"Department of Clinical Immunology & Allergy, Westmead Hospital, Westmead, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2023,5,2]]},"reference":[{"key":"2025082702583997000_16.5.e254632.1","doi-asserted-by":"crossref","unstructured":"Lee AYS , Wang JJ , Gordon TP , et al . 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