{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T07:09:56Z","timestamp":1789456196898,"version":"build-2803163510"},"reference-count":15,"publisher":"SAGE Publications","issue":"12","license":[{"start":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T00:00:00Z","timestamp":1785196800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Lupus"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Complete heart block (CHB) is an exceptionally rare manifestation of adult systemic lupus erythematosus (SLE), typically occurring in less than 1% of patients. While classically associated with anti-SSA\/Ro antibodies, we report a rare case of inaugural CHB in a young woman with anti-SSA-negative SLE, highlighting the diagnostic importance of anti-PM-Scl 100 antibodies and microvascular assessment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Description<\/jats:title>\n                    <jats:p>A 21-year-old woman with a strong family history of SLE presented with symptomatic CHB (40 bpm). Cardiac MRI and standard workup ruled out myocarditis, infiltrative diseases, and common reversible causes. The patient showed subtle \u201csentinel\u201d signs, including alopecia and inflammatory arthralgia. Immunological profiling revealed positive ANA (1\/160) and elevated anti-dsDNA, but strict negativity for anti-SSA\/Ro and anti-SSB\/La. However, anti-PM-Scl 100 antibodies were strongly positive. Nailfold capillaroscopy demonstrated organic microangiopathy, supporting a microvascular-driven pathogenic process. A dual-chamber pacemaker was implanted due to irreversible conduction failure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>This case challenges the diagnostic reliance on classic Ro\/La antibodies for autoimmune CHB. The presence of anti-PM-Scl 100 and microvascular alterations on capillaroscopy suggests that nodal damage may result from an insidious fibrotic or microvascular process rather than acute inflammatory myocarditis. This \u201cmicrovascular hit\u201d can induce structural degradation even when systemic disease activity is quiescent.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>CHB can be the inaugural sign of SLE even in the absence of anti-SSA antibodies. We recommend integrating extended antibody profiling and nailfold capillaroscopy into the diagnostic workup of unexplained heart block in young adults to bridge the current \u201cdiagnostic gap\u201d in atypical autoimmune presentations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/09612033261474084","type":"journal-article","created":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T05:39:11Z","timestamp":1785303551000},"page":"1324-1328","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Inaugural complete heart block in anti-SSA negative systemic lupus erythematosus: the diagnostic role of anti-PM-Scl 100 antibodies"],"prefix":"10.1177","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-8975-0173","authenticated-orcid":false,"given":"Nadia","family":"Dammene Debbih","sequence":"first","affiliation":[{"name":"University of Algiers 1 Faculty of Medicine, Algiers, Algeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leila","family":"Laouar","sequence":"additional","affiliation":[{"name":"University of Algiers 1 Faculty of Medicine, Algiers, Algeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nassima","family":"Dekdouk","sequence":"additional","affiliation":[{"name":"Algiers, Algeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Houda","family":"Belguendouz","sequence":"additional","affiliation":[{"name":"University of Science and Technology Houari Boumediene Faculty of Biological Sciences, Algiers, Algeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riad","family":"Benkouar","sequence":"additional","affiliation":[{"name":"University of Algiers 1 Faculty of Medicine, Algiers, Algeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed Seddik","family":"A\u00eft Messaoud\u00e8ne","sequence":"additional","affiliation":[{"name":"University of Algiers 1 Faculty of Medicine, Algiers, Algeria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,7,28]]},"reference":[{"issue":"6","key":"e_1_3_6_2_2","first-page":"294","article-title":"Complete auriculoventricular blockage in adult patients with systemic lupus erythematosus. Case series and a review of the literature","volume":"2","author":"S\u00e1nchez Rom\u00e1n J","year":"2006","unstructured":"S\u00e1nchez Rom\u00e1n J, Oca\u00f1a Medina C, Garc\u00eda Hern\u00e1ndez FJ, et al. Complete auriculoventricular blockage in adult patients with systemic lupus erythematosus. Case series and a review of the literature. Reumatol Clin 2006; 2(6): 294\u2013297. https:\/\/doi.org\/10.1016\/S1699-258X(06)73064-9","journal-title":"Reumatol Clin"},{"key":"e_1_3_6_3_2","doi-asserted-by":"publisher","DOI":"10.1177\/0961203318770526"},{"key":"e_1_3_6_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(75)90017-X"},{"key":"e_1_3_6_5_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1987.00370010168034"},{"issue":"2","key":"e_1_3_6_6_2","first-page":"344","article-title":"Complete atrioventricular block as initial manifestation of systemic lupus erythematosus","volume":"27","author":"Salinas CA","year":"2009","unstructured":"Salinas CA, Escamilla MA, Garc\u00eda FR. Complete atrioventricular block as initial manifestation of systemic lupus erythematosus. 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