Title: Laboratory risk factors for coexistent primary biliary cholangitis in patients with Sjögren’s
syndrome: a retrospective study
Version: 1 Date: 10 Apr 2023
Reviewer's report:
In this study, the authors aimed to investigate the laboratory risk factors for the coexistence of
primary biliary cholangitis (PBC) in patients with Sjögren's syndrome (SS).
Overall, eighty-two patients with coexistent SS and PBC were studied . The clinical and
laboratory characteristics of the two groups were compared.
Among the compared features, they found that cytoplasmic, centromeric, and nuclear
membranous patterns of ANA and positive anti-centromere antibody (ACA) were observed
more frequently in the SS+PBC group (P < 0.05). Logistic regression analysis showed that
elevated IgM levels, high ANA titer, cytoplasmic pattern, and ACA were independent risk
factors for PBC coexistence in SS.
They concluded that elevated IgM levels, positive ACA, and high ANA titer with cytoplasmic
pattern also provide clues to clinicians for the early screening and diagnosis of PBC in patients
with SS.
The study is of interest with potential clinical relevance. However, some issues deserve further
data and should be addressed.
-Autoantibody detection: this is an important issue since the right interpretation of
immunofluorescence ANA patterns requires experienced laboratory in autoimmune diagnostic.
Could the Authors confirm that autoantibody test were performed in a referral laboratory for
autoimmunity?
-Clinical significance of ACA: according to literature data, ACA may be considered as a
clue for diagnosis and prognosis of PBC as previously demonstrated (Antibodies to SS-A/
Ro-52kD and centromere in autoimmune liver disease: a clue to diagnosis and prognosis of
primary biliary cirrhosis. Aliment Pharmacol Ther. 2007 Sep 15;26(6):831-8. doi: 10.1111/
j.1365-2036.2007.03433.x.) while other ANA IIF patterns are exclusively confined to PBC,
as previously demonstrated in a very large serological study (Antinuclear antibodies giving
the 'multiple nuclear dots' or the 'rim-like/membranous' patterns: diagnostic accuracy for
primary biliary cirrhosis. Aliment Pharmacol Ther. 2006 Dec;24(11-12):1575-83. doi: 10.1111/
j.1365-2036.2006.03172.x.). Please recall and discuss the study findings according to literature
data.
Title: Laboratory risk factors for coexistent primary biliary cholangitis in patients with Sjögren’s
syndrome: a retrospective study
Version: 1 Date: 10 Apr 2023
Reviewer's report:
In this study, the authors aimed to investigate the laboratory risk factors for the coexistence of
primary biliary cholangitis (PBC) in patients with Sjögren's syndrome (SS).
Overall, eighty-two patients with coexistent SS and PBC were studied . The clinical and
laboratory characteristics of the two groups were compared.
Among the compared features, they found that cytoplasmic, centromeric, and nuclear
membranous patterns of ANA and positive anti-centromere antibody (ACA) were observed
more frequently in the SS+PBC group (P < 0.05). Logistic regression analysis showed that
elevated IgM levels, high ANA titer, cytoplasmic pattern, and ACA were independent risk
factors for PBC coexistence in SS.
They concluded that elevated IgM levels, positive ACA, and high ANA titer with cytoplasmic
pattern also provide clues to clinicians for the early screening and diagnosis of PBC in patients
with SS.
The study is of interest with potential clinical relevance. However, some issues deserve further
data and should be addressed.
-Autoantibody detection: this is an important issue since the right interpretation of
immunofluorescence ANA patterns requires experienced laboratory in autoimmune diagnostic.
Could the Authors confirm that autoantibody test were performed in a referral laboratory for
autoimmunity?
-Clinical significance of ACA: according to literature data, ACA may be considered as a
clue for diagnosis and prognosis of PBC as previously demonstrated (Antibodies to SS-A/
Ro-52kD and centromere in autoimmune liver disease: a clue to diagnosis and prognosis of
primary biliary cirrhosis. Aliment Pharmacol Ther. 2007 Sep 15;26(6):831-8. doi: 10.1111/
j.1365-2036.2007.03433.x.) while other ANA IIF patterns are exclusively confined to PBC,
as previously demonstrated in a very large serological study (Antinuclear antibodies giving
the 'multiple nuclear dots' or the 'rim-like/membranous' patterns: diagnostic accuracy for
primary biliary cirrhosis. Aliment Pharmacol Ther. 2006 Dec;24(11-12):1575-83. doi: 10.1111/
j.1365-2036.2006.03172.x.). Please recall and discuss the study findings according to literature
data.
Please review this paper.
user
Title: Laboratory risk factors for coexistent primary biliary cholangitis in patients with Sjögren’s
syndrome: a retrospective study
Version: 1 Date: 10 Apr 2023
Reviewer's report:
In this study, the authors aimed to investigate the laboratory risk factors for the coexistence of
primary biliary cholangitis (PBC) in patients with Sjögren's syndrome (SS).
Overall, eighty-two patients with coexistent SS and PBC were studied . The clinical and
laboratory characteristics of the two groups were compared.
Among the compared features, they found that cytoplasmic, centromeric, and nuclear
membranous patterns of ANA and positive anti-centromere antibody (ACA) were observed
more frequently in the SS+PBC group (P < 0.05). Logistic regression analysis showed that
elevated IgM levels, high ANA titer, cytoplasmic pattern, and ACA were independent risk
factors for PBC coexistence in SS.
They concluded that elevated IgM levels, positive ACA, and high ANA titer with cytoplasmic
pattern also provide clues to clinicians for the early screening and diagnosis of PBC in patients
with SS.
The study is of interest with potential clinical relevance. However, some issues deserve further
data and should be addressed.
-Autoantibody detection: this is an important issue since the right interpretation of
immunofluorescence ANA patterns requires experienced laboratory in autoimmune diagnostic.
Could the Authors confirm that autoantibody test were performed in a referral laboratory for
autoimmunity?
-Clinical significance of ACA: according to literature data, ACA may be considered as a
clue for diagnosis and prognosis of PBC as previously demonstrated (Antibodies to SS-A/
Ro-52kD and centromere in autoimmune liver disease: a clue to diagnosis and prognosis of
primary biliary cirrhosis. Aliment Pharmacol Ther. 2007 Sep 15;26(6):831-8. doi: 10.1111/
j.1365-2036.2007.03433.x.) while other ANA IIF patterns are exclusively confined to PBC,
as previously demonstrated in a very large serological study (Antinuclear antibodies giving
the 'multiple nuclear dots' or the 'rim-like/membranous' patterns: diagnostic accuracy for
primary biliary cirrhosis. Aliment Pharmacol Ther. 2006 Dec;24(11-12):1575-83. doi: 10.1111/
j.1365-2036.2006.03172.x.). Please recall and discuss the study findings according to literature
data.
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