Title: Laboratory risk factors for coexistent primary biliary cholangitis in patients with Sjögren’s
syndrome: a retrospective study
Version: 1 Date: 17 May 2023
Reviewer's report:
The coexistence of primary biliary cholangitis (PBC) in patients with Sjögren's syndrome (SS)
is well recognized in previous studies. Here, the authors in this retrospective study aimed to
analyze the clinical and laboratory characteristics of the two patient groups to investigate other
related risk factors for PBC in the SS group, in addition to established factors such as ALP
and AMA. Eighty-two patients with coexistent SS and PBC were studied and a comparison of
clinical and laboratory characteristics of the two groups was performed.
From the immunological point of view,  they found that cytoplasmic, centromeric, and nuclear
membranous ANA patterns were observed more frequently in the SS+PBC group.
Of interest, elevated IgM levels, high ANA titer, cytoplasmic pattern, and ACA were
independent risk factors for PBC coexistence in SS.
The study provides clinical results. To improve the clinical impact some points should be
addressed.
-In the setting of autoimmune diseases, the autoantibody test is a crucial point since
Immunofluorescence ANA pattern identification requires expertise and a referral laboratory.
The authors should add more information about autoantibody detection.
-an important point is the time of autoantibody detection. Was autoantibody detected at diagnosis
or during the follow-up? According to Table 1,  21 (25.6) of SS+PBC  patients had cirrhosis.
This is quite not usual at diagnosis. Please add details.
-Study population: the authors stated that patients with autoimmune hepatitis were excluded.
However, it is well known that PBC patients may have overlap features of AIH. It would
be therefore important to specify that in all patients, particularly in those with cirrhosis,
an overlap PBC/AIH  syndrome was excluded as previously described (Review article:
autoimmune hepatitis -- current management and challenges. Aliment Pharmacol Ther. 2013
Oct;38(8):887-913. doi: 10.1111/apt.12470.)
-Prognostic role of ACA:  the authors should discuss the different clinical/diagnostic/prognostic
significance of ANA in autoimmune liver disease, in particular the difference with other
antinuclear autoantibodies such as antibodies to speckled protein as recently summarized
(Autoantibodies to speckled protein family in primary biliary cholangitis. Allergy Asthma Clin
Immunol. 2021 Mar 31;17(1):35. doi: 10.1186/s13223-021-00539-0.).
Title: Laboratory risk factors for coexistent primary biliary cholangitis in patients with Sjögren’s
syndrome: a retrospective study
Version: 1 Date: 17 May 2023
Reviewer's report:
The coexistence of primary biliary cholangitis (PBC) in patients with Sjögren's syndrome (SS)
is well recognized in previous studies. Here, the authors in this retrospective study aimed to
analyze the clinical and laboratory characteristics of the two patient groups to investigate other
related risk factors for PBC in the SS group, in addition to established factors such as ALP
and AMA. Eighty-two patients with coexistent SS and PBC were studied and a comparison of
clinical and laboratory characteristics of the two groups was performed.
From the immunological point of view,  they found that cytoplasmic, centromeric, and nuclear
membranous ANA patterns were observed more frequently in the SS+PBC group.
Of interest, elevated IgM levels, high ANA titer, cytoplasmic pattern, and ACA were
independent risk factors for PBC coexistence in SS.
The study provides clinical results. To improve the clinical impact some points should be
addressed.
-In the setting of autoimmune diseases, the autoantibody test is a crucial point since
Immunofluorescence ANA pattern identification requires expertise and a referral laboratory.
The authors should add more information about autoantibody detection.
-an important point is the time of autoantibody detection. Was autoantibody detected at diagnosis
or during the follow-up? According to Table 1,  21 (25.6) of SS+PBC  patients had cirrhosis.
This is quite not usual at diagnosis. Please add details.
-Study population: the authors stated that patients with autoimmune hepatitis were excluded.
However, it is well known that PBC patients may have overlap features of AIH. It would
be therefore important to specify that in all patients, particularly in those with cirrhosis,
an overlap PBC/AIH  syndrome was excluded as previously described (Review article:
autoimmune hepatitis -- current management and challenges. Aliment Pharmacol Ther. 2013
Oct;38(8):887-913. doi: 10.1111/apt.12470.)
-Prognostic role of ACA:  the authors should discuss the different clinical/diagnostic/prognostic
significance of ANA in autoimmune liver disease, in particular the difference with other
antinuclear autoantibodies such as antibodies to speckled protein as recently summarized
(Autoantibodies to speckled protein family in primary biliary cholangitis. Allergy Asthma Clin
Immunol. 2021 Mar 31;17(1):35. doi: 10.1186/s13223-021-00539-0.).
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: 17 May 2023
Reviewer's report:
The coexistence of primary biliary cholangitis (PBC) in patients with Sjögren's syndrome (SS)
is well recognized in previous studies. Here, the authors in this retrospective study aimed to
analyze the clinical and laboratory characteristics of the two patient groups to investigate other
related risk factors for PBC in the SS group, in addition to established factors such as ALP
and AMA. Eighty-two patients with coexistent SS and PBC were studied and a comparison of
clinical and laboratory characteristics of the two groups was performed.
From the immunological point of view,  they found that cytoplasmic, centromeric, and nuclear
membranous ANA patterns were observed more frequently in the SS+PBC group.
Of interest, elevated IgM levels, high ANA titer, cytoplasmic pattern, and ACA were
independent risk factors for PBC coexistence in SS.
The study provides clinical results. To improve the clinical impact some points should be
addressed.
-In the setting of autoimmune diseases, the autoantibody test is a crucial point since
Immunofluorescence ANA pattern identification requires expertise and a referral laboratory.
The authors should add more information about autoantibody detection.
-an important point is the time of autoantibody detection. Was autoantibody detected at diagnosis
or during the follow-up? According to Table 1,  21 (25.6) of SS+PBC  patients had cirrhosis.
This is quite not usual at diagnosis. Please add details.
-Study population: the authors stated that patients with autoimmune hepatitis were excluded.
However, it is well known that PBC patients may have overlap features of AIH. It would
be therefore important to specify that in all patients, particularly in those with cirrhosis,
an overlap PBC/AIH  syndrome was excluded as previously described (Review article:
autoimmune hepatitis -- current management and challenges. Aliment Pharmacol Ther. 2013
Oct;38(8):887-913. doi: 10.1111/apt.12470.)
-Prognostic role of ACA:  the authors should discuss the different clinical/diagnostic/prognostic
significance of ANA in autoimmune liver disease, in particular the difference with other
antinuclear autoantibodies such as antibodies to speckled protein as recently summarized
(Autoantibodies to speckled protein family in primary biliary cholangitis. Allergy Asthma Clin
Immunol. 2021 Mar 31;17(1):35. doi: 10.1186/s13223-021-00539-0.).
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