Ankylosing Spondylitis and Autoantibodies in Young Patients

Q: Ankylosing Spondylitis and Autoantibodies in Young Patients

Hello, thank you for your inquiry. <br>Here are my responses： 1) Although ankylosing spondylitis is an autoimmune disease, it does not mean that patients with ankylosing spondylitis will necessarily have autoantibodies, correct? --> Yes. <br>2) According to the attached report, d

Ankylosing spondylitis and autoantibodies?

Hello Doctor, my son is currently over 18 years old and has ankylosing spondylitis.
The notes below are from a previous examination report at Chang Gung Memorial Hospital.
I would like to ask the doctor: 1) Although ankylosing spondylitis is an autoimmune disease, it does not necessarily mean that patients with ankylosing spondylitis will have autoantibodies, correct? 2) Based on the report notes, does my son have any autoantibodies? 3) There are many types of autoantibodies, and hospitals cannot test for all of them.
The autoantibodies my son was tested for should be common ones, and the likelihood of rare autoantibodies being present is low, correct? The reason I am asking these questions is that there was a report (https://news.tvbs.com.tw/life/1702549) stating that long COVID may be related to autoantibodies, and I am concerned that if my child contracts COVID-19 in the future, he may have a higher risk of developing long COVID.
Thank you, Doctor.
Notes: 1) Mycoplasma pneumoniae antibody IgM (MYCO-IgM) Negative 248.8 (U/mL) 2) Rheumatoid factor (RF) <9.5 (IU/mL) 3) Antinuclear antibody (ANA) Negative 1:40 4) dsDNA antibody (A-DSDNA) <40.5 (WHO unit/mL) 5) Complement C3 130 (mg/dL) 6) Complement C4 30.4 (mg/dL) 7) HLA-B27 Positive

Hao, 50~59 year old female. Ask Date: 2022/04/18

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your inquiry.
Here are my responses: 1) Although ankylosing spondylitis is an autoimmune disease, it does not mean that patients with ankylosing spondylitis will necessarily have autoantibodies, correct? --> Yes.
2) According to the attached report, does my child have any autoantibodies? --> All antibodies in the attached report are negative.
B27 is a genetic marker, not an antibody.
3) There are many autoantibodies, and hospitals cannot test for all of them.
The autoantibodies tested for my child should be common ones, and the likelihood of finding other rare autoantibodies is low, correct? --> These antibodies are typically tested based on what your physician needs to confirm regarding the type of rheumatic disease.
The body naturally produces antibodies, but whether there are abnormal autoantibodies requires further testing.
The report you provided is a basic study, and while it may serve as a reference in clinical practice, there is still a significant gap.
Media can easily misinterpret findings, so caution is advised.
I believe there is no need to worry excessively.
Best regards from the Allergy, Immunology, and Rheumatology Department of Changhua Hospital, Ministry of Health and Welfare.

Reply Date: 2022/04/18

More Info

Ankylosing Spondylitis (AS) is a chronic inflammatory autoimmune disease primarily affecting the spine and sacroiliac joints, leading to pain and stiffness. It is part of a group of diseases known as spondyloarthritis. Your concerns regarding your son’s condition and the relationship between autoantibodies and AS are valid and important to address.

1. Autoantibodies and Ankylosing Spondylitis: While AS is classified as an autoimmune disease, not all patients with AS will test positive for autoantibodies. Autoantibodies are proteins produced by the immune system that mistakenly target and react with a person's own tissues. In the case of AS, the presence of the HLA-B27 antigen is a significant genetic marker, but it does not guarantee the presence of autoantibodies. Many individuals with AS may not have detectable autoantibodies, and the absence of these antibodies does not negate the diagnosis of AS.

2. Your Son's Test Results: Based on the report you provided, your son has tested positive for HLA-B27, which is commonly associated with AS. However, the other tests for autoantibodies, such as rheumatoid factor (RF), anti-nuclear antibodies (ANA), and anti-double-stranded DNA (dsDNA), returned negative. This suggests that while he has AS, he does not have the common autoantibodies typically associated with other autoimmune diseases, such as rheumatoid arthritis or lupus. Therefore, it is accurate to say that your son does not have autoantibodies based on the tests listed.

3. Testing for Autoantibodies: It is true that there are many types of autoantibodies, and not all can be tested for in a standard laboratory setting. The tests performed on your son are indeed among the more common ones used to assess autoimmune conditions. While rare autoantibodies exist, the likelihood of finding them in a patient with AS who has already tested negative for the more common ones is relatively low. The focus should remain on managing AS and monitoring any symptoms or changes in his condition.

4. Concerns Regarding Long COVID: Your concern about the potential link between autoantibodies and long COVID is understandable, especially given the evolving research in this area. Some studies have suggested that certain autoantibodies may be associated with long COVID symptoms, but the relationship is complex and not fully understood. It is essential to note that having AS and being HLA-B27 positive does not inherently increase the risk of developing long COVID. However, it is advisable to maintain regular follow-ups with healthcare providers to monitor your son's health, especially if he contracts COVID-19.

In summary, while your son has been diagnosed with ankylosing spondylitis and is HLA-B27 positive, he does not have the common autoantibodies associated with other autoimmune diseases based on the tests performed. It is crucial to focus on managing his AS through appropriate medical treatment, physical therapy, and lifestyle modifications. Regular consultations with rheumatologists and other specialists can help ensure that he receives comprehensive care tailored to his needs. If you have further concerns about long COVID or any other health issues, discussing them with his healthcare provider will provide the best guidance.

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