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Clinical and serological associations with anti‐RNA polymerase antibodies in systemic sclerosis

There are three classes of RNA polymerase enzyme (RNAPs I, II and III). In systemic sclerosis (SSc), three main groups of anti‐RNAP sera have been characterized by radioimmunoprecipitation techniques: anti‐RNAP I/III sera, anti‐RNAP I/II/III sera, and a group precipitating both RNAP II and topoisomerase I (topo I). Some sera in this third group precipitate the phosphorylated (IIO) form of RNAP II in the absence of the unphosphorylated (IIA) form. Certain other antinuclear antibodies (ANA) have also been detected in anti‐RNAP IIO/IIA/topo I and anti‐RNAP IIO/topo I sera. In the present study of 155 SSc patients, clinical features of individuals from each of these antibody groups were assessed and compared with those of patients from other autoantibody‐defined groups. The anti‐RNAP I/II/III antibody specificity was closely associated with the presence of diffuse cutaneous SSc (dc‐SSc) (77.8%; cf. remaining group, 12.4%; P < 0.001; relative risk (RR) 6.3). Patients with anti‐RNAP I/III antibodies also had an increased incidence of dc‐SSc, but this was not significant (42.9%; cf. remainder, 15.7%). Anti‐RNAP+ patients had a significantly increased incidence of renal involvement (29.0%, cf. remainder, 11.3%; P < 0.05; RR 2.6), with 40% of anti‐RNAP I/II/III patients having renal disease. Meanwhile, the presence of anti‐centromere antibodies (ACA) was associated with limited cutaneous SSc (lc‐SSc) (100.0%; cf. remainder, 75.3%; P < 0.005), together with reduced incidences of both renal disease (2.4%, cf. remainder, 22.1%: P < 0.01) and pulmonary fibrosis (21.4%, cf. remainder, 52.3%; P < 0.005; RR 1.9). Anti‐topo I antibodies were associated with the presence of pulmonary fibrosis (69.7%; cf. remainder, 32.6%; P < 0.001; RR 2.1). A majority of anti‐topo I sera were from lc‐SSc patients, regardless of whether anti‐topo I antibodies occurred alone (75.0%) or together with anti‐RNAP IIO + IIA antibodies (75.0%), and this was similar to the remainder (86.5%; NS). However, when anti‐topo I+ patients were compared with the ACA group, and then with all anti‐RNAP I+ patients (37.5% lc‐SSc), significant differences were found in the occurrence of dc‐ versus lc‐SSc (P < 0.005 and P < 0.05, respectively). In conclusion, these results confirm that there are three main groups of SSc sera, each characterized by the presence of a mutually exclusive SSc‐specific autoantibody (ACA, anti‐topo I or anti‐RNAP I), and distinguished by patterns of cutaneous involvement and specific clinical features. It appears that, in each of the three groups of SSc patients, distinct pathological processes are occurring, which are responsible for the characteristic symptoms, for the modification of particular autoantigens and, consequently, for the production of particular autoantibodies. Based on these data, together with our previous results, it is further hypothesized that anti‐RNAP II antibodies may be produced in the context of two different immune response pathways.