**6. Conclusions**

**4.8. Anti-alpha-fodrin antibodies**

128 Autoantibodies and Cytokines

**development of MALT lymphoma**

**Auto-antibody Clinical findings** Anti-Ro52 kD Interstitial lung disease

dryness Anti-SS-B/La Liver (autoimmune disease) PBC

Anti-CENP-B Interstitial lung disease and fibrosis

Anti-CA6 Dryness and renal tubular acidosis

Anti-CEP-1 Arthritis and renal tubular dysfunction.

**Table 4.** Antibodies in pSS and their association with clinical manifestation.

ACPA Arthralgia and arthritis

Novel autoantibodies

Anti-PSP Dryness Anti-SP1 Dryness

Alpha fodrin is an actin-binding, organ-specific protein of the cytoskeleton. Antibodies against alpha-fodrin are detected in serum samples from patients with primary or secondary Sjögren's syndrome especially with sicca symptoms. Some authors suggest that they can be detected earlier in the course of pSS, sometimes before the emergence of anti SS-A or SS-B antibodies [64]. These antibodies, in the IgA and IgG class of immunoglobulins, are found in the serum and salivary glands of patients with pSS. However, other researchers did not describe any

Major salivary glands are the main extra endocrine glands targeted in pSS and saliva of patients with pSS is also a source of antibodies and cytokines. Large salivary glands are also the site for MALT lymphoma development. Investigators are interested in finding biomarkers in saliva, that allow for early pSS diagnosis, as well as the detection of mucosa associated lymphoma (MALT lymphoma). Cui et al. suggest set of three autoantibodies such as anti-cofilin-1 antibodies, anti-alpha enolase and anti-Rho GDP dissociation inhibitor 2(RGI2) antibodies, which, due to high specificity and sensitivity, may play a role as such biomarkers [68].

In the current pSS criteria, only anti-SS-A/Ro antibodies are taken into account as the most sensitive and specific for pSS diagnosis. Still, the multisymptom picture of this rheumatic disease compels the search for other immunologic markers of at least equal prognostic importance.

Anti-Ro60 kD Hematologic changes, photosensitivity, skin involvement, Raynaud's phenomena, and

significant sensitivity and specificity of these antibodies [65–67].

**5. Autoantibodies in course of pSS—summary**

RF Dryness, hypergammaglobulinemia, and leukopenia

**4.9. Autoantibodies in saliva that may be relevant in pSS associated with the** 

pSS is a still not fully understood autoimmune disease, requiring doctor's vigilance. Even despite of a pSS having a mild course for a long time, there is a risk of organs and systems involvement. As it has been known for many years already, the risk of developing lymphomas is particularly increased in pSS patients compared to the healthy population. Although only one antibody (SS-A/Ro) has been included in the pSS diagnostic criteria, a lot of attention has been paid to new autoantibodies that can help clinicians in patient stratification in the early stages of diagnosis or may have a prognostic value.
