Abstract Background/Aims To evaluate infertility in patients with systemic lupus erythematosus (SLE) and assess the relationship with the presence of specific antibodies by using real-world data from a rheumatology clinic in Karachi, Pakistan. Methods This retrospective cohort observational study enrolled outpatients (n = 304) from a single centre with a confirmed diagnosis of SLE based on the 2019 ACR/EULAR classification criteria. Disease activity was measured using SLEDAI-2K. Infertility was classified as a composite of low ovarian reserve, abortions and intra-uterine deaths. ANA Subsets antibodies (against 17-antigens) were tested using the AESKU or Euroimmun immunoblots as per manufacturer’s protocol. Ethical approval was obtained from ImmunoCure Ethics Review Committee (IC-ERC #0002). We used Spearman’s rank correlation to examine associations between antibody status and infertiliy. Logistic regression was performed to determine antibody predictors of infertility. All analysis were done in Stata V17 and Python using appropriate packages. Results Patients (n = 304) did not differ between SLEDAI categories (Low disease activity ≤ 6; High 6) by age (mean age 38.7 ± 14.0 years), sex (female = 92%), BMI or inflammatory markers (ESR/CRP). Ribosomal-P protein antibody (RIB-P) was associated (P 0.001) with low activity SLE, while anti-Histone antibodies (Hist) showed a trend towards low disease activity (P = 0.055). RIB-P (Spearman Rho (ρ) = 0.29, P= 1.54E-06) and Hist (ρ = 0.24, P=7.3E-05) were strongly associated with infertility. SSB associated with infertility also (ρ = 0.19; P=0.0022). Interestingly, all three antibodies (RIB-P, Hist, SSB) had a frequency of 16%. In our cohort, there were 15 patients who tested positive for both RIB-P and Hist and 47% had infertility. In logistic regression analysis, RIB-P (OR = 4.4, CI95 = 1.9 - 10.4, P = 0.001) and Hist (OR = 2.8, CI95 = 1.2 - 6.1, P = 0.013) were significantly associated with female infertility. Conclusion We report here that antibodies against Ribosomal P protein and Histones are strongly associated with female infertility in a SLE cohort from Pakistan. Interestingly, Histone H1 has been previously shown to physically interact with several ribosomal proteins in the nucleus, and these complexes are involved in transcriptional gene repression. Disclosure M. Khan: None. Z. Kamdi: None. K. Rashid: None. U. Imran: None. A. Pasha: None.
Khan et al. (Wed,) studied this question.