Discovery of Anti-SS-A Antibodies during Stroke Investigations in Young Adults: What Impact?

Abstract

OBJECTIVES\nFrench national guidelines recommend searching for anti-SS-A antibodies during the second-line assessment of stroke in adults < 55 years of age in the absence of an identified etiology. We aimed to assess the impact of finding anti-SS-A antibodies during the etiological investigations of stroke in young adults.\n\n\nMETHODS\nMedical files from all patients ≤ 55 years of age admitted to a single stroke unit during a five-year period and for whom anti-SS-A antibodies were positive were retrospectively analyzed.\n\n\nRESULTS\nTwelve patients were included (9 women; median age 48.5 years), with a rate of anti-SS-A antibody positivity of 1.6% (95% confidence interval [0.71-2.55] %; 12/735 admissions). The etiologies of the 12 ischemic events based on the TOAST classification were large-artery atherosclerosis (n\xa0=\xa01), cardioembolism (n\xa0=\xa01), small-vessel disease (n\xa0=\xa01), other determined etiology (n\xa0=\xa03), multiple etiology (n\xa0=\xa01), and no determined etiology (n\xa0=\xa05). A connective tissue disease (CTD) was discovered in 8/12 patients (1 primary Sjögren s Syndrome, 1 mixed CTD, 1 systemic sclerosis, 2 antiphospholipid syndromes, 1 undetermined CTD, 2 lupus). Anti-SSA antibodies were not directly responsible for the stroke in any of the 12 cases. A link between the autoimmune disease and the neurological vascular episode could be hypothesized for four patients, but it never influenced the therapeutic decision.\n\n\nCONCLUSIONS\nFinding anti-SS-A antibodies during the etiological assessment of a stroke of young adults is rare. However, it may be worthwhile to refer the patient to a rheumatologist/an internist because CTD may be discovered and may require specific follow-up.