Introduction Anti-RNP antibody is associated with overlap syndrome, which is classified either systemic lupus erythematosus (SLE) or systemic sclerosis (SSc) later. The aim of current study is to investigate whether certain clinical features of anti-RNP positive patients can predict further disease predisposition.

Method We reviewed medical records of patients visited at Soonchunhyang University Cheonan Hospital since April of 1990. Initial clinical symptoms and its’ onset, other clinical symptoms developed during observational periods, autoantibody profiles were investigated.

Results A total of thirty-two patients with anti-RNP positive patients were identified during 2008 to 2017 (female n=28, male n=4). The most common initial clinical symptoms were musculoskeletal symptoms including arthritis, arthralgia, myositis, myalgia, and puffy hands (n=10, 31.1%), followed by mucocutaneous symptoms including photosensitivity, malar rash (n=9, 28.1%), cytopenia including hemolytic anaemia, leucopenia, and thrombocytopenia (n=8, 25%), Raynaud’s phenomenon (RP, n=7, 21.9%), renal involvement (n=3, 9.4%), serositis (n=3, 9.4%), and enteritis (n=2, 6.3%). Average 9 years of follow-up duration, 87.5% of patients were diagnosed SLE (n=28) while 18.8% of patients were diagnosed SSc (n=6). None of patients diagnosed SSc showed initial clinical symptoms such as enteritis, serositis, cytopenia, or renal involvement. Patients who had RP at the beginning showed significantly high risk for developing SSc (Risk ratio 7.1 95% confidential interval 1.6–31.3). Patients with positive anti-dsDNA (n=17, 53.1% of all patients, p=0.004) and anti-Sm (n=17, 56.3%, p=0.03) anti-Ro/SSA (n=16, 50%, p=0.07) antibody were significantly frequently diagnosed as SLE during follow-up periods. higher in SLE than those with SSc, while patients with SSc. Of six patients with SSc, three patients (50%) showed anti-Scl t antibody, one patient (16.7%) showed anti-centromere antibody, and, of note, two patients (33.3%) showed no SSc specific antibody.

Conclusion In patients with anti-RNP positive, patients with Raynaud’s phenomenon have increased risk of developing systemic sclerosis even without SSc specific autoantibodies, while patients with serositis, cytopenia, enteritis, or renal involvement have higher probability to have SLE.