These patients may have autoantibodies that bind only the Ro antigen and no other specificities and for this reason the ANA reactivity may be low or absent.24 Titers of anti-Ro and anti-La autoantibodies remined quite constant in our population of patients with pSS, confirming previous literature.3,25 Interestingly, titers of anti-ENA antibodies of patients with pSLE declined over time and in one patient became negative. Here, ENAH is linked to peeling skin syndrome.