ObjectiveThe biological diagnosis of primary Sjögren's disease (SjD) mainly relies on anti‐Ro60/SSA antibodies, while the significance of anti‐Ro52/TRIM21 antibodies currently remains unclear. The aim of this study was to characterize the clinical, serological, biological, transcriptomic and interferon profiles of SjD patients according to their anti‐Ro52/TRIM21 antibody status.MethodsSjD patients from the European PRECISESADS (n=376) and the Brittany DIApSS (n=146) cohorts were divided into four groups: double negative (Ro52‐/Ro60‐), isolated anti‐Ro52/TRIM21 positive (Ro52+), isolated anti‐Ro60/SSA positive (Ro60+), and double positive (Ro52+/Ro60+) patients. Clinical information, ESSDAI, a score representing systemic activity, and biological markers associated with disease severity were evaluated. Transcriptome data obtained from whole blood by RNAseq and type I and type II interferon signatures were analysed for PRECISESADS patients.ResultsIn the DIAPSS cohort, Ro52+/Ro60+ patients showed significantly more parotidomegaly (33.3% vs 0‐11%), along with higher β2‐microglobulin (p=0.0002), total immunoglobulin (p<0.0001), erythrocyte sedimentation rate levels (p=0.002), and rheumatoid factor (RF) positivity (66.2% vs. 20.8%‐25%) compared to other groups. The PRECISESADS cohort corroborated these observations, with increased arthritis (p=0.046), inflammation (p=0.005), hypergammaglobulinemia (p<0.0001), positive RF (p<0.0001), leukopenia (p=0.004), and lymphopenia (p=0.009) in Ro52+/Ro60+ patients. Cumulative ESSDAI results further confirmed these disparities (p=0.002). Transcriptome analysis linked anti‐Ro52/TRIM21 antibody positivity to interferon pathway activation, as an underlying cause for these clinical correlations.ConclusionThese results suggest that the combination of anti‐Ro52/TRIM21 and anti‐Ro60/SSA antibodies is associated with a clinical, biological, and transcriptional profile linked to greater disease severity in SjD, through the potentiation of the interferon pathway activation by anti‐Ro52/TRIM21 antibodies.image