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Secondary Sjögren's syndrome impacts quarter of patients with SLE
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Secondary Sjögren’s syndrome affects approximately one-quarter of all patients with systemic lupus erythematosus, and the frequency increases with age, according to data published in the Journal of Rheumatology.
“The clinical SLE-[secondary Sjögren’s syndrome (sSS)] phenotype has been described as a mild version of SLE with dominance of skin and joint manifestations and with less severe internal organ involvement especially nephritis,” Guillermo Ruacho, DMD, of the Karolinska Institute, in Stockholm, and colleagues wrote. “Differences and similarities between [primary] SS and SLE with SS (SLE-sSS) have been studied, but to what extent the inflammatory pattern differs between SLE-sSS and SLE patients without SS (SLE-nonsSS) is not known, and this information may be important with regard to treatment perspectives.”
They added, “To our knowledge, no previous study has investigated SLE patients and matched population controls for both subjective and objective symptoms of SS and associated SSA/SSB autoantibodies.”
In their analysis of patients with SLE and secondary Sjögren’s syndrome, Ruacho and colleagues studied 504 consecutive patients fulfilling the 1982 revised American College of Rheumatology criteria for SLE at Karolinska University Hospital and Danderyd Hospital. The inclusion period stretched from February 2004 to December 2014. The researchers also recruited 319 control participants from the general population. These control participants were matched based on sex, age and geographic region to the first 319 patients with SLE.
Ruacho and colleagues identified secondary Sjögren’s syndrome using the American-European Consensus Criteria (AECC), and completed clinical investigations of sicca symptoms in all participants, including subjective and objective quantifications. In addition, they measured autoantibodies using Luminex, as well as 20 selected cytokines with multiplex analysis.
According to the researchers, 23.2% of patients with SLE demonstrated secondary Sjögren’s syndrome. In addition, patients in the SLE group with secondary Sjögren’s syndrome were older, and more predominantly female, compared with those without. Those with secondary Sjögren’s syndrome were older at inclusion (P < .0001) and at SLE onset (P < .0001), compared with those without. In addition, the percentage of patients with SLE and secondary Sjögren’s syndrome increased with rising age.
The researchers also found that circulating levels of six of the 20 investigated pro-inflammatory cytokines — TNF-alpha, IL-6, MCP-4, MIP-1beta, IL-12/IL23p40 and IP-10 — total IgG, anti-SSA/Ro52, anti-SSA/Ro60, anti-SSB/La antibodies and rheumatoid factor (IgM and IgA) were increased among those with secondary Sjögren’s syndrome, compared with those without (P < .05 for all).
“Our investigations of the SLE-sSS subset demonstrate that it affects roughly [one-quarter] of SLE patients, and the frequency increases with rising age,” Ruacho and colleagues wrote. “Autoantibodies, SSA/SSB, occur in the majority, but a large minority, 39%, were SSA/SSB negative. SLE-sSS shares many features with [primary] SS such as a striking female predominance, older age at onset and neuropathy. It is a novel observation, with possible therapeutic implications, that an inflammatory state with higher levels of pro-inflammatory cytokines occurred in SLE-sSS than in SLE-nonsSS.” – by Jason Laday
Disclosure: Ruacho reports no relevant financial disclosures. Please see the full study for all other authors’ relevant financial disclosures.
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