Disease activity, symptom burden can indicate Sjögren’s treatment strategy
Click Here to Manage Email Alerts
SAN DIEGO — Determining which of several phenotypes a patient with Sjögren’s disease falls under can help inform their treatment strategy, according to data presented at the 2024 Congress of Clinical Rheumatology West.
The different phenotypes depend on a patient’s level of systemic disease and self-reported symptom burden, Dana D. DiRenzo, MD, MHS, RhMSUS, assistant professor of medicine at the University of Pennsylvania, in Philadelphia, told attendees.
DiRenzo highlighted a “very, very important study” regarding phenotypes in Sjögren’s disease, which Yann Nguyen, PhD, and colleagues published this year in The Lancet Rheumatology. The study used hierarchical clustering analysis to group patients together based on 26 different variables, including disease activity — assessed via the EULAR Sjögren's Syndrome Disease Activity Index (ESSDAI) — and symptom burden — measured using the EULAR Sjögren’s Syndrome Patient Reported Index (ESSPRI).
The analysis identified three clusters of Sjögren’s disease patients, which DiRenzo described as:
- those with high systemic disease and low symptom burden;
- those with high systemic disease and high symptom burden; and
- those with low systemic disease and low symptom burden.
Which group a patient falls under has implications for management, according to DiRenzo. For example, those with high systemic disease and high symptom burden should be treated “right away,” she said.
“That’s going to be the obvious patient coming into your clinic,” she said. “They might have inflammatory markers, they might have low complements, a lot of glandular activity, maybe other organ manifestations, and that is going to be fairly obvious to you in clinic.”
On the other hand, those with high systemic disease activity and low symptom burden are patients “you’re going to want to watch very closely and over time,” according to DiRenzo.
“This might be your younger patient coming in who has really severe glandular manifestations, but maybe it’s early on,” she said. “Maybe it didn’t scar and give them very profound dryness at that point. Maybe they’re not having profound fatigue at that point. Their lab work looks abnormal, and they might have very high immunoglobulins, high inflammatory markers, but they’re not feeling the symptom burden from it yet.
“These are also the patients you’re worried about progressing to lymphoma,” she added.
Lastly, regarding those with both low systemic disease and low symptom burden, DiRenzo stated that these patients rarely demonstrate disease progression.
“We know from epidemiologic data, cohort data, that the low systemic disease patients in general tend not to progress,” she said. “These also tend to be the patients who are SSA negative.”
Collapse
DiRenzo DD. Updates on Sjögren’s Disease. Presented at The Congress of Clinical Rheumatology West; Sept. 26-29, 2024. (hybrid meeting).
Read more about
Click Here to Manage Email Alerts