Background/Purpose: Secondary Sjögren’s Syndrome (sSS) is a common extraarticular manifestation in patients with Rheumatoid Arthritis (RA). According to the 2002 European American criteria (EA 2002) classification for Sjögren’s Syndrome (SS), the secondary term is used for all cases present concomitantly with another connective tissue disease. There is little evidence regarding the difference between patients with SS associated with RA with minor salivary gland biopsy with and without focal lymphocytic sialadenitis (FLS).

Objetive: Determine whether FLS is associated with clinical and serological differences in a group of patients diagnosed with RA and sSS.

Methods: Patients with RA diagnosis were included according to ACR 1987 and / or ACR-EULAR 2010 criteria, and who also met criteria EA 2002 for sSS. Ocular tests, sialometry and minor salivary gland biopsy were performed. Clinical, serological and treatment characteristics were compared between patients with positive FLS and negative FLS. For continuous variables, t-test or Mann Whitney test was used, and for the categorical variables Chi square or Fisher’s exact test was used. A multivariate logistic regression analysis was performed taking the presence of FLS as a dependent variable.

Results: We included 88 patients with SS associated with RA. 92% were women, with a mean age of 53 years (SD ± 11.3) and 12.5 years of RA evolution (IQR 6-17). 63.6% had FLS vs. 36.4% that did not. In the univariate analysis, patients who presented FLS had higher current HAQ (1.12 IQR 0.5-1.62 vs 0.55 IQR 0.06-1.37, p 0.04); parotid swelling frequency (23% vs 0%, p 0.003); interstitial lung disease (25% vs 6.25%, p 0.04); autoimmune liver disease (14.3% vs 0%, p 0.047); hypergammaglobulinemia (51.8% vs 3%, p ˂0.001); anemia (35.7% vs 15.6%, p 0.04); hypocomplementemia (51.9% vs 16%, p 0.001); double seropositivity for RF and ACPA (87.5% vs. 68.7%, p 0.03); Positive ANA (94.6% vs 71.8%, p 0.007) and extra-joint and extraglandular manifestations (66% vs 21.9%, p ˂0.001). No differences were found regarding the positivity of RO and / or LA, in the positivity of ACPA (92.8% vs 81.3%), nor in treatments and total number of immunosuppressants received. The variables that were found to be independently associated with the presence of FLS were the presence of extra-joint and extraglandular manifestations (OR 5.67 CI95% 1.6-20), positive ANA (OR 11.7 CI95% 1.6-83) and hypergammaglobulinemia (OR 21 CI95% 2.46-179).

Conclusion: Patients with RA and sSS who have FLS in the minor salivary gland present greater frequency of extra-articular and extraglandular manifestations, as well as serological differences with respect to patients without FLS.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/minor-salivary-gland-biopsy-its-importance-in-rheumatoid-arthritis-and-secondary-sjogrens-syndrom/