The Joint Disease Burden in Patients with Secondary Sjögren’s Syndrome and RA Compared to Patients with RA Only

Evo Alemao¹, Yogesh Saini², Ying Bao¹, Aarti Rao², Christine K Iannaccone³, Michael E Weinblatt³ and Nancy A. Shadick³, ¹Bristol-Myers Squibb, Princeton, NJ, ²Mu Sigma, Bangalore, India, ³Brigham and Women's Hospital, Boston, MA

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: autoantibodies, extraarticular manifestations, joint damage and rheumatoid arthritis (RA), Sjogren's syndrome

Session Information

Date: Tuesday, October 23, 2018

Title: Rheumatoid Arthritis – Diagnosis, Manifestations, and Outcomes Poster III: Complications of Therapy, Outcomes, and Measures

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose: Secondary Sjögren’s syndrome (sSS) is considered a poor prognostic factor in RA and is a common extra-articular manifestation of RA. We estimated prevalence of sSS and joint disease burden in patients (pts) with RA with sSS based on physician diagnosis or Ro-antibody positive (SSa), plus presence of dry eyes or dry mouth.

Methods: Data from adult pts with RA enrolled in a longitudinal RA registry were analyzed. Pts in the registry were evaluated by a rheumatologist annually for disease activity and treatments and semi-annually for multiple clinical pt-reported outcomes (PROs) and resource utilization parameters. For this analysis, pts with RA were categorized into two cohorts: pts with sSS and pts with RA only. Prevalence estimates of pts with sSS were based on clinician diagnosis or meeting ACR/EULAR 2016 classification of primary Sjögren’s syndrome. Baseline characteristics between the two cohorts were compared using the Kruskal-Wallis test for continuous variables and chi-square test for categorical variables, with a significance level of 0.05. Mean change from baseline to 12 months in disease activity measures and PROs of fatigue were assessed for pts with data available at baseline and follow-up.

Results: A total of 1471 pts with RA were included in the analysis. The prevalence of sSS was 28.2% (n=415); the remaining 71.8% (n=1056) were included in the RA only cohort. Physician diagnosis comprised ~10% of pts with sSS; the remainder was based on SSa positivity and symptoms of dry eyes or dry mouth. Compared with the RA only cohort, pts with RA with sSS were more likely to be female, have early onset of RA, longer RA disease duration, greater seropositivity, higher antibody titers, higher disease activity levels (Rheumatoid Arthritis Disease Activity Index, CDAI and DAS28[CRP]), higher fatigue and more likely to have comorbidities of vasculitis, neuropathy and pulmonary nodules (Table 1). In addition, a greater proportion of pts with RA with sSS had prior biologic (b)DMARD exposure (n [%] 248 [59.8] vs 463 [43.8]; p<0.0001), with a higher proportion currently taking bDMARDs (195 [47] vs 382 [36.2]; p=0.0001). Pts with RA with sSS continued to experience higher disease activity and fatigue at 12 months, with a significantly lower reduction in disease activity versus pts in the RA only cohort (Table 2).

Conclusion: The prevalence of sSS was 28% in pts with RA. Although the majority of pts with RA with sSS compared with pts with RA without sSS had exposure to bDMARDs, they continued to experience higher autoantibody burden (RF and ACPA), joint disease activity and fatigue.


Table 1. Baseline Characteristics in Patients With sSS Compared With Patients With RA Only
	Pts with sSS		Pts with RA only		p value*
	N	Mean (SD)	N	Mean (SD)	p value*
Age, years	415	57.8 (13.4)	1056	56.0 (14.7)	0.044
Age at RA diagnosis, years	414	42.4 (14.5)	1054	44.1 (15.7)	0.060
Age at onset of RA symptoms, years	411	39.6 (14.7)	1049	41.9 (15.9)	0.016
Duration of RA symptoms, years	411	18.0 (13.4)	1049	14.1 (12.5)	<0.0001
Female, n (%)	415	378 (91.1)	1056	828 (78.4)	<0.0001
BMI	370	26.9 (6.1)	980	26.9 (5.6)	0.754
RF titer, IU/mL	381	168.0 (401.3)	906	117.8 (300.8)	0.002
RF+, n (%)	381	255 (66.9)	906	546 (60.3)	0.024
ACPA titer, IU/mL	383	154.1 (173.0)	928	121.8 (149.0)	0.0005
ACPA+, n (%)	383	259 (67.6)	928	551 (59.4)	0.005
RADAI	388	3.6 (2.2)	938	3.2 (2.3)	0.002
DAS28 (CRP)	355	3.9 (1.7)	923	3.6 (1.6)	0.033
CDAI score	356	21.8 (17.9)	927	18.7 (15.7)	0.009
Number of swollen joints	393	6.6 (7.5)	1055	6.0 (6.8)	0.364
Number of painful joints	393	7.8 (8.6)	1055	6.5 (7.2)	0.084
MDHAQ fatigue scale	387	49.4 (30.5)	942	38.5 (28.5)	<0.0001
Comorbidities, n (%)
Vasculitis, cutaneous	415	13 (3.1)	1056	4 (0.4)	<0.0001
Vasculitis, other	415	3 (0.7)	1056	0 (0.0)	0.022
Lymphoma	415	2 (0.5)	1056	10 (0.9)	0.527
Neuropathy	415	15 (3.6)	1056	9 (0.9)	0.001
Lung cancer	415	2 (0.5)	1050	5 (0.5)	1.000
Pulmonary fibrosis	415	13 (3.1)	1056	28 (2.7)	0.601
Pulmonary nodules	415	17 (4.1)	1056	12 (1.1)	0.001
Data are expressed as mean (SD) unless otherwise indicated *Significant at p<0.05 ACPA=anti-citrullinated protein antibody; MDHAQ=Multidimensional Health Assessment Questionnaire; pts=patients; RADAI=Rheumatoid Arthritis Disease Activity Index; sSS=secondary Sjogren’s syndrome

Table 2. Disease Activity Measures and Fatigue at 12 Months and Change From Baseline

12 months

Change from baseline

Pts with sSS

(n=372)

Pts with RA only

(n=925)

Pts with sSS (n=372)

Pts with RA only (n=925)

p value

RADAI

3.3 (2.1)

344

2.6 (2.0)

840

–0.2 (1.7)

344

–0.6 (1.9)

840

0.006

DAS28 (CRP)

3.5 (1.7)

250

3.1 (1.5)

628

–0.3 (1.4)

250

–0.5 (1.3)

628

0.037

CDAI score

18.5 (17.3)

249

14.0 (13.9)

642

–2.6 (14.3)

249

–4.7 (13.0)

642

0.029

Number of swollen joints

4.8 (6.7)

307

3.9 (5.8)

766

–1.6 (6.3)

307

–2.1 (5.8)

766

0.361

Number of painful joints

5.9 (7.9)

307

4.9 (6.8)

766

–1.4 (7.3)

307

–1.4 (6.1)
766

0.424

MDHAQ fatigue scale

46.1 (27.7)

342

36.5 (26.5)

841

–2.8 (22.8)

342

–1.5 (22.7)

841

0.503

Data are expressed as mean (SD) N

MDHAQ=Multidimensional Health Assessment Questionnaire; pts=patients; RADAI=Rheumatoid Arthritis Disease Activity Index; sSS=secondary Sjogren’s syndrome

Disclosure: E. Alemao, Bristol-Myers Squibb, 1, 3; Y. Saini, Mu-sigma, 5; Y. Bao, Bristol-Myers Squibb, 1, 3; A. Rao, Mu Sigma for Bristol-Myers Squibb, 5; C. K. Iannaccone, None; M. E. Weinblatt, Amgen, Crescendo Bioscience, Bristol-Myers Squibb, Sanofi/Regeneron, 2,AbbVie, Ablynx, Amgen, Bristol-Myers Squibb, Canfite, Corrona, Crescendo, GSK, Gilead, Lilly, Lycera, Merck, Momenta, Novartis, Pfizer, Roche, Samsung, Set Point, UCB, Vertex, 5; N. A. Shadick, Amgen, Mallinckrodt, Bristol-Myers Squibb, Sanofi-Regeneron, 2,Bristol-Myers Squibb, 5.

To cite this abstract in AMA style:

Alemao E, Saini Y, Bao Y, Rao A, Iannaccone CK, Weinblatt ME, Shadick NA. The Joint Disease Burden in Patients with Secondary Sjögren’s Syndrome and RA Compared to Patients with RA Only [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/the-joint-disease-burden-in-patients-with-secondary-sjogrens-syndrome-and-ra-compared-to-patients-with-ra-only/. Accessed .

« Back to 2018 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-joint-disease-burden-in-patients-with-secondary-sjogrens-syndrome-and-ra-compared-to-patients-with-ra-only/