Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose:
Secondary Sjögren’s syndrome (sSS) is a common extra-articular manifestation of rheumatoid arthritis (RA). However, the clinical characteristics of this subgroup of patients are not well characterized. In addition, whether sSS is associated with worse outcomes such as joint damage remains unclear. This study aims to characterize sSS patients in an RA cohort and determine whether there is an association between sSS and worse joint damage.
Methods:
We conducted a cross-sectional study in an observational cohort of RA patients at a large academic center. We included all subjects with >=1 year of follow-up. Subjects with comorbid diseases, which can also result in sicca symptoms, e.g. sarcoidosis, viral hepatitis,HIV/AIDS, were excluded from the analysis. Subjects were considered to have sSS if they were reported as having sSS by their rheumatologist at recruitment into the cohort (baseline) and had the diagnosis confirmed by manual chart review. Fifty subjects without sSS were also reviewed to determine the negative predictive value (NPV) of having no sSS reported at baseline. The primary outcome was Sharp scores associated with bilateral hand radiographs at baseline. We conducted univariate analyses on potential clinical variables associated with sSS, e.g. age, gender, race, ACPA or RF positivity, DAS28-CRP, methotrexate and anti-TNF use at baseline. We constructed a linear regression model to determine the association of sSS status and baseline Sharp score, adjusted by age, gender, RA disease duration and variables significant from the univariate analyses.
Results:
We studied 829 RA subjects, mean age was 57 years, 83% female, mean RA duration 13 years, 63% ACPA positive; fifty-seven subjects (7%) had sSS (the NPV of not having sSS if not reported at baseline was 100%). We observed a female predominance (98%) and a significantly higher percentage of African-Americans subjects (10%) with sSS than the general RA cohort; subjects with sSS also had a significantly higher DAS28-CRP at baseline in the univariate analysis (Table 1). Having sSS at baseline was associated with higher Sharp scores (p=0.01), adjusted for age, gender, disease duration and variables significant from the univariate analyses (African American race, RF positive, baseline DAS28-CRP) (Table 2).
Conclusion:
In our RA cohort, sSS affected a significantly higher proportion of women and African Americans than the overall cohort. RA subjects with sSS had worse joint damage, suggesting that sSS may a marker of more aggressive disease.
|
Table 1. Clinical characteristics of subjects with Secondary Sjögren’s Syndrome (sSS) in the RA cohort (n=829). |
|||
|
Clinical characteristics |
sSS, n=57 (6.9%) |
No sSS, n=772 (93.1%) |
p-value |
|
Age, mean yrs (SD) |
57.2 (10.5) |
56.9 (13.7) |
0.869 |
|
Female gender (%) |
98.3 |
81.4 |
0.001 |
|
Disease duration, mean yrs (SD) |
16.1 (10.8) |
13.5 (12.4) |
0.13 |
|
Race (%) |
|
|
|
|
Caucasian |
84.2 |
93.7 |
0.004 |
|
African American |
10.5 |
3.8 |
0.02 |
|
ACPA positive (%) |
70.4 |
61.7 |
0.20 |
|
RF positive (%) |
80.0 |
62.1 |
0.008 |
|
Baseline DAS28-CRP, mean (SD) |
4.36 (1.7) |
3.89 (1.6) |
0.03 |
|
Baseline Sharp score, median (IQR) |
48.0 (82.0) |
17.0 (61.0) |
0.002 |
|
Anti-TNF at baseline, % |
45.6 |
35.8 |
0.14 |
|
MTX at baseline, % |
57.9 |
46.3 |
0.10 |
|
Table 2. Association between sSS at baseline and joint damage (as measured by Sharp scores*). |
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|
Clinical variable |
Beta coefficient (SE) |
p-value |
|
Age, yrs |
0.02 (0.007) |
0.18 |
|
Female gender |
-0.13 (0.23) |
0.62 |
|
Disease duration, yrs |
0.04 (0.007) |
<.0001 |
|
African-American race |
-0.78 (0.32) |
0.02 |
|
RF positivity |
0.76 (0.19) |
<.0001 |
|
Baseline DAS28-CRP |
0.18 (0.05) |
0.0003 |
|
Presence of sSS |
0.43 (0.17) |
0.01 |
|
*Sharp scores were non-normally distributed and were categorized into quintiles (Q1: <1, Q2: ≥1 and <10, Q3: ≥10 and <32.5, Q4: ≥32.5 and <81.5, Q5: ≥81.5 units) |
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Disclosure:
L. E. Brown,
None;
M. A. Frits,
None;
C. K. Iannaccone,
None;
M. E. Weinblatt,
Janssen Research & Development, LLC.,
5;
N. A. Shadick,
None;
K. P. Liao,
None.
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