Background/Purpose: Antimalarials are frequently used in patients with primary Sjögren’s syndrome (SS). The aim of this study was to assess their impact on damage accrual among this group of patients.

Methods: We included 377 consecutive patients with the diagnosis of primary SS according to the AECG criteria, attending tertiary referral centers from three countries: Argentina (n=110), Brazil (n= 49) and Mexico (n=218). We retrospectively registered demographics, age at disease onset, disease duration, use of prednisone (PDN), immunusupressors, comorbidities and use of antimalarials (cloroquine or hydroxychloroquine, time of use and indication). We also scored the cumulative ESSDAI at last follow-up as well as the SSDDI.

Results:  The mean age at diagnosis was 48.9±12.7 years, 97.3% females, median disease duration 6 years, mean SSDDI score 2.7±1.8 and mean cumulative ESSDAI score 9.3±8.3. There were not differences regarding these variables among countries, with the exception of the SSDDI that was lower in Brazil (1.8±2.3, Mexico 2.8±2, Argentina 3±1.6, p≤0.001) and the median disease duration that was longer in Mexico (7 years, Argentina 4.5 years, Brazil 5 years). Thirty nine percent of patients used PDN, 37.4% immunosuppressors, 23.1% had hypertension, 16.5% dyslipidemia and 6.6% diabetes mellitus. A total of 190 patients (50.3%) had ever used antimalarials, mean use of 43.5±40 months, being the indications: arthritis (65.2%), parotid enlargement (6.3%), only sicca symptoms (19.4%) and other causes (8.9%). When we compared patients with and without antimalarials, the first ones were younger (46.6±11.7 vs. 51.3±13.1, p=0.0001), with a longer disease duration (median 7 vs. 4 years, p=0.0001), used more PDN (44.5% vs. 33.3%, p=0.002) and immunosuppressors (44% vs. 30.6%, p=0.007) and had a lower SSDDI score (2.4±1.7 vs 2.9±1.8, p=0.01). Regarding the domains of the SSDDI, the pulmonary domain was the only one with a significant difference among groups (6.7% with antimalarials vs. 14.9% without antimalarials, p=0.01). Then, we compared patients with a SSDDI ≥3 vs. SSDDI<3, the first ones had longer follow up (6 vs. 5 years, p=0.04), a higher cumulative ESSDAI score (12.4±9.3 vs. 6.7±6.2, p=0.0001) and less use of antimalarials (42.9% vs. 57%, p=0.007). At the logistic regression analysis adjusted by country and disease duration, the following variables were independent predictors of damage: use of antimalarial OR 0.58 (0.36-0.93 CI 95%, p=0.02) and cumulative ESSDAI OR 1.1 (1.07-1.15 CI 95%, p=<0.001).

Conclusion:  During the course of disease, half of the SS patients received antimalarials. This drug was associated with a lower damage accrual independently of disease activity and duration.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/antimalarials-protect-against-damage-accrual-in-primary-sjogrens-syndrome/