Background/Purpose: To evaluate the clinical manifestations, systemic disease activity, and serological profile of patients of Primary Sjögren’s syndrome, and to assess associations between specific autoantibodies and ESSDAI domain involvement, with the aim of identifying patterns that could guide diagnosis, disease monitoring, and management.

Methods: This prospective observational study was conducted in the Department of Rheumatology at XYZ Hospital from July 2017 to January 2019, following institutional ethical approval. Patients diagnosed with primary Sjögren’s syndrome based on ACR classification criteria1 were included. Exclusion criteria encompassed coexisting infections, malignancies, radiation history, or other autoimmune conditions. Informed consent was obtained from all participants.Each patient underwent a detailed clinical evaluation, laboratory testing (including ANA, RF, ACPA, and a panel of autoantibodies), and additional assessments like Schirmer’s test, imaging, and minor salivary gland biopsy. Systemic disease activity was assessed using ESSDAI and patient-reported symptoms via ESSPRI. Data analysis was performed using Jamovi software.2 Categorical data were presented as frequencies; continuous data as mean ± SD. Associations were tested using chi-square and t-tests.

Results: Out of 144 screened individuals, 105 were included in the final analysis. The mean age was 38.5±11.1 years; 95.2% were female. Sicca symptoms (ocular and oral dryness), dental caries (61.9%), fatigue (30.5%), and glandular swelling were common. Mild to moderate breathlessness was reported by 19%. (Table 1A)Laboratory findings (Table 1B) showed elevated ESR (mean 48.3 mm/hr), mild anemia (mean hemoglobin 10.8 g/dL), and low vitamin D levels (mean 20.7 ng/dL). IgG was elevated in many patients (mean 1853.7 mg/dL), with RF positivity in 45 (42.9%) and anti-CCP positivity in 35 (49.3%). ANA patterns were predominantly coarse speckled (48 patients).ESSDAI analysis revealed minimal disease activity in most domains (Figure 1), except articular (43.8% had moderate to high activity), biological (50.5% had low/moderate activity), and lymphadenopathy domains. Significant associations were observed between autoantibodies and ESSDAI domains (Table 2): anti-SSA with glandular (p=0.032), anti-Ro52 and anti-SCL70 with biological (p=0.020, p=0.017), anti-nucleosome with pulmonary (p=0.001), anti-histone with pulmonary and cutaneous (p=0.026, p=0.049), and anti-AMA with glandular and muscular (p=0.002, p=0.001) domains.

Conclusion: This study demonstrates the systemic heterogeneity of Sjögren’s syndrome, with prominent articular and biological domain involvement. Significant associations between autoantibody profiles and specific organ/system involvement can help to identify distinguishing disease subgroups.

Clinical Symptoms and Laboratory Parameters of the study population

Chi-square test values of the various auto-antibodies and ESSDAI domains. Chi-square test p-values showing associations between various autoantibodies and ESSDAI domains in patients with Sjögren’s Syndrome.

This table presents the statistical significance (p-values) of associations between the presence of different autoantibodies and disease activity across 12 ESSDAI domains. Significant associations (p < 0.05) are highlighted in green and marked with an asterisk (*). Notable associations include SSA with the Glandular domain (p = .032), PCNA with the Glandular domain (p = .033), and AMA with the Renal (p = .002) and Muscular (p = .001) domains. These findings may indicate domain-specific immunological patterns in Sjögren’s Syndrome.

Figure 1: Distribution of disease activity across domains of the EULAR Sjögren’s Syndrome Disease Activity Index (ESSDAI).

The bar chart illustrates the frequency of disease activity levels—high (red), moderate (purple), low (green), and no activity (blue)—across 12 clinical domains of ESSDAI in a cohort of patients. The Central Nervous System, Muscular, and Renal domains show the highest number of cases with no disease activity, whereas domains such as the Articular and Biological Activity domains demonstrate a wider distribution across all activity levels. The data highlights the heterogeneity of systemic involvement in Sjögren’s Syndrome.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/autoantibody-profiles-and-their-association-with-organ-involvement-in-primary-sjogrens-syndrome-insights-from-essdai/