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Abstract Number: 2883

Clinical Characteristics of Rheumatoid Arthritis Patients with Secondary Sjögren’s Syndrome and Association with Joint Damage

Lindsay E. Brown1, Michelle A. Frits2, Christine K. Iannaccone2, Michael E. Weinblatt2, Nancy A. Shadick3 and Katherine P. Liao4, 1Internal Medicine, Massachusetts General Hospital, Boston, MA, 2Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, 3Rheumatology/Immunology, Brigham and Women's Hospital, Boston, MA, 4Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords: Disease Activity, joint damage, radiography and rheumatoid arthritis (RA), Sjogren's syndrome

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Session Information

Title: Sjögren's Syndrome: Clinical Advances

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*).

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)

 


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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