Background/Purpose: Primary Sjögren’s syndrome (pSS) is a complex disorder that may affect any organ and system. In this new era of personalized medicine, a growing interest has arisen for a more tailored patient care designed on individual’s specific features and comorbidities. However, to date a limited number of studies have analysed the prevalence of chronic comorbidities in pSS, especially during the long-term evolution of the disease. Aims of the study were therefore: 1) to describe the prevalence of comorbidities in a cohort of patients with pSS and a minimum follow-up of 10 years from the time of the diagnosis; 2) to explore any association between comorbidities and pSS clinical phenotypes, disease activity and treatments.

Methods: Out of a single-centre cohort of 542 pSS patients we identified 112 subjects who had a minimum follow-up of 10 years from the time of the diagnosis. Information on patients’ demographics, clinico-serological features and treatments were retrieved. Conventional statistics and autocontractive map analysis were used to define pSS clinical phenotypes. An adapted version of the Charlson Comorbidity Index (CCI) was used to score the comorbidity burden.

Results: We included 112 (109 F: 3 M) pSS patients, median age 65 years (IQR 53-73), and median follow-up of 14 years (min 10-max 34 yrs). The comorbidities most frequently observed included: osteoporosis (53/112, 47.3%), autoimmune thyroiditis (35/112, 31.3%), arterial hypertension (27/112, 24.1%) depression and anxiety (23/112, 20.5%), dislipidemia (19/112, 17%), diabetes (9/112, 8%), cerebrovascular disease (8/112, 7,1%) and myocardial infarction (4/112, 3.6%). To explore the association between comorbidities and pSS features, patients were stratified by conventional and autocontractive map analysis in three subsets: “glandular” (30/112, 26.8%), “systemic vasculitic” (16/112, 14.3%) and “systemic not-vasculitic” (66/112, 58.9%). The “vasculitic” subset presented the highest ESSDAI scores (p<0.001), the highest glucocorticoid (p=0.001) and DMARDs (p=0.001) use and the highest comorbidity burden (p<0.001). The mean (SD) CCI of the “vascultic” subset was significantly higher with respect to the CCI of the other pSS subgroups (2.9(2.3) vs 1.0(1.2) vs 1.2 (1.1), p<0.001), particularly regarding cerebrovascular diseases. CCI correlated significantly with the use of glucocorticoids (r=0.298, p=0.001), DMARDs (r=0.290, p=0.002) and with the age of the patients (R=0.426, p<0.001).

Conclusion: Long term comorbidities are common in pSS and are related to both the disease and its treatment. The data suggest that it would be advisable to reduce glucocorticoid use, especially in older pSS patients.

« Back to 2018 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/comorbidity-burden-in-primary-sjogrens-syndrome-a-long-term-observation-in-clinical-practice/