Lung Involvement in Primary Sjögren's Syndrome: Spectrum of Pulmonary Abnormalities and Computed Tomography Findings

Janet Flores¹, Diego Baenas², Nadia Riscanevo³, Emanuel Saad⁴, Maria Jezabel Haye Salinas⁵, Soledad Retamozo⁶, Ana C. Alvarez⁵, Alejandro Alvarellos⁷, Juan Pablo Pirola⁸, Nadia Benzaquén⁵, Verónica Saurit⁹ and Francisco Caeiro⁸, ¹Rheumatology Unit, Hospital privado Universitario de Córdoba, Cordoba, Argentina, ²Reumatologia, Hospital Privado Centro Médico de Córdoba, Córdoba, Argentina, ³Rheumatology, Rheumatology Unit, Hospital privado Universitario de Córdoba, Cordoba, Argentina, ⁴Internal medicine, Hospital Privado, Cordoba, Argentina, ⁵Rheumatology, Rheumatology Unit, Hospital Privado Universitario de Córdoba, Córdoba, Argentina, ⁶Sociedad Argentina de Reumatologia, Córdoba, Argentina, ⁷Rheumatology, Rheumatology Unit, Hospital Privado Universitario de Córdoba, Cordoba, Argentina, ⁸Rheumatology, Hospital Privado Centro Médico de Córdoba, Córdoba, Argentina, ⁹Hospital Privado Centro Médico de Córdoba, Cordoba, Argentina

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: Pulmonary Involvement, Sjogren's syndrome and computed tomography (CT)

Session Information

Date: Tuesday, October 23, 2018

Title: Imaging of Rheumatic Diseases Poster III: Other Modalities

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose: Primary Sjögren’s syndrome (pSS) is a chronic autoimmune disease that affects exocrine glands. It can generate pulmonary compromise due to dysfunction of the glandular epithelium of the airway.

To know the prevalence of pulmonary involvement in patients with pSS in our environment; to detail clinical characteristics associated with pulmonary involvement; to compare demographic, clinical, serological and therapeutic characteristics of patients with and without pulmonary involvement in pSS.

Methods: Retrospective descriptive study. Patients diagnosed with pSS (American-European criteria 2002) were included from 2010 to 2017. Abnormal salivary gland biopsy (SGB) was considered to grades III and IV of the Chisholm and Mason classification.Multivariate analyzes were performed comparing pSS with pulmonary involvement versus pSS without this involvement; p <0.05 value was considered statistically significant. The results were analyzed with the software SPSS 19.0.

Results: 197 patients were included, 180 (90%) were women. The mean age at diagnosis was 54 ± 13.62 years.The most frequent symptoms were xerostomia in 166 (83%) patients and xerophthalmia in 178 (89.0%). In 25 (12.5%) patients, pulmonary involvement was diagnosed by high resolution computed tomography (HRCT), 19 (76%) with interstitial lung disease (ILD) and 6 (24%) with bronchiectasis in the absence of DILD; 21 (10.5%) patients had a history of smoking. The most frequent pattern of ILD was nonspecific interstitial pneumonia (NSIP) in 68.4%, followed by lymphocytic interstitial pneumonia (LIN) and usual interstitial pneumonia (UIP) with 15.78% in both groups.
Erythrocyte sedimentation rate (ESR)> 50 mm/h was observed at the time of diagnosis in 26 (13.0%) patients, and elevated C-reactive protein (CRP) in 22 (11.0%), median value of 0.06 (RIQ 0-0.39). Anemia was observed in 14 (7.0%) patients, leukopenia in 16 (8.0%) and hypergammaglobulinemia in 47/81 (58.0%). SGB was abnormal in 179 (89.5%), grade III in 75 (37.5%) and IV in 104 (52.0%). Regarding treatment, 61 (30.5%) received hydroxychloroquine, 56 (28.0%) prednisone <20 mg / day and only 5 (2.5%) prednisone ≥20 mg / day. Three (1.5%) patients died during the 7 years of follow-up. In the univariate analysis, it was observed that patients with pSS and pulmonary involvement were associated with greater age at the time of diagnosis (61 ± 10.75 vs 53 ± 13.7, p = 0.004), smoking history (40% vs 6, 4%, p <0.001); ESR> 50 mm/h at diagnosis (36% vs 9.9%, p = 0.002), high CRP (36% vs 7.6%, p <0.001), anemia (20% vs 5.3%; p = 0.02), greater use of hydroxychloroquine (60% vs 26.9%, p = 0.002) and greater use of prednisone at doses> 20 mg / day (12% vs 1.2%, p = 0.01) with respect to to patients with pSS without pulmonary involvement. In the multivariate analysis, statistical significance was maintained for smoking (OR: 31, 95% CI: 4.513-212.970, p <0.001) and high CRP (OR: 10.49, 95% CI: 1.609-68.405, p = 0.014).

Conclusion: The pulmonary involvement in pSS was mainly associated with a history of smoking and was observed more frequently in older patients, with high inflammatory parameters and anemia.

Disclosure: J. Flores, None; D. Baenas, None; N. Riscanevo, None; E. Saad, None; M. J. Haye Salinas, None; S. Retamozo, None; A. C. Alvarez, None; A. Alvarellos, None; J. P. Pirola, None; N. Benzaquén, None; V. Saurit, None; F. Caeiro, None.

To cite this abstract in AMA style:

Flores J, Baenas D, Riscanevo N, Saad E, Haye Salinas MJ, Retamozo S, Alvarez AC, Alvarellos A, Pirola JP, Benzaquén N, Saurit V, Caeiro F. Lung Involvement in Primary Sjögren’s Syndrome: Spectrum of Pulmonary Abnormalities and Computed Tomography Findings [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/lung-involvement-in-primary-sjogrens-syndrome-spectrum-of-pulmonary-abnormalities-and-computed-tomography-findings/. Accessed .

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