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Abstract Number: 2506

The Joint Disease Burden in Patients with Secondary Sjögren’s Syndrome and RA Compared to Patients with RA Only

Evo Alemao1, Yogesh Saini2, Ying Bao1, Aarti Rao2, Christine K Iannaccone3, Michael E Weinblatt3 and Nancy A. Shadick3, 1Bristol-Myers Squibb, Princeton, NJ, 2Mu Sigma, Bangalore, India, 3Brigham and Women's Hospital, Boston, MA

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: autoantibodies, extraarticular manifestations, joint damage and rheumatoid arthritis (RA), Sjogren's syndrome

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Session Information

Date: Tuesday, October 23, 2018

Title: Rheumatoid Arthritis – Diagnosis, Manifestations, and Outcomes Poster III: Complications of Therapy, Outcomes, and Measures

Session Type: ACR Poster Session C

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

Background/Purpose: Secondary Sjögren’s syndrome (sSS) is considered a poor prognostic factor in RA and is a common extra-articular manifestation of RA. We estimated prevalence of sSS and joint disease burden in patients (pts) with RA with sSS based on physician diagnosis or Ro-antibody positive (SSa), plus presence of dry eyes or dry mouth.

Methods: Data from adult pts with RA enrolled in a longitudinal RA registry were analyzed. Pts in the registry were evaluated by a rheumatologist annually for disease activity and treatments and semi-annually for multiple clinical pt-reported outcomes (PROs) and resource utilization parameters. For this analysis, pts with RA were categorized into two cohorts: pts with sSS and pts with RA only. Prevalence estimates of pts with sSS were based on clinician diagnosis or meeting ACR/EULAR 2016 classification of primary Sjögren’s syndrome. Baseline characteristics between the two cohorts were compared using the Kruskal-Wallis test for continuous variables and chi-square test for categorical variables, with a significance level of 0.05. Mean change from baseline to 12 months in disease activity measures and PROs of fatigue were assessed for pts with data available at baseline and follow-up.

Results: A total of 1471 pts with RA were included in the analysis. The prevalence of sSS was 28.2% (n=415); the remaining 71.8% (n=1056) were included in the RA only cohort. Physician diagnosis comprised ~10% of pts with sSS; the remainder was based on SSa positivity and symptoms of dry eyes or dry mouth. Compared with the RA only cohort, pts with RA with sSS were more likely to be female, have early onset of RA, longer RA disease duration, greater seropositivity, higher antibody titers, higher disease activity levels (Rheumatoid Arthritis Disease Activity Index, CDAI and DAS28[CRP]), higher fatigue and more likely to have comorbidities of vasculitis, neuropathy and pulmonary nodules (Table 1). In addition, a greater proportion of pts with RA with sSS had prior biologic (b)DMARD exposure (n [%] 248 [59.8] vs 463 [43.8]; p<0.0001), with a higher proportion currently taking bDMARDs (195 [47] vs 382 [36.2]; p=0.0001). Pts with RA with sSS continued to experience higher disease activity and fatigue at 12 months, with a significantly lower reduction in disease activity versus pts in the RA only cohort (Table 2).

Conclusion: The prevalence of sSS was 28% in pts with RA. Although the majority of pts with RA with sSS compared with pts with RA without sSS had exposure to bDMARDs, they continued to experience higher autoantibody burden (RF and ACPA), joint disease activity and fatigue.

Table 1. Baseline Characteristics in Patients With sSS Compared With Patients With RA Only

Pts with sSS

Pts with RA only

p value*

N

Mean (SD)

N

Mean (SD)

Age, years

415

57.8 (13.4)

1056

56.0 (14.7)

0.044

Age at RA diagnosis, years

414

42.4 (14.5)

1054

44.1 (15.7)

0.060

Age at onset of RA symptoms, years

411

39.6 (14.7)

1049

41.9 (15.9)

0.016

Duration of RA symptoms, years

411

18.0 (13.4)

1049

14.1 (12.5)

<0.0001

Female, n (%)

415

378 (91.1)

1056

828 (78.4)

<0.0001

BMI

370

26.9 (6.1)

980

26.9 (5.6)

0.754

RF titer, IU/mL

381

168.0 (401.3)

906

117.8 (300.8)

0.002

RF+, n (%)

381

255 (66.9)

906

546 (60.3)

0.024

ACPA titer, IU/mL

383

154.1 (173.0)

928

121.8 (149.0)

0.0005

ACPA+, n (%)

383

259 (67.6)

928

551 (59.4)

0.005

RADAI

388

3.6 (2.2)

938

3.2 (2.3)

0.002

DAS28 (CRP)

355

3.9 (1.7)

923

3.6 (1.6)

0.033

CDAI score

356

21.8 (17.9)

927

18.7 (15.7)

0.009

Number of swollen joints

393

6.6 (7.5)

1055

6.0 (6.8)

0.364

Number of painful joints

393

7.8 (8.6)

1055

6.5 (7.2)

0.084

MDHAQ fatigue scale

387

49.4 (30.5)

942

38.5 (28.5)

<0.0001

Comorbidities, n (%)

Vasculitis, cutaneous

415

13 (3.1)

1056

4 (0.4)

<0.0001

Vasculitis, other

415

3 (0.7)

1056

0 (0.0)

0.022

Lymphoma

415

2 (0.5)

1056

10 (0.9)

0.527

Neuropathy

415

15 (3.6)

1056

9 (0.9)

0.001

Lung cancer

415

2 (0.5)

1050

5 (0.5)

1.000

Pulmonary fibrosis

415

13 (3.1)

1056

28 (2.7)

0.601

Pulmonary nodules

415

17 (4.1)

1056

12 (1.1)

0.001

Data are expressed as mean (SD) unless otherwise indicated

*Significant at p<0.05

ACPA=anti-citrullinated protein antibody; MDHAQ=Multidimensional Health Assessment Questionnaire; pts=patients; RADAI=Rheumatoid Arthritis Disease Activity Index; sSS=secondary Sjogren’s syndrome

Table 2. Disease Activity Measures and Fatigue at 12 Months and Change From Baseline

12 months

Change from baseline

Pts with sSS

(n=372)

Pts with RA only

(n=925)

Pts with sSS (n=372)

Pts with RA only (n=925)

p value

RADAI

N

3.3 (2.1)

344

2.6 (2.0)

840

–0.2 (1.7)

344

–0.6 (1.9)

840

0.006

DAS28 (CRP)

N

3.5 (1.7)

250

3.1 (1.5)

628

–0.3 (1.4)

250

–0.5 (1.3)

628

0.037

CDAI score

N

18.5 (17.3)

249

14.0 (13.9)

642

–2.6 (14.3)

249

–4.7 (13.0)

642

0.029

Number of swollen joints

N

4.8 (6.7)

307

3.9 (5.8)

766

–1.6 (6.3)

307

–2.1 (5.8)

766

0.361

Number of painful joints

N

5.9 (7.9)

307

4.9 (6.8)

766

–1.4 (7.3)

307

–1.4 (6.1)
766

0.424

MDHAQ fatigue scale

N

46.1 (27.7)

342

36.5 (26.5)

841

–2.8 (22.8)

342

–1.5 (22.7)

841

0.503

Data are expressed as mean (SD) N

MDHAQ=Multidimensional Health Assessment Questionnaire; pts=patients; RADAI=Rheumatoid Arthritis Disease Activity Index; sSS=secondary Sjogren’s syndrome


Disclosure: E. Alemao, Bristol-Myers Squibb, 1, 3; Y. Saini, Mu-sigma, 5; Y. Bao, Bristol-Myers Squibb, 1, 3; A. Rao, Mu Sigma for Bristol-Myers Squibb, 5; C. K. Iannaccone, None; M. E. Weinblatt, Amgen, Crescendo Bioscience, Bristol-Myers Squibb, Sanofi/Regeneron, 2,AbbVie, Ablynx, Amgen, Bristol-Myers Squibb, Canfite, Corrona, Crescendo, GSK, Gilead, Lilly, Lycera, Merck, Momenta, Novartis, Pfizer, Roche, Samsung, Set Point, UCB, Vertex, 5; N. A. Shadick, Amgen, Mallinckrodt, Bristol-Myers Squibb, Sanofi-Regeneron, 2,Bristol-Myers Squibb, 5.

To cite this abstract in AMA style:

Alemao E, Saini Y, Bao Y, Rao A, Iannaccone CK, Weinblatt ME, Shadick NA. The Joint Disease Burden in Patients with Secondary Sjögren’s Syndrome and RA Compared to Patients with RA Only [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/the-joint-disease-burden-in-patients-with-secondary-sjogrens-syndrome-and-ra-compared-to-patients-with-ra-only/. Accessed .
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