Cardiopulmonary Predictors of Mortality in Sjögren Disease: Insights for Clinical Risk Stratification

To the Editor:

The prospective cohort study of patients with Sjögren disease (SjD) published in The Journal of Rheumatology provides significant contributions to better understand the mortality risk associated with this disease.¹ The analysis of a large cohort of 314 patients revealed an overall 70% increased mortality compared to the general population, highlighting the need for more targeted and effective preventive clinical strategies.

The primary causes of mortality identified, including infections, malignancies, and cardiovascular diseases, align with existing literature that indicates systemic complications as the major negative prognostic factors in these patients.^1-3 Particularly relevant is the identification, through multivariate analysis, of specific independent predictors of mortality, including advanced age, reduced complement C4, elevated erythrocyte sedimentation rate (ESR), heart failure, and pulmonary involvement.¹

Pulmonary involvement, in particular, emerges as a crucial determinant of poor prognosis in these patients and is often underestimated in everyday clinical practice. Its association with pulmonary hypertension represents one of the most severe complications, necessitating rigorous and systematic cardiopulmonary evaluations.^4,5

Considering the presented data, a multidisciplinary approach aimed at early diagnosis and regular monitoring of clinical variables predictive of negative outcomes is essential. In this context, the systematic and timely use of serological and clinical indicators (C4, ESR, pulmonary and echocardiographic evaluation with particular attention to the tricuspid annular plane systolic excursion/systolic pulmonary artery pressure ratio) could facilitate earlier and more targeted therapeutic interventions,^6,7 thus potentially reducing the elevated mortality risk highlighted in the study by Rusinovich-Lovgach et al.¹

Finally, further longitudinal studies are needed to explore in greater depth the role of gender differences in mortality associated with SjD, an aspect thus far less investigated but suggested by recent analyses of gender differences in diseases related to SjD.^2,8

In conclusion, the study by Rusinovich-Lovgach et al¹ provides a clear and comprehensive overview of mortality in patients with SjD, highlighting significant predictors and suggesting potential strategies for preventive interventions that should be further implemented and validated through specific clinical and research protocols.

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