Abstract
Objective To determine whether positive ACA serology affects the severity of sicca symptoms in pSS patients.
Methods Evaluation to detect subjective and objective sicca symptoms included questionnaires, physical examination, and pathology. pSS was classified according the 2002 AECG criteria. All patients were evaluated for presence of anti-Ro, anti-La, and ACA serology. pSS patients were categorized into ACA+ SS and ACA- SS. The two groups were compared for measures of severity of oral and ocular sicca.
Results The pSS group had 446 patients, of whom 26 were ACA+ SS. Subjective ocular sicca measured 7.0 ±2.4 (out of 10) in ACA+ SS and 6.4 ±2.6 in ACA- SS (p = 0.197). Objective ocular sicca measured 3.2mm ±1.8mm/5 mins in ACA+ SS and 4.2mm ±4.4mm/5 mins in ACA- SS (p = 0.038). Subjective oral sicca measured 8.5 ±1.4 in ACA+ SS and 6.7 ±2.4 in ACA- SS (p < 0.001). Objective oral sicca measured 0.1mL ±0.2mL/15 mins in ACA+ SS and 0.4 mL ±1.0mL/15 mins in ACA- SS (p < 0.001). Only 35% of ACA+ SS patients were anti-Ro or anti-La positive compared with 77% of the ACA- SS patients (p < 0.001). There was no significant difference in MSG fibrosis or focus scores between ACA+ SS and ACA- SS patients.
Conclusion ACA+ SS is associated with more severe objective ocular sicca and more severe subjective and objective oral sicca compared to ACA- SS. The majority of ACA+ SS patients meet AECG criteria for pSS despite negative serology for anti-Ro/La antibodies.