RT Journal Article
SR Electronic
T1 Sjögren’s syndrome in Systemic Lupus Erythematosus - a subset characterized by a systemic inflammatory state
JF The Journal of Rheumatology
JO J Rheumatol
FD The Journal of Rheumatology
SP jrheum.190250
DO 10.3899/jrheum.190250
A1 Guillermo Ruacho
A1 Marika Kvarnström
A1 Agneta Zickert
A1 Vilija Oke
A1 Johan Rönnelid
A1 Susanna Eketjäll
A1 Kerstin Elvin
A1 Iva Gunnarsson
A1 Elisabet Svenungsson
YR 2019
UL http://www.jrheum.org/content/early/2019/09/11/jrheum.190250.abstract
AB Objective Secondary Sjögren’s syndrome (SLE-sSS) is an often-neglected subset of patients with Systemic lupus erythematosus (SLE). Furthermore, primary Sjögren’s syndrome overlaps and can be difficult to delineate from SLE. To shed light on the SLE-sSS subset, we investigated a large and well-characterized SLE cohort comparing patients with SLE-sSS versus SLE patients without SS (SLE-nonsSS) and controls. Methods We included 504 consecutive SLE patients, fulfilling the 1982 revised ACR criteria, and 319 controls from the general population, matched for age and gender to the first 319 patients. SLE-sSS was defined according to the American-European Consensus Criteria (AECC). A thorough clinical investigation, including subjective and objective quantifications of sicca symptoms, was performed in all participants. Autoantibodies and 20 selected cytokines were measured by luminex and multiplex analysis, respectively. Results SLE-sSS, as defined by AECC, occurred in 23% of the SLE patients. In comparison to SLE-nonsSS, the SLE-sSS group was older, more enriched in females. Leucopenia and peripheral neuropathy was more and nephritis less frequent. Circulating levels of 6/20 investigated pro-inflammatory cytokines (TNF-α, IL-6, MCP-4, MIP-1β, IL-12/IL23p40 and IP-10), total IgG, anti-SSA/Ro52, anti-SSA/Ro60, anti-SSB/La antibodies and rheumatoid factor (IgM and IgA) were higher in the SLE-sSS group (p<0.05 for all comparisons). Conclusion The frequency of SLE-sSS increased with age and affected roughly ¼ of all SLE patients. Despite less internal organ involvement, a systemic inflammatory state with high levels of pro-inflammatory cytokines is present in the SLE-sSS subgroup. This is a novel observation which may impact future understanding and treatment of the SLE-sSS subset.