Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.


Immunological Differences in Sicca Patients Based on Age.

Coca,  Andreea, Sanford,  Tracey, Roberts,  Mustimbo, Englert,  Jason, Anolik,  Jennifer H., Sanz,  Ignacio

Background/Purpose:

Sjogren's syndrome is a chronic autoimmune disease that affects primarily the lacrimal and salivary glands. It may occur as a primary disorder (pSS) or secondary to other autoimmune disease. With a prevalence ranging from 0.1 to 0.6%, it is considered a common immunological disease. Despite the fact that most people develop the disease in mid-life, its presentation at extremes of age is not uncommon. The focus of this study is to analyze the age related disease discrepancies in patients with early and established Sjogren's syndrome.

Methods:

Our cohort included patients that fulfill the American European Consensus Group criteria for the diagnosis of Sjogren's syndrome (AECG group). Early sicca (ES) group are patients that have subjective and/or objective dryness, some evidence of autoimmune disregulation (positive ANA, and/or Ro/La) but do not fulfill the AECG criteria. We collected demographic and laboratory data (anti-Ro, anti-La, ANA, RF, IgG, ESR, CBC, % lymphocytes, C3, C4, VAS for subjective oral and ocular dryness, Schirmer test, unstimulated whole sialometry - UWS). We excluded patients with head and neck radiation, hepatitis C infection, AIDS, sarcoidosis, graft vs. host disease, use of anticholinergic drugs. The data was analyzed using unpaired t-test.

Results:

We included in the analysis 52 AECG and 33 ES. By breaking down these two groups based on age (< and > than 50 y/o) we observed a trend: younger patients had more immunological activation than older people and less dryness (better Schirmer, better VAS for oral and ocular dryness and UWS in ES only). Younger pSS patients perceived less subjective dryness, but it was the opposite for early disease. As such, more patients with leucopenia (p=0.02), higher IgG levels (p<0.05) and higher % lymphocytes (p<0.05) were observed in younger AECG patients. In the sicca population we observed more statistically significant differences in the population younger than 50 y/o: more patients had increased RF levels, positive anti-Ro, anti-La and the combination of both, as well as higher IgG levels and better Schirmer test higher (all p<0.05).

AECG #%ANA%RF%Ro%LaWBCs%Ro La% hypergamESR>30% lymphSchirmerVAS ocularVAS oralUWS
 <501687.537.568.7507.5505056.213.347.810.61.2
 >503669.441.677.747.25.641.616.627.793.421.314.91.2
   NSNSNSNSp=0.02NSp<0.05NSp<0.05NSp=0.07NSNS
pre-SS<501478.528.564.235.74.835.735.77.614.22111.118.33.1
 >501957.85.242.105.900.215.75.210.69.62.12.1
   NSp<0.05p<0.05p<0.05NSp<0.05p<0.05NSNSp=0.03NSNSNS

Conclusion:

In our cohort of Sjogren's we have observed that those younger than 50 y/o tend to have more of an active immunological disease (higher number had autoantibodies, hypergammaglobulinemia) but less subjective dryness. This trend was more obvious and statistically significant in pre-clinical disease, (higher number of patients with RF, positive anti-Ro, anti-La, and hypergammaglobulinemia). As this active immunological phenotype seems more pronounced early on, it could suggest a "burned-out disease" by the time the classical pSS phenotype establishes itself.

Our main limitation comes from the small number of patients. We are actively recruiting patients into this database, as we recognize the need for larger sample size to validate our results.

To cite this abstract, please use the following information:
Coca, Andreea, Sanford, Tracey, Roberts, Mustimbo, Englert, Jason, Anolik, Jennifer H., Sanz, Ignacio; Immunological Differences in Sicca Patients Based on Age. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :470
DOI:

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