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Digestive Involvement in Primary Sjögren's Syndrome: Analysis from the Sjögrenser Registry

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Digestive Involvement in Primary Sjögren's Syndrome: Analysis from the Sjögrenser Registry Digestive involvement in primary Sjögren’s syndrome: analysis from the Sjögrenser registry S. Melchor1, C. Sánchez-Piedra2, M. Fernández Castro3, J.L. Andreu3, V. Martínez Taboada4, A. Olivé5, J. Rosas6, R. Menor7, Á. García-Aparicio8, F.J. López Longo9, S. Manrique-Arija10, J.A. García Vadillo11, R. López-González12, J. Narváez13, C. Galisteo14, J. González Martín15, A. Naranjo16, Ó. Illera17, B. Moreira18, E. Raya19, M. Rodríguez López20, E. Júdez21, C. Moriano22, V. Torrente-Segarra23, B. García Magallón24, C. Guillén Astete25, I. Castellvi26, C. Bohórquez27, J. Loricera4, J. Belzunegui28, P.E. Carreira1, on behalf of the Sjögrenser group, part of the Spanish Society of Rheumatology Systemic Autoimmune Diseases Study Group (EASSER) Affiliations: page S115. ABSTRACT pancreatic involvement presented more Sheila Melchor, Carlos Sánchez-Piedra, Objective. Digestive involvement (DI) central nervous system and renal in- Mónica Fernández Castro, Jose Luis has been reported in 10–30% of prima- volvement, Raynaud’s phenomenon, Andreu, Víctor Martínez Taboada, ry Sjögren’s syndrome (pSS) patients, lymphoma and C3/C4 hypocomplemen- Alejandro Olivé, José Rosas, Raúl Menor, Ángel García-Aparicio, Francisco Javier and few studies have systematically taemia. López Longo, Sara Manrique-Arija, Jesús analysed the prevalence of DI in pSS Conclusion. DI is frequent in Sjög- Alberto García Vadillo, Ruth López- patients. The aim of this study was to renser patients, mainly in the form of González, Javier Narváez, Carlos Galisteo, describe DI prevalence in pSS patients autoimmune disorders, and seem to be Jorge González Martín, Antonio Naranjo, from the Sjögrenser Study, and to ana- associated with a more severe pheno- Óscar Illera, Begoña Moreira, Enrique Raya, Marina Rodríguez López, Enrique lyse its clinical associations. type. Our results suggest that DI should Júdez, Clara Moriano, Vicenc Torrente- Methods. All patients included in the be evaluated in pSS patients, especially Segarra, Blanca García Magallón, Sjögrenser study, a Spanish multicentre those with more severe disease. Carlos Guillén Astete, Iván Castellvi, randomised cohort, containing demo- Cristina Bohórquez, Javier Loricera, graphic, clinical and histologic data, Introduction Joaquín Belzunegui, Patricia E. Carreira. have been analysed retrospectively. Pa- Primary Sjögren’s syndrome (pSS) is Please address correspondence to: Sheila Melchor Díaz, tients were classified according to the a systemic autoimmune disease char- Rheumatology Department, presence of DI (oesophageal, gastric, acterised by lymphocytic infiltration of Hospital Universitario Doce de Octubre, intestinal, hepatic and pancreatic), and exocrine glands, mainly salivary and Avd. Córdoba s/n, we have performed DI clinical associa- lacrimal glands. It is a very heterogene- 28041 Madrid, Spain. tions, descriptive statistics, Student t or ous disease, and may present extraglan- E-mail: [email protected] χ2 test, and uni and multivariate logistic dular involvement in any internal organ Received on July 8, 2020; accepted in regression. (1). Systemic involvement is frequent, revised form on September 14, 2020. Results. From 437 included patients, occurs in more than half of the patients Clin Exp Rheumatol 2020; 38 (Suppl. 126): S110-S115. 95% were women, with a median age of with long standing disease (2), is asso- 58 years, 71 (16.2%) presented DI: 21 ciated with anti-Ro/La antibodies (3), © Copyright CLINICAL AND EXPERIMENTAL RHEUMATOLOGY 2020. (29.5%) chronic atrophic gastritis, 12 and usually determines patient progno- (16.9%) oesophageal motility dysfunc- sis and quality of life. Extraglandular Key words: primary Sjögren’s tion, 3 (4.2%) lymphocytic colitis, 18 involvement of any part of the digestive syndrome, digestive involvement, (25.3%) primary biliary cholangitis, 15 system, including the hepatobiliary sys- chronic atrophic gastritis, primary (21.1%) autoimmune hepatitis, 7 (9.8%) tem, or digestive involvement (DI) has biliary cholangitis, autoimmune pancreatic involvement and 5 (7%) coe- been described in up to 10–30% of pSS hepatitis liac disease. Half of them developed DI patients (4). Although this is a rather at the same time or after pSS diagno- high prevalence, few studies have spe- sis. Patients with DI were significantly cifically analysed in detail DI globally older at pSS diagnosis (p=0.032), more in pSS cohorts. frequently women (p=0.009), presented Some studies have analysed specific more autoimmune hypothyroidism and subtypes of DI, such as upper dyspha- Funding: all authors have received C3 hypocomplementaemia (p=0.040), gia, secondary to the lack of saliva, (5, financial contributions for their and were treated more frequently with 6), oesophageal motility (7), gastroe- participation in the Sjögrenser registry. glucocorticoids, immunosuppressant sophageal reflux (8), and atrophic or Competing interests: page S114. and biologic therapies. Patients with chronic gastritis (6, 9, 10, 11). Non- S-110 Clinical and Experimental Rheumatology 2020 Digestive involvement in pSS: analysis from the Sjögrenser registry / S. Melchor et al. specific bowel symptoms (12, 13), coe- rheumatology centres in Spain in the Statistical analysis liac disease (14), inflammatory bowel period 2013-2014, and including pSS Patients were divided according to disease (12), lymphocytic colitis (15), patients fulfilling the 2002 European- the presence of DI, globally and by or severe intestinal dysbiosis (16) have American consensus criteria for pSS the predefined DI subtypes. Descrip- been found in selected pSS patients. (24). To ensure unbiased inclusion in tive analysis and comparison between Liver involvement, such as enzymatic Sjögrenser, prior to inclusion 20 pa- groups were carried out by parametric abnormalities (17, 18), primary biliary tients were randomly selected from or non-parametric test, based on the cholangitis (19), or autoimmune hepa- existing databases in each centre (23). distribution of the variables. Quantita- titis (20), have also been described, and This study was conducted in accord- tive variables were described by mean pancreatitis has been found in up to ance with Good Clinical Practice and and standard deviation (SD) or median 0.6% pSS patients (6, 21, 22). Although the current version of the revised Dec- and interquartile range, and qualitative some of these DI manifestations have laration of Helsinki (World Medical variables by frequencies and percent- been studied in large cohorts of patients Association Declaration of Helsinki), ages. The association between DI with (6, 8, 11, 22), the majority have been and was approved by the ethics com- demographic, clinical, serological and described in small, selected groups, or mittee of all participating centres. All therapeutic characteristics was assessed symptomatic patients. Many of these patients gave their informed consent calculating crude association measures types of DI have been associated with before being included in Sjögrenser. (OR) with its 95% confidence interval other extraglandular involvement, or (CI). Clinical associations of DI were signs of disease activity. All in all, these Patient selection and data acquisition analysed following multivariate logis- findings might suggest that DI involve- All patients from Sjögrenser Study tic regression model. In this model, ment could be also a marker for a more were included. The data were obtained independent factors associated with DI severe disease. In this regard, it would through a protocolised medical inter- in the bivariate analysis with a p-value be important to specifically describe view with the patients the day of the <0.20 were included, and the effect of the full picture of DI in unselected pSS inclusion, and from chart review. The age and sex was controlled. In order to patients, including the different clini- data were then included in a database, identify possible differences in clinical cal manifestations, disease associations specifically created for the study, and determinants of the different subtypes and need for systemic therapies. kept by the Spanish Society for Rheu- of DI, bivariate and multivariate asso- Sjögrenser is a multicentric cohort, matology (SER) (23). ciation analysis were conducted inde- containing data from 437 pSS Spanish pendently for every subgroup (stratified patients from 33 Rheumatology centres Variables analysis). in Spain (23). Twenty patients from 298 variables had been included in each centre were randomly selected be- Sjögrenser, grouped in epidemiologi- Results fore the inclusion, enabling us to estab- cal, clinical, serological, histological, Sjögrenser cohort includes 437 patients lish a cohort of unselected pSS patients therapeutic, and outcome characteris- with pSS, 95% women, with median from daily clinical practice. Sjögrenser tics. ESSDAI activity index was also age of 58 years at inclusion. Seventy- included detailed information on epi- included. Definitions of these variables one (16.2%) presented DI: 21 (29.5%) demiological, clinical, serological and have been previously published (23). chronic atrophic gastritis; 12 (16.9%) therapeutic features from a large group As part of the study protocol, all Sjög- altered oesophageal motility; 3 (4.2%) of pSS patients, and constitutes an ad- renser participants answered specific lymphocytic colitis; 18 (25.3%) pri- equate setting to thoroughly study DI questions included in the interview to mary biliary cholangitis (PBC); 15 involvement in this disease. evaluate DI involvement.
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