Organ-specific autoimmunity in primary Sjögren's disease

To assess the prevalence of organ-specific autoimmunity (OSA) among patients with primary Sjögren's disease (SjD), and its association with clinical and serological variables and disease activity.

We included 328 patients with SjD according to ACR/EULAR criteria. We recorded the following types of OSA: gastrointestinal [primary biliary cholangitis (PBC), autoimmune hepatitis (AH), coeliac disease], haematological (pernicious anaemia, haemolytic anaemia, idiopathic thrombocytopenia purpura), neurological (myasthenia gravis), dermatological (vitiligo, alopecia areata), and endocrinological (autoimmune thyroid disease and type 1 diabetes). We also registered demographics, basal Schirmer I test, non-stimulated whole salivary flow, serological variables, treatment (ever), and basal and cumulative EULAR Sjögren's Syndrome Disease Activity Index (ESSDAI) score at last follow-up.

We found OSA in 122 patients (37.9%), the most frequent being autoimmune hypothyroidism (n = 56), PBC (n = 28), and AH (n = 8). OSA preceded SjD in 37 patients (30.3%), followed it in 62 (50.8%), and was concomitant in 23 (18.8%). In logistic regression analysis comparing patients with OSA (concomitant/post-SjD diagnosis) versus those without OSA, the variables associated with OSA were anti-Ro/SSA [odds ratio (OR) 0.44, 95% confidence interval (CI) 0.20-0.97, p = 0.04], disease duration (OR 1.03, 95% CI 1.005-1.06, p = 0.01), and use of methotrexate (OR 0.32, 95% CI 0.55-0.73, p = 0.007) and azathioprine (OR 2.12, 95% CI 1.14-3.84, p = 0.01).

One-third of patients with primary SjD had OSA, with endocrine involvement being the most common. OSA may precede, follow, or accompany the diagnosis of SjD, and is not associated with higher disease activity. Monitoring for OSA is important as it contributes to comorbidity in these patients.