Late-Onset Sjögren disease: A different clinical entity?

Sjögren's disease(SjD) exhibits heterogeneous clinical phenotypes influenced by age at onset. This study aimed to evaluate the impact of onset age on the clinical and serological characteristics of SjD in a Turkish cohort.

We retrospectively analyzed 411 patients diagnosed with SjD between 2013 and 2024, fulfilling the 2002 AECG or 2016 ACR/EULAR criteria. Patients were classified as young-onset (<40 years; YoSjD), adult-onset (40-60 years; AoSjD), or elderly-onset (>60 years; EoSjD). Demographic, clinical, laboratory, and treatment characteristics were compared among groups.

The cohort comprised predominantly females (93.4%) with a median age of 55 years. RF positivity was significantly higher in EoSjS (35.5%) compared to YoSjD (27.9%) and AoSjD (19.2%, p=0.007). Inflammatory markers (ESR, CRP) were more frequently elevated in EoSjD. Interstitial lung disease (ILD) prevalence was highest in EoSjD (25.8%, p<0.05), particularly in males. Artropathy was more frequent in EoSjD (80.6%) and YoSjD (76%) than in AoSjD (64.5%, p=0.007). Anemia was more common in EoSjD (20.4%, p=0.040). Hydroxychloroquine was widely used (86.6%), with glucocorticoid and azathioprine use significantly higher in EoSjD.

Elderly-onset SjD demonstrates a distinct phenotype characterized by higher ILD prevalence, increased RF positivity, greater inflammatory activity, and more frequent artropathy and anemia compared to younger-onset groups. These findings highlight the need for age-tailored diagnostic vigilance, proactive ILD screening, and cautious use of immunosuppressants in older patients. Prospective multicenter studies are warranted to refine management strategies in this subgroup.