Beyond the Glands: Extraglandular Manifestations Associated With Sicca Symptoms in Systemic Sclerosis

Sicca symptoms, including ocular and oral dryness, are frequently reported among patients with systemic sclerosis (SSc). Yet most studies have focused on patients with associated Sjögren disease (SjD) and data on SSc patients with isolated sicca symptoms remain limited. Therefore, we aimed to (i) investigate the characteristics of SSc patients with and without sicca symptoms, after excluding individuals with associated SjD or other potential causes of dryness, and (ii) identify factors independently associated with the presence of sicca manifestations.

This single-center retrospective observational study included consecutive SSc patients attending the Department until December 2024. Demographic, clinical and serological data were extracted from medical records. Sicca symptoms were defined as the presence of either dry eye or dry mouth symptoms documented in the medical records, using a structured approach. Multivariable logistic regression analysis was performed to determine variables significantly associated with sicca symptoms.

In total, 237 SSc patients were included, 25.7% of whom reported sicca symptoms. In univariate analysis, age, female sex, arthralgias, left ventricular diastolic dysfunction (LVDD), and ratio of residual volume to total lung capacity (RV/TLC) ≥40% were associated with sicca symptoms. In multivariate analysis, only female sex [OR: 4.808 (95% CI: 1.088-15.308)] and RV/TLC≥40% [OR: 4.413 (95% CI: 1.982-9.826)] remained independent predictors of sicca manifestations.

Sicca symptoms are common in SSc, even in the absence of SjD, and are characterized by female predominance and small airway involvement. SSc patients with isolated sicca symptoms may represent a distinct clinical phenotype.