THU0365 Potential predictive factors influencing essdai of primary sjÖgren’s syndrome patients
Authors: M. Ma&sacute;li&nacute;ska, J. Dmowska-Chalaba, M. Ma&nacute;czak, B. Kwiatkowska
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> The useful tool to assessing disease activity in primary Sjögren's syndrome(pSS) is an EULAR Sjögren's syndrome disease activity index (ESSDAI)[.<sup><sup>1,2</sup></sup> <h3>Objectives</h3> The aim of this study was indication of laboratory and clinical factors affecting the ESSDAI in pSS patients. <h3>Methods</h3> 75 pSS patients were included; 65 (87%) female, 10 (13%)men; mean age 50 years SD ±15. The tests included:basic laboratory tests, rheumatoid factor (RF), erythrocyte sedimentation rate, CRP, gammaglobulins serum concentration, C4 and C3 component of complement, antinuclear antibodies (ANA) - IF test HEp-2000, anti-SS-A and anti-SS-B antibodies evaluation with semi-quantitative immunoblotting, standard ELISA assays for serum cytokines levels (BAFF, APRIL, FLT-3L, TNF-β, IL-21) and β2-microglobulin. Biopsy of minor salivary gland with the histopathological evaluation (focus score-FS) and the immunochemistry was also performed with the CD3+, CD4 +, CD19 +, CD21 +, CD35 +cells presence assessment. The Schirmer's test and ocular staining score (OSS) were performed. The Bioethics Committee aproval was obtained. Statistics: U Mann-Whitney (continuous variables) tests, Spearman correlation coefficient (correlations between quantative variables) with statistical significance set at p&lt;0.05. <h3>Results</h3> ESSDAI depends on FS, the presence of CD4 +, CD3 +cells in the minor salivary glands infiltrates, RF and cryoglobulins (p&lt;0.05). The division of pSS subjects into two subgroups (ESSDAI &gt;5;&lt;5) revealed, that the autoantibodies as anti-SS-A and anti-SS-B, influence the severity of the disease (p=0,046; p=0015 respectively). ESSDAI positively correlated with OSS, but not with the Schirmer's test, other tested cytokines, ESR, CRP and gammaglobulins concentration - yet interestingly ESSDAI correlates negatively with IgG4 (rho=-0,435). <h3>Conclusions</h3> The results confirm, that organ-related complications are influenced by inflammatory activity. This activity is expressed by mononuclear cell infiltrates (FS), which consist primarily of T-lymphocytes (indicators of active and early stage inflammation). However, contrary to other observations,<sup><sup>3</sup></sup> no correlation between ESSDAI and cytokines or β2- microglobulin was found. The correlation of ESSDAI with the presence of pSS marker autoantibodies (anti-SS-A, anti SS-B antibodies), as well as with non-specific ones (RF or cryoglobulins), indicates the immunological disease activity and overactivity of B lymphocytes as suspected. The reduction of IgG4 concentration in pSS patients correlating with higher ESSDAI can be associated with breaking the autotolerance and lack of stimulation of IgG4 production. But the role and importance of IgG4 in immunological processes both as an activator of dependent autoimmune diseases and, on the other hand, the marker of induction of immune tolerance requires further research. <h3>References</h3> [1] Seror R, Bowman SJ, Brito-Zeron P, et al. EULAR Sjögren's syndrome disease activity index (ESSDAI): a user guide. RMD Open2015;1: e000022. [2] Risselada AP, Kruize AA, Bijlsma JW. Clinical applicability of the EULAR Sjogren's syndrome disease activity index: a cumulative ESSDAI score adds in describing disease severity. Ann Rheum Dis2012;71(4):631. [3] Seror R, Theander E, Bootsma H, et al. Outcome measures for primary Sjögren's syndrome: a comprehensive review. J Autoimmun2014;51:51–6. <h3>Disclosure of Interest</h3> None declared