SAT0060 OVERLAPPING SJOGREN’S SYNDROME REDUCES THE PROBABILITY OF REACHING TARGET IN RHEUMATOID ARTHRITIS PATIENTS: A PROPENSITY SCORE MATCHED REAL-WORLD COHORT FROM 2009 TO 2019
Authors: H. Zhang, H. Zhang, D. Gao, Z. Zhang
Journal: Annals of the Rheumatic Diseases (2020)

Background: Overlapping Sjogren’s syndrome (SS) is not uncommon in rheumatoid arthritis (RA), and considered as a probable detrimental factor of RA. But data on the impact of overlapping SS on RA therapeutic response is limited. Objectives: Our current study aimed to identify the effect in a real-world cohort from 2009 to 2019. Methods: The medical records of RA patients who attended the outpatient department of our medical center from 2009 to 2019 were reviewed, and the disease activity based on DAS28-ESR, DAS28-CRP, SDAI and CDAI at each follow-up point were collected. To correct confounders which may affect the therapeutic response between those RA patients with SS (RA-SS) and without (RA-noSS), we compared both the propensity score-matched and unmatched cohorts using the Cox proportional hazards model. Results: Among the 1099 RA patients, 129 (11.7%) overlapped with SS validated by positive anti-SSA or pathological minor salivary gland biopsy (MSGB). After propensity score matching based on their baseline characteristics, 126 of 129 RA-SS and 126 of 970 RA-noSS patients were statistically extracted. Overlapping SS was associated with a 29%, 26%, 18%, 22% lower probability of reaching remission in RA patients based on DAS28-ESR, DAS28-CRP, SDAI, CDAI, respectively, which trend kept true for reaching low disease activity (LDA) either. Although overlapping SS had the most significant impact on ESR (HR 0.69, 95%CI 0.61-0.79), other components assessing RA disease activity were also in jeopardy. When stratified by age, RA duration, RF and ACPA status, baseline DAS28-CRP, the trend remained. Conclusion: Overlapping SS is associated with a lower probability of reaching target in RA patients, and should be regarded as one of the poor prognostic factors in the management of RA. Table Hazard Ratios for Reaching Remission/Low disease activity and Individual Components in RA patients Associated with Overlapping SS Unmatched cohort (n=1099) Matched cohort (n=252) Trimmed cohort (n=242) Remission Based on Composite Disease Activity Score DAS28-ESR 0.68 (0.62, 0.75) 0.71 (0.62, 0.82) 0.74 (0.64, 0.85) DAS28-CRP 0.80 (0.74, 0.87) 0.74 (0.66, 0.83) 0.74 (0.66, 0.83) SDAI 0.82 (0.74, 0.91) 0.82 (0.70, 0.94) 0.83 (0.72, 0.97) CDAI 0.77 (0.70, 0.86) 0.78 (0.67, 0.91) 0.78 (0.67, 0.91) Boolean 0.83 (0.75, 0.92) 0.80 (0.69, 0.93) 0.82 (0.70, 0.95) Remission/LDA Based on Composite Disease Activity Score DAS28-ESR 0.76 (0.70, 0.82) 0.73 (0.65, 0.82) 0.74 (0.66, 0.83) DAS28-CRP 0.80 (0.74, 0.86) 0.76 (0.68, 0.84) 0.75 (0.68, 0.84) SDAI 0.79 (0.73, 0.85) 0.74 (0.66, 0.82) 0.74 (0.66, 0.82) CDAI 0.78 (0.73, 0.84) 0.74 (0.66, 0.82) 0.74 (0.66, 0.82) Individual Components of Disease Activity Score 28SJC≤1 0.83 (0.77, 0.89) 0.77 (0.69, 0.85) 0.76 (0.68, 0.84) 28TJC≤1 0.81 (0.75, 0.87) 0.79 (0.70, 0.88) 0.78 (0.70, 0.88) PtGA≤1 0.81 (0.74, 0.89) 0.82 (0.71, 0.94) 0.82 (0.72, 0.95) PrGA≤1 0.81 (0.74, 0.88) 0.78 (0.69, 0.88) 0.79 (0.70, 0.89) ESR≤ULN 0.66 (0.61, 0.73) 0.69 (0.61, 0.79) 0.74 (0.65, 0.84) CRP≤1mg/dL 0.84 (0.78, 0.90) 0.76 (0.68, 0.84) 0.77 (0.69, 0.85) Disclosure of Interests: None declared