THU0120 OVERLAPPING SJOGREN’S SYNDROME AND ULTRASOUND REMISSION, FUNCTIONAL DISABILITY AND MANAGEMENT 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: Rheumatoid arthritis (RA) patients with Sjogren’s syndrome (SS) are often referred to as more severe synovitis. Objectives: We intend to clarify the impact of overlapping SS on ultrasound remission, functional ability improvement and clinical decision-making in RA patients in a real-world cohort from 2009 to 2019. Methods: The medical records of RA patients in our medical center from 2009 to 2019 were reviewed. Cox proportional hazards models of ultrasound remission and health assessment questionnaire (HAQ) improvement were conducted in both the 1-to-1 nearest propensity score matched (PSM) and unmatched cohorts between those RA patients with SS (RA-SS) and without (RA-noSS) to correct critical confounders. Four kinds of PSM methods were used and the corresponding average treatment effect on the treated (ATT) was calculated to clarify the effect of overlapping SS on distinguishable characteristics or drug prescription in RA patients. Results: A total of 1100 RA patients were included in the study, of which 133 (12.1%) overlapped with SS. Among 256 patients consisting of 128 RA-SS and 128 RA-noSS after 1-to-1 nearest PSM, overlapping SS was associated with a 44%, 32% lower probability of reaching ultrasound remission, no-functional disability in RA patients, respectively. More prevalent interstitial lung disease (ILD), leukopenia, hypergammaglobulinemia, rheumatoid factor (RF) positivity, higher erythrocyte sedimentation rate (ESR) and more hydroxychloroquine (HCQ) usage, less biologic disease-modifying anti-rheumatic drugs (bDMARDs) prescription were confirmed to be correlated with overlapping SS by the robust PSM. Conclusion: Overlapping SS is associated with a lower probability of reaching ultrasound remission and functional activity improvement, higher prevalence of ILD, leukopenia and hypergammaglobulinemia in RA patients. Weaker interventions such as HCQ may be the mainstream of clinical decision making. Table. Hazard Ratios for Ultrasound Remission/No Functional Disability Associated with Overlapping SS Unmatched cohort Matched cohort US remission No functional disability US remission No functional disability Unstratified 0.63 (0.51, 0.79) 0.60 (0.52, 0.70) 0.56 (0.42, 0.74) 0.68 (0.55, 0.83) Stratified Gender 0.62 (0.50, 0.77) 0.63 (0.54, 0.74) 0.53 (0.40, 0.71) 0.66 (0.54, 0.80) Age 0.63 (0.51, 0.78) 0.60 (0.52, 0.70) 0.54 (0.40, 0.72) 0.62 (0.50, 0.76) RF 0.64 (0.52, 0.80) 0.63 (0.54, 0.73) 0.56 (0.42, 0.74) 0.68 (0.55, 0.83) ACPA 0.63 (0.51, 0.79) 0.59 (0.50, 0.68) 0.57 (0.43, 0.76) 0.63 (0.51, 0.78) Seropositivity 0.64 (0.52, 0.80) 0.63 (0.54, 0.74) 0.59 (0.45, 0.79) 0.75 (0.61, 0.92) RA duration 0.64 (0.51, 0.79) 0.61 (0.52, 0.71) 0.58 (0.44, 0.77) 0.70 (0.57, 0.86) BLDAS28CRP 0.64 (0.51, 0.80) 0.62 (0.53, 0.72) 0.54 (0.41, 0.72) 0.66 (0.54, 0.81) Values are presented as total and stratified Hazard Ratio (95% CI) for ultrasound remission and no functional disability associated with overlapping SS in RA patients according to gender, age, RF/ACPA status, RA duration and DAS28-CRP at 1 st visit. US remission refers to ultrasound GS&lt;2 and PD=0. Unmatched cohort refers to whole sample (n=1100), matched cohort refers to propensity score matched (PSM) patients (n=256). The values are statistically significant at the level of 0.01. Disclosure of Interests: None declared