POS0368 GLANDULAR AND EXTRAGLANDULAR DAMAGE IS HIGHLY PREVALENT IN PATIENTS WITH SJÖGREN’S DISEASE AND IS ASSOCIATED WITH AGE, DISEASE DURATION, RHEUMATOID FACTOR, AND GLANDULAR ENLARGEMENT
Authors: C. G Costa, M. Bandeira, M. Silvério-António, N. Khmelinskii, J. E. Fonseca, V. C Romão
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> The differentiation between disease activity and irreversible damage in Sjögren's Disease (SjD) is an ongoing matter of debate. The association of damage with different clinical and biological markers has been scarcely studied. <h3>Objectives:</h3> We aimed to characterize damage in SjD, identify predictors for its development, and compare the performance of the Sjögren's Syndrome Disease Damage Index (SSDDI) and the Sjögren's Syndrome Damage Index (SSDI). <h3>Methods:</h3> We conducted a cross-sectional analysis of our SjD cohort to assess damage in SjD patients. Cumulative demographic, clinical, and laboratory variables were compared between the groups with and without damage (i.e., SSDDI≥1), using the appropriate parametric or non-parametric tests, as applicable. In addition to oral or ocular damage, we defined systemic damage if there was ≥1 in any of the neurological, pleuropulmonary, renal, or lymphoproliferative domains of the SSDDI. Damage predictors were identified through logistic regression modeling. The performance of the SSDDI and SSDI was compared using the Wilcoxon and McNemar tests. <h3>Results:</h3> 215 patients fulfilling the ACR/EULAR 2016 criteria were included, 170 (79.1%) of whom presented damage according to SSDDI (Table 1). While the ocular (80.6%) and oral (60.0%) domains were the most affected, systemic damage was present in 15.3% of these 170 patients (12% of total), mainly affecting the neurologic (6.5%) and pleuropulmonary domains (4.7%). Five patients developed non-Hodgkin lymphoma (NHL) (2.9%), which was more frequent in those with persistent lymphadenopathy (<i>p</i>&lt;0.001). Paraproteinemia was more frequent in those with neurological (<i>p</i>=0.017) and systemic damage (<i>p</i>=0.046), whereas cryoglobulinemia was only associated with neurological damage (<i>p</i>=0.003). Patients with neurological damage and lymphoma had longer disease duration (<i>p</i>=0.026 and <i>p</i>=0.010, respectively), but no association was found with older age. Multivariate analysis identified older age [OR (95% CI): 1.076 (1.034-1.118); <i>p</i>&lt;0.001], longer disease duration [OR (95% CI): 1.170 (1.058-1.294); <i>p</i>=0.002], rheumatoid factor (RF) positivity [OR (95% CI): 3.171 (1.198-8.391); <i>p</i>=0.020], and glandular enlargement [OR (95% CI): 5.863 (1.721-19.978); <i>p</i>=0.005] as damage predictors. Rituximab was strongly associated with systemic damage [OR (95% CI): 5.498 (1.176-25.710); <i>p</i>=0.030]. Although moderately correlated (R<sup>2</sup>=0.403), the SSDDI and SSDI performed differently in damage classification (79.1% vs. 92.6%; <i>p</i>&lt;0.001) and median scores assigned [1 (1-2) vs. 2 (2-3); <i>p</i>&lt;0.001]. <h3>Conclusion:</h3> This study confirmed that damage is highly prevalent in SjD, affecting up to 80% of patients. Patients with RF positivity and glandular enlargement are at a higher risk of developing damage. The influence of age and disease duration highlights the importance of early diagnosis and timely treatment in this disease. <h3>REFERENCES:</h3> <b>NIL.</b> <h3>Acknowledgements:</h3> CGC and MB contributed equally. <h3>Disclosure of Interests:</h3> <b>None declared.</b>