AB0817 PRELIMINARY DATA ON THE PREVALENCE OF PRIMARY SJÖGREN’S SYNDROME IN PREMENOPAUSAL WOMEN WITH VAGINAL DRYNESS (DRYSCREEN STUDY)
Authors: N. Zehrfeld, A. C. Müller-Vahl, M. Abelmann, S. Benz, T. Witte, R. Klapdor, D. Ernst
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Primary Sjögren's syndrome (pSS) is a chronic, inflammatory autoimmune disease characterized by sicca symptoms due to lymphocytic infiltration of the lachrymal and salivary glands. Based on data from our own cohort (N = 161), it can be assumed that around 61.5 % of women with pSS also suffer from vaginal dryness. According to the literature, the proportion may even be 74%1. However, up to now there is no data available on the number of women with vaginal dryness who actually suffer from pSS. <h3>Objectives:</h3> In this population-based study, we aim to determine the prevalence of pSS in premenopausal women with vaginal dryness and to investigate clinical differences between patients with and without pSS. <h3>Methods:</h3> As part of routine outpatient gynaecological examinations, we aim to screen 10,000 premenopausal women (18-52 years) without pSS or known other reasons für vaginal dryness from 2/2023-05/2024. Vaginal dryness is measured using the Vaginal Health Index (VHI) and medical history is recorded in four collaborating private gynaecological practices. Subjects with evidence of vaginal dryness are referred to our rheumatological outpatient clinic and are evaluated with respect to pSS using the Saxon and Schirmer test, blood sampling for ANA, Ro/SSA and other biomarkers diagnostics, salivary gland ultrasound (OMERACT-score), and further history using standardized questionnaires including the Female Sexual Function Index (FSFI). Here we report preliminary results. <h3>Results:</h3> Since 2/2023, we were able to include 5153 women (mean age=34.1 years, range, 18-52 years) (as of 11/01/2024). Of these, only 30 (0.6%) women (mean age=33.9 years, median age=31.8 years, range, 22-52 years) with symptoms or clinical signs suggestive of vaginal dryness were detected. So far, 20 of these 30 women (66.7%) participated in further examinations. The complete dataset is available in 17/20 women (85%). Only in 1/17 (5.8%) patients, a diagnosis of pSS could be confirmed by objective xerostomia, borderline Schirmer test, highly positive ANA (1:5120), and elevated sedimentation rate. Even though the classification-criteria of pSS were not fulfilled, the diagnosis of pSS was made based on expert opinion. A salivary gland biopsy is still pending. In addition, a previously unknown possible associated autoimmune hepatitis was diagnosed. However, EULAR Sjogren's Syndrome Patient Reported Index (ESSPRI) (total Score=3) and the EULAR Sjögren's syndrome disease activity index (ESSDAI) (total Score=0) were unremarkable corresponding to the patient's overall well-being. The FSFI and the VHI also showed no pathological results with no evidence for sexual dysfunction and Vulvovaginal Atrophy. In 7/17 (41.2%) women, pSS was suspected and further investigations are still ongoing. In 9/17 (52.9%) women, pSS could be excluded. Additional rheumatological examination revealed that 14/20 (70%) premenopausal women with vaginal sicca symptoms also experienced arthralgia and 8/19 (42.1%) xerostomia, while 10/17 (58.8%) had elevated ANA (titer &gt; 1:160). According to the FSFI, sexual dysfunction was reported by 11/16 (68.8%) women. Based on VHI, 2/16 (12.5%) the diagnosis of vulvovaginal atrophy was made. However, the OMERACT score was negative in all patients. <h3>Conclusion:</h3> Vaginal dryness seems to be uncommon in premenopausal women. In nearly half of the premenopausal women experiencing vaginal sicca symptoms or clinical signs of vaginal dryness, the diagnosis of Sjögren`s Syndrome can be suspected. The diagnosis of pSS was confirmed so far in at least 1/17. Thus, in premenopausal women with gynaecologically confirmed vaginal sicca symptoms, further rheumatological examination can be recommended. <h3>REFERENCES:</h3> [1] Minopoulou I, Pyrgidis N, Tishukov M, Sokolakis I, Baniotopoulos P, Kefas A, Doumas M, Hatzichristodoulou G, Dimitroulas T. Sexual dysfunction in women with systemic autoimmune rheumatic disorders: a systematic review and meta-analysis. Rheumatology (Oxford). 2023 Mar 1;62(3):1021-1030. doi: 10.1093/rheumatology/keac457. PMID: 35951753 <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> Nadine Zehrfeld Nadine Zehrfeld received research grants by Novartis and financial support for conference attandance by Abbvie., Anna Charlotte Müller-Vahl: None declared, Malin Abelmann: None declared, Sabrina Benz: None declared, Torsten Witte Torsten Witte reseived honoria for lectures by Abbvie, BMS, Chugai, Galapagos, Janssen, Lilly, Pfizer, UCB and Roche., Torsten Witte received funding from the DFG (German Research Foundation) under Germany´s Excellence Strategy - EXC 2155 - project number 390874280., Rüdiger Klapdor: None declared, Diana Ernst Diana Ernst received presentation honoria from Abbvie, Amgen, BMS, Chugai, Cilag-Janssen, Galapagos, GSK, Medac, Lilly, Pfizer, Novartis and Roche., Diana Ernst participated in advisory boards for Abbvie, Galapagos, Amgen and Novartis., Diana Ernst received research grants by Novartis an Abbvie.