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Punnanitinont A, Biswas S, Kasperek EM, Osinski J, Zhu C, Miecznikowski JC, Romano RA, Kramer JM. Tlr7 drives sex- and tissue-dependent effects in Sjögren's disease. Front Cell Dev Biol 2024; 12:1434269. [PMID: 39310226 PMCID: PMC11413591 DOI: 10.3389/fcell.2024.1434269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Accepted: 08/19/2024] [Indexed: 09/25/2024] Open
Abstract
Primary Sjögren's disease (pSD) is a systemic autoimmune disease that has the strongest female predilection of all autoimmune diseases. The underlying mechanisms that govern this sexual dimorphism, however, remain poorly understood. We hypothesized that pSD females would exhibit more robust disease as compared to males, and that Tlr7 controls distinct disease manifestations in males and females. Using a well-established pSD mouse model, we harvested exocrine glands, and pulmonary and renal tissue from males and females and quantified the inflammation present. We then collected salivary glands, spleens, and cervical lymph nodes and performed flow cytometry to assess immune populations implicated in disease. We also harvested sera to examine total and autoreactive antibodies. Our data revealed that pSD mice displayed sex-biased disease, as pSD females showed decreased dacryoadenitis, but increased nephritis as compared to males. Moreover, females exhibited increased proportions of germinal center B cells and CD4+ activated/memory T cells in the periphery. Additionally, salivary gland immune populations were altered in a sex-dependent manner in pSD. Females with pSD also displayed elevated total and autoreactive IgG as compared to males. Additionally, splenic B cell Tlr7 expression was increased in females. We next generated pSD mice that lacked Tlr7 systemically and found that ablation of Tlr7 was primarily protective in pSD females, while Tlr7-deficient pSD males showed heightened disease. Thus, pSD mice display sex-biased disease and these dichotomous manifestations are governed by Tlr7 activation. This study identifies Tlr7 as a druggable target for pSD, and highlights the importance of studying pSD disease mechanisms in both sexes.
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Affiliation(s)
- Achamaporn Punnanitinont
- Department of Oral Biology, School of Dental Medicine, The University at Buffalo, State University of New York, Buffalo, NY, United States
| | - Sheta Biswas
- Department of Oral Biology, School of Dental Medicine, The University at Buffalo, State University of New York, Buffalo, NY, United States
- Department of Biochemistry and Molecular Biology, Noakhali Science and Technology University, Noakhali, Bangladesh
| | - Eileen M. Kasperek
- Department of Oral Biology, School of Dental Medicine, The University at Buffalo, State University of New York, Buffalo, NY, United States
| | - Jason Osinski
- Department of Oral Biology, School of Dental Medicine, The University at Buffalo, State University of New York, Buffalo, NY, United States
| | - Chengsong Zhu
- Department of Immunology, Microarray and Immune Phenotyping Core Facility, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Jeffrey C. Miecznikowski
- Department of Biostatistics, School of Public Health and Health Professions, The University at Buffalo, State University of New York, Buffalo, NY, United States
| | - Rose-Anne Romano
- Department of Oral Biology, School of Dental Medicine, The University at Buffalo, State University of New York, Buffalo, NY, United States
| | - Jill M. Kramer
- Department of Oral Biology, School of Dental Medicine, The University at Buffalo, State University of New York, Buffalo, NY, United States
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Liu H, Yuan J, Tan X, Song W, Wang S. Male patients with primary Sjögren's syndrome have unique clinical manifestations and circulating lymphocyte profiles. Clin Rheumatol 2024; 43:1927-1937. [PMID: 38602613 DOI: 10.1007/s10067-024-06955-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/27/2024] [Accepted: 03/22/2024] [Indexed: 04/12/2024]
Abstract
OBJECTIVES We aimed to explore the relationship between clinical characteristics and circulating lymphocyte profiles in Chinese male patients with primary Sjögren's syndrome (pSS). METHOD Data from 397 patients with pSS were analyzed retrospectively. 37 were male, which is a prevalence of 9.3%. The clinical, laboratory, and immunophenotypic profiles of peripheral blood lymphocyte subsets were compared between male and female pSS patients. RESULTS Male patients with primary Sjögren's syndrome have unique clinical manifestations and circulating lymphocyte profiles. Male patients complained more about xerophthalmia and presented with more extra-glandular manifestations as compared with female patients. The CD4+/CD8+ ratio (P = 0.030), the prevalence of CD4-CD8- T cells in lymphocytes (P = 0.020), the absolute number of CD4-CD8- T cells (P = 0.035), the prevalence of CD4+ T cells in lymphocytes (P < 0.001), and the absolute number of CD4+ T cells (P = 0.023) were significantly lower in male patients compared to female patients. On the other hand, the prevalence of CD8+CD28+ T cells (P = 0.030) and CD4+CD25high T cells (P = 0.040) in lymphocytes was significantly higher in male patients than in female patients. Moreover, compared to females with pSS, an elevated serum IgG level, low C3 and C4 levels, anti-SSB positivity, and ANA titers of ≥ 1:160 positivity were more frequent in male with pSS. CONCLUSIONS Male patients with pSS have distinctive peripheral blood lymphocyte subpopulations, present with more severe clinical symptoms and immunological features, and have an unfavorable prognosis. Key Points • Male patients with pSS have more severe clinical symptoms and specific characteristics of peripheral blood lymphocyte subsets. • Male pSS patients exhibit a higher intensity of the disease (as evaluated by ESSDAI). • Male patients with pSS require individualized treatment regimens and closer follow-up.
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Affiliation(s)
- Huan Liu
- Qingdao Municipal Hospital, Qingdao University, Qingdao, 266000, China
| | - Jiangshui Yuan
- Department of Laboratory Medicine, Qingdao Municipal Hospital, No.5 Donghai Middle Road, Qingdao, 266000, Shandong, China
| | - Xueying Tan
- Department of Laboratory Medicine, Qingdao Municipal Hospital, No.5 Donghai Middle Road, Qingdao, 266000, Shandong, China
| | - Weiqing Song
- Department of Laboratory Medicine, Qingdao Municipal Hospital, No.5 Donghai Middle Road, Qingdao, 266000, Shandong, China
| | - Shuguo Wang
- Department of Laboratory Medicine, Qingdao Municipal Hospital, No.5 Donghai Middle Road, Qingdao, 266000, Shandong, China.
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Xuan Y, Zhang X, Wu H. Impact of sex differences on the clinical presentation, pathogenesis, treatment and prognosis of Sjögren's syndrome. Immunology 2024; 171:513-524. [PMID: 38156505 DOI: 10.1111/imm.13740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/30/2023] [Indexed: 12/30/2023] Open
Abstract
Sjögren's syndrome is a common chronic autoimmune disease that manifests as dry mouth, dry eyes and systemic complications. There are sex differences in the clinical manifestations between men and women, with the average age of onset being around 55 years and the majority of female patients developing the disease during the menopausal years. Understanding the impact of sex differences on SS may help in the treatment and prognosis of patients. Studies have confirmed that a number of factors are associated with the onset of SS, but the exact mechanisms are not fully understood. Sex hormones (especially oestrogens and androgens) play a very important role, and the balance of sex hormone levels in the body is crucial for maintaining homeostasis in the acinar cells of the lacrimal and salivary glands. In addition, chromosomes play a very important role in the sex differences in SS. The gut microbiota also has some influence on sex differences in SS. In this review, we focus on oestrogens and androgens, which are important in the pathogenesis of SS, and summarize the progress of non-clinical studies. Sex differences may influence differences in individualized treatment regimens and further studies are needed.
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Affiliation(s)
- Yuhao Xuan
- Institute of Clinical Pharmacology, Anhui Medical University, Key Laboratory of Anti-inflammatory and Immune Medicine, Ministry of Education, Anhui Collaborative Innovation Center of Anti-Infammatory and lmmune Medicine, Hefei, Anhui Province, China
| | - Xiao Zhang
- Institute of Clinical Pharmacology, Anhui Medical University, Key Laboratory of Anti-inflammatory and Immune Medicine, Ministry of Education, Anhui Collaborative Innovation Center of Anti-Infammatory and lmmune Medicine, Hefei, Anhui Province, China
| | - Huaxun Wu
- Institute of Clinical Pharmacology, Anhui Medical University, Key Laboratory of Anti-inflammatory and Immune Medicine, Ministry of Education, Anhui Collaborative Innovation Center of Anti-Infammatory and lmmune Medicine, Hefei, Anhui Province, China
- Anhui Provincial Institute of Translational Medicine, Hefei, Anhui Province, China
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Zhang Y, Chen JQ, Yang JY, Liao JH, Wu TH, Yu XB, Huang ZW, He Q, Wang Q, Song WJ, Luo J, Tao QW. Sex Difference in Primary Sjögren Syndrome: A Medical Records Review Study. J Clin Rheumatol 2023:00124743-990000000-00104. [PMID: 37068269 PMCID: PMC10368225 DOI: 10.1097/rhu.0000000000001962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
OBJECTIVES The aim of this study was to study clinical and biological differences between men and women with primary Sjögren syndrome (pSS) in China and perform a literature review to confirm if the clinical phenotypes are affected by sex in patients with pSS. METHODS Data from 961 patients with pSS treated at a tertiary hospital in China between January 2013 and March 2022 were analyzed based on medical records. Clinical characteristics, including disease manifestations and serological parameters of the disease, were compared between men and women with pSS using the Mann-Whitney U test and χ2 test. RESULTS This study included 140 (14.6%) men and 821 (85.4%) women with pSS. Women with pSS demonstrated a higher prevalence of dry mouth, dry eyes, arthralgia, and dental caries (p < 0.05); higher erythrocyte sedimentation rate and immunoglobulin M levels (p < 0.05); higher prevalence of leukopenia, neutropenia, anemia, low complement 3, and low complement 4 (p < 0.05); and higher titers of antinuclear antibody, anti-Sjögren syndrome A, anti-Ro52, and rheumatoid factor positivity (p < 0.05) than men, whereas men with pSS had a higher prevalence of parotid enlargement and interstitial lung disease (p < 0.05). CONCLUSIONS Women with pSS are associated with more dryness, cytopenia, hypocomplementemia, and autoantibody positivity. Although men with pSS probably have lighter sicca symptoms and lower immunoactivity and serologic responses, regular monitoring of interstitial lung disease in men is vital.
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Affiliation(s)
- Yan Zhang
- From the Graduate School, Beijing University of Chinese Medicine
| | - Jia-Qi Chen
- From the Graduate School, Beijing University of Chinese Medicine
| | - Jian-Ying Yang
- From the Graduate School, Beijing University of Chinese Medicine
| | - Jia-He Liao
- From the Graduate School, Beijing University of Chinese Medicine
| | - Tzu-Hua Wu
- From the Graduate School, Beijing University of Chinese Medicine
| | - Xin-Bo Yu
- From the Graduate School, Beijing University of Chinese Medicine
| | - Zi-Wei Huang
- From the Graduate School, Beijing University of Chinese Medicine
| | - Qian He
- From the Graduate School, Beijing University of Chinese Medicine
| | - Qin Wang
- From the Graduate School, Beijing University of Chinese Medicine
| | - Wei-Jiang Song
- Traditional Chinese Medicine Department, Peking University Third Hospital
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Wiriyakijja P, Niklander S, Santos-Silva AR, Shorrer MK, Simms ML, Villa A, Sankar V, Kerr AR, Riordain RN, Jensen SB, Delli K. World Workshop on Oral Medicine VIII: Development of a Core Outcome Set for Dry Mouth: A Systematic Review of Outcome Domains for Xerostomia. Oral Surg Oral Med Oral Pathol Oral Radiol 2023:S2212-4403(23)00068-8. [PMID: 37198047 DOI: 10.1016/j.oooo.2023.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/11/2022] [Accepted: 01/25/2023] [Indexed: 03/08/2023]
Abstract
OBJECTIVE The purpose of this study was to identify all outcome domains used in clinical studies of xerostomia, that is, subjective sensation of dry mouth. This study is part of the extended project "World Workshop on Oral Medicine Outcomes Initiative for the Direction of Research" to develop a core outcome set for dry mouth. STUDY DESIGN A systematic review was performed on MEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials databases. All clinical and observational studies that assessed xerostomia in human participants from 2001 to 2021 were included. Information on outcome domains was extracted and mapped to the Core Outcome Measures in Effectiveness Trials taxonomy. Corresponding outcome measures were summarized. RESULTS From a total of 34,922 records retrieved, 688 articles involving 122,151 persons with xerostomia were included. There were 16 unique outcome domains and 166 outcome measures extracted. None of these domains or measures were consistently used across all the studies. The severity of xerostomia and physical functioning were the 2 most frequently assessed domains. CONCLUSION There is considerable heterogeneity in outcome domains and measures reported in clinical studies of xerostomia. This highlights the need for harmonization of dry mouth assessment to enhance comparability across studies and facilitate the synthesis of robust evidence for managing patients with xerostomia.
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Pezoulas VC, Goules A, Kalatzis F, Chatzis L, Kourou KD, Venetsanopoulou A, Exarchos TP, Gandolfo S, Votis K, Zampeli E, Burmeister J, May T, Marcelino Pérez M, Lishchuk I, Chondrogiannis T, Andronikou V, Varvarigou T, Filipovic N, Tsiknakis M, Baldini C, Bombardieri M, Bootsma H, Bowman SJ, Soyfoo MS, Parisis D, Delporte C, Devauchelle-Pensec V, Pers JO, Dörner T, Bartoloni E, Gerli R, Giacomelli R, Jonsson R, Ng WF, Priori R, Ramos-Casals M, Sivils K, Skopouli F, Torsten W, A. G. van Roon J, Xavier M, De Vita S, Tzioufas AG, Fotiadis DI. Addressing the clinical unmet needs in primary Sjögren's Syndrome through the sharing, harmonization and federated analysis of 21 European cohorts. Comput Struct Biotechnol J 2022; 20:471-484. [PMID: 35070169 PMCID: PMC8760551 DOI: 10.1016/j.csbj.2022.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/30/2021] [Accepted: 01/01/2022] [Indexed: 12/26/2022] Open
Abstract
For many decades, the clinical unmet needs of primary Sjögren's Syndrome (pSS) have been left unresolved due to the rareness of the disease and the complexity of the underlying pathogenic mechanisms, including the pSS-associated lymphomagenesis process. Here, we present the HarmonicSS cloud-computing exemplar which offers beyond the state-of-the-art data analytics services to address the pSS clinical unmet needs, including the development of lymphoma classification models and the identification of biomarkers for lymphomagenesis. The users of the platform have been able to successfully interlink, curate, and harmonize 21 regional, national, and international European cohorts of 7,551 pSS patients with respect to the ethical and legal issues for data sharing. Federated AI algorithms were trained across the harmonized databases, with reduced execution time complexity, yielding robust lymphoma classification models with 85% accuracy, 81.25% sensitivity, 85.4% specificity along with 5 biomarkers for lymphoma development. To our knowledge, this is the first GDPR compliant platform that provides federated AI services to address the pSS clinical unmet needs.
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Affiliation(s)
- Vasileios C. Pezoulas
- Unit of Medical Technology and Intelligent Information Systems, Dept. of Materials Science and Engineering, University of Ioannina, Ioannina, Greece
| | - Andreas Goules
- Dept. of Pathophysiology, School of Medicine, University of Athens, Athens, Greece
| | - Fanis Kalatzis
- Unit of Medical Technology and Intelligent Information Systems, Dept. of Materials Science and Engineering, University of Ioannina, Ioannina, Greece
| | - Luke Chatzis
- Dept. of Pathophysiology, School of Medicine, University of Athens, Athens, Greece
| | - Konstantina D. Kourou
- Unit of Medical Technology and Intelligent Information Systems, Dept. of Materials Science and Engineering, University of Ioannina, Ioannina, Greece
| | - Aliki Venetsanopoulou
- Dept. of Pathophysiology, School of Medicine, University of Athens, Athens, Greece
- University Hospital of Ioannina, Ioannina, Greece
| | - Themis P. Exarchos
- Unit of Medical Technology and Intelligent Information Systems, Dept. of Materials Science and Engineering, University of Ioannina, Ioannina, Greece
- Dept. of Informatics, Ionian University, Corfu, Greece
| | - Saviana Gandolfo
- Clinic of Rheumatology, Dept. of Medical and Biological Sciences, Udine University, Udine, Italy
| | | | - Evi Zampeli
- Institute for Systemic Autoimmune and Neurological Diseases, Athens, Greece
| | - Jan Burmeister
- Fraunhofer Institute for Computer Graphics Research IGD, Darmstadt, Germany
| | - Thorsten May
- Fraunhofer Institute for Computer Graphics Research IGD, Darmstadt, Germany
| | | | - Iryna Lishchuk
- Institute of Legal Informatics, Leibniz Universität Hannover, Hannover, Germany
| | - Thymios Chondrogiannis
- Institute of Communication and Computer Systems, School of Electrical and Computer Engineering, National and Technical University of Athens, Athens, Greece
| | - Vassiliki Andronikou
- Institute of Communication and Computer Systems, School of Electrical and Computer Engineering, National and Technical University of Athens, Athens, Greece
| | - Theodora Varvarigou
- Institute of Communication and Computer Systems, School of Electrical and Computer Engineering, National and Technical University of Athens, Athens, Greece
| | - Nenad Filipovic
- Bioengineering Research and Development Center, Faculty of Engineering, University of Kragujevac, Kragujevac, Serbia
| | - Manolis Tsiknakis
- Biomedical Informatics and eHealth Laboratory, Dept. of Electrical and Computer Engineering, Hellenic Mediterranean University, Heraklion, Greece
| | - Chiara Baldini
- Dept. of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Michele Bombardieri
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Queen Mary University of London and Barts’ Health NHS Trust, London, United Kingdom
| | - Hendrika Bootsma
- Dept. of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, the Netherlands
| | - Simon J. Bowman
- Rheumatology Dept., University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Dorian Parisis
- Laboratory of Pathophysiological Biochemistry and Nutrition, Université Libre de Bruxelles, Brussels, Belgium
| | - Christine Delporte
- Laboratory of Pathophysiological Biochemistry and Nutrition, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Jacques-Olivier Pers
- Univ Brest, Inserm, CHU de Brest, UMR1227, Lymphocytes B et Autoimmunité, Brest, France
| | - Thomas Dörner
- Dept. of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Elena Bartoloni
- Rheumatology Unit, Dept. of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Roberto Gerli
- Rheumatology Unit, Dept. of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Roberto Giacomelli
- Division of Rheumatology, Dept. of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Roland Jonsson
- Dept. of Clinical Science, University of Bergen, Bergen, Norway
| | - Wan-Fai Ng
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Roberta Priori
- Dept. of Internal Medicine and Medical Specialties, Rheumatology Clinic, Sapienza University of Rome, Rome, Italy
| | - Manuel Ramos-Casals
- Laboratory of Autoimmune Diseases Josep Font, IDIBAPS-CELLEX, Barcelona, Spain
| | | | - Fotini Skopouli
- Institute for Systemic Autoimmune and Neurological Diseases, Athens, Greece
- Dept. of Internal Medicine and Clinical Immunology, Euroclinic Hospital, Athens, Greece
| | - Witte Torsten
- Dept. of Rheumatology and Immunology, Hanover Medical School, Hanover, Germany
| | - Joel A. G. van Roon
- Dept. of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Mariette Xavier
- Dept. of Rheumatology, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Salvatore De Vita
- Clinic of Rheumatology, Dept. of Medical and Biological Sciences, Udine University, Udine, Italy
| | | | - Dimitrios I. Fotiadis
- Unit of Medical Technology and Intelligent Information Systems, Dept. of Materials Science and Engineering, University of Ioannina, Ioannina, Greece
- Dept. of Biomedical Research, FORTH-IMBB, Ioannina, Greece
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Yayla ME, Şahin Eroğlu D, Uslu Yurteri E, Keleşoğlu Dinçer AB, Sezer S, Aydemir Gülöksüz EG, Yüksel ML, Yılmaz R, Ateş A, Turgay TM, Kınıklı G. Indications and risk factors for hospitalization in patients with primary Sjögren syndrome: experience from a tertiary center in Turkey. Clin Rheumatol 2022; 41:1457-1463. [PMID: 34988683 PMCID: PMC8731179 DOI: 10.1007/s10067-022-06053-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 12/20/2021] [Accepted: 12/31/2021] [Indexed: 11/16/2022]
Abstract
Objective In this study, it was aimed to reveal the hospitalization reasons for patients diagnosed with primary Sjögren syndrome (pSS) and potentially associated factors in a tertiary health center. Method One hundred and sixty-three pSS patients who regularly attended their follow-ups between January 2010 and May 2021 were included in the study. These patients’ reasons for hospitalization, duration of hospitalization, and numbers of presenting to the hospital were recorded. The demographic, clinical and serological characteristics of the hospitalized and non-hospitalized patients were compared. Results Hospitalization occurred in 22.7% of the patients, and the total number of hospitalizations was 79. The hospitalization incidence density rate was 6.21 per 100 patient-years. The most frequently encountered reason for hospitalizations was pSS-related organ involvement (44.3%). Infections (17.7%), malignancy (16.5%), endocrine, and various other reasons were the other indications for hospitalization. While male sex (p = 0.005), the presence of extra-glandular involvement (p < 0.001), and interstitial lung disease (p = 0.001) were more common in the hospitalized patients, anti-nuclear antibody positivity was less frequent (p = 0.032). The usage rate of hydroxychloroquine (p = 0.022) was lower in the hospitalized patients, whereas the use of glucocorticoids (p < 0.001) and azathioprine (p = 0.005) was more frequent. The multivariable analyses revealed a relationship between extra-glandular involvement (OR: 4.57 [1.05–19.84], p = 0.043), glucocorticoid use (OR: 3.23 [1.13–9.21], p = 0.028) and hospitalization. Conclusion pSS-related system involvement and infection accounted for the majority of hospitalizations of the pSS patients. The presence of extra-glandular involvement and glucocorticoid use were found to be associated with hospitalization.Key Points • pSS-related system involvement and infection accounted for the majority of hospitalizations of pSS patients. • The presence of extra-glandular involvement was found to be associated with hospitalization. |
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Affiliation(s)
- Müçteba Enes Yayla
- Department of Rheumatology, Faculty of Medicine, Ankara University, Ankara, Turkey. .,Clinic of Rheumatology, Ankara Training and Research Hospital, Ankara, Turkey.
| | - Didem Şahin Eroğlu
- Department of Rheumatology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Emine Uslu Yurteri
- Department of Rheumatology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | | | - Serdar Sezer
- Department of Rheumatology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | | | - Mehmet Levent Yüksel
- Department of Rheumatology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Recep Yılmaz
- Department of Rheumatology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Aşkın Ateş
- Department of Rheumatology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Tahsin Murat Turgay
- Department of Rheumatology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Gülay Kınıklı
- Department of Rheumatology, Faculty of Medicine, Ankara University, Ankara, Turkey
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