Symptoms Outside Glands in Sjögren’s Patients May Increase Risk of Other Diseases

People with primary Sjögren’s syndrome who have symptoms outside their glands may carry a higher risk of developing other conditions, such as heart or thyroid disease, and might also be more prone to fractures, according to a study.

The findings suggest that making the evaluation of these additional conditions part of routine clinical practice may improve the care of primary Sjögren’s syndrome patients with extraglandular symptoms.

The study, “Association Between Comorbidities and Extraglandular Manifestations in Primary Sjögren’s Syndrome: A Multicenter Cross-Sectional Study,” was published in the journal Clinical Rheumatology.

Patients with primary Sjögren’s syndrome are known to be more likely to have comorbidities, which is defined as the co-occurrence of more than one disease in the same patient.

While damage and dryness of specific glands are the most common symptoms of patients, many develop extraglandular manifestations that involve the kidneys, lungs, muscles, and the nervous system.

According to previous studies, extraglandular manifestations are associated with an increased risk of cardiovascular disease and lymphoma. However, the number of studies that have examined comorbidities among Sjögren’s patients with and without extraglandular manifestations are limited — particularly among patients of different ethnicities.

To examine this, a group of researchers in China set out to assess the relationship between comorbidities and extraglandular manifestations in a group of patients in China using data from a multicenter primary Sjögren’s syndrome registry established by the Chinese Rheumatism Data Center.

“This is the first study assessing the association between extraglandular manifestations and comorbidity burden based on the largest pSS [primary Sjögren’s syndrome] registry in China,” the researchers wrote.

The study included 4,087 patients, at a mean age of 51.2 years, most of whom were women (95.7%), who had been included in the registry from May 2016 to December 2018.

Researchers collected data on demographics, disease characteristics, comorbidities, and extraglandular manifestations, and conducted statistical analyses to assess the relationship between comorbidities and extraglandular manifestations.

Results showed that about 17.9% of patients reported at least one of the comorbidities examined, including thyroid disease (12.1%), cardiovascular disease (3.8%), cancer (1.8%), and fragility fracture (1.7%; meaning they had suffered a fracture after falling from a standing height or less).

Among the 495 patients with thyroid disorders, a poorly functioning thyroid was present in 263 patients, 62 had an overactive thyroid, and 164 had a thyroid inflammation (thyroiditis).

Cardiovascular disease was present in 154 patients, including 89 with coronary artery disease, 52 with stroke, and 13 with both conditions.

Of the 72 patients with cancer, 12 had lymphoma, eight had breast cancer, seven had thyroid carcinoma, and four had stomach cancer.

Among the 71 patients with fragility fractures, 12 had experienced hip fracture, and 17 had had a vertebral fracture.

Researchers found that 38% of the patients analyzed had symptoms outside their glands, and that the presence of extraglandular manifestations was associated with a higher prevalence of comorbidities.

In fact, patients with more than one extraglandular manifestation had a 2.68 times higher risk of fragility fracture, were two times more likely to have cardiovascular disease, and were 1.38 times more likely to have thyroid disorder, even after adjusting for age, sex, disease duration, and other variables.

This finding is important, as many clinicians are faced not only with achieving remission of the primary disease, but also screening for and potentially managing comorbidities. Knowing which conditions are more likely to present can help physicians become more aware of symptoms related to them.