Sjögren’s patients at higher risk for new, repeat infections
Study finds risk particularly strong for younger people with disease
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People with Sjögren’s disease, especially younger patients, have more infections and more repeat infections than their healthy peers, according to a study that analyzed medical records.
Most infections were recorded after a Sjögren’s diagnosis, which “may reflect immunologic shifts associated with the onset of SjD [Sjögren’s disease], utilization of immune-modulating therapies, or increased detection due to heightened clinical surveillance following diagnosis,” the researchers wrote.
Still, some infections occurred before diagnosis, “raising the possibility that they may act as environmental triggers of SjD,” they wrote, adding that future studies following patients over time are needed to “resolve these temporal relationships.”
The study, “Increased Risk of Environmental and Endemic Infectious Diseases in Sjögren’s Disease: A Retrospective Analysis (2015–2023),” was published in ACR Open Rheumatology by a team of researchers in the U.S.
Sjögren’s is caused by an abnormal immune system attack against the body’s healthy tissues that mainly damages moisture-producing glands such as those that produce tears and saliva. The hallmark Sjögren’s symptoms are dry eyes and mouth, but the disease can affect several other tissues and organs throughout the body.
Potential triggers
“A variety of pathogens [disease-causing organisms], including viruses, bacteria, and fungi, have been associated with the onset and progression of SjD,” the researchers wrote. “Whether these pathogens act as initiating triggers or arise due to compromised mucosal barriers and altered immune responses remains an open question.” Mucosal barriers, including the airways, lungs, and gut, are mucus-lined internal tracts that absorb food and water while blocking dangerous microbes.
Previous studies have shown that people with Sjögren’s are more likely to be hospitalized for infections.
The researchers set out to determine whether people with Sjögren’s have more infections than people without the disease and whether they develop certain infections more often. They retrospectively analyzed medical records from the University of Utah’s health system from 2015 to 2023 and identified 3,826 people with Sjögren’s.
Most were women (88.6%), and the average age at diagnosis was 56.5. The team compared these patients with 11,478 age- and sex-matched healthy people, used as controls.
Data showed that infections were significantly more common in people with Sjögren’s than among healthy controls (46.7% vs. 41.6%). The mean number of unique infection diagnoses was also significantly higher in the Sjögren’s group (5.3 vs. 4.86). The increased number of infections involved viruses, bacteria, fungi, and parasites.
Viral infections, including shingles, cytomegalovirus, Epstein-Barr virus, and some respiratory viruses, were significantly more common in people with Sjögren’s. In contrast, hepatitis (a viral liver infection) and sexually transmitted viral infections were significantly less common.
People with Sjögren’s were also significantly more likely to have records of bacterial infections caused by Mycobacterium, Pseudomonas, Staphylococcus, and some species of Streptococcus. However, some infections, including group A Streptococcus and strep throat, were significantly less common among patients than among controls.
Rates of fungal infections, particularly candidiasis and aspergillosis, were significantly increased in Sjögren’s patients. While parasitic infections were rare overall, the Sjögren’s group was significantly more likely to have onchocerciasis (a parasitic disease that causes eye and skin problems).
Sjögren’s patients had significantly more unique infections after receiving their diagnosis than before (3.98 vs. 2.68). This rise “was driven primarily by viral, bacterial, and unspecified infections,” the team wrote, adding that it may “partly reflect surveillance bias because patients typically undergo more frequent health care encounters and diagnostic testing.”
Reinfection rates (repeat infections after an earlier infection) were also significantly higher among people with Sjögren’s compared with controls (2.72 vs. 1.23 infections per patient). “This aligns with previous hypotheses that persistent or reactivating infections contribute to chronic inflammation,” the researchers wrote.
Patients who tested positive for anti-SSA/Ro antibodies, which are commonly linked to Sjögren’s, had significantly more unique infections and reinfections than those who tested negative. Those diagnosed before age 39 also had significantly more infections and reinfections.
The team compared infection patterns in Sjögren’s patients with those of people with dry eyes and mouth but no Sjögren’s, and with those of people with one of two autoimmune diseases, systemic lupus erythematosus (SLE) or rheumatoid arthritis. They found that Sjögren’s was most similar to SLE.
“Notably, a distinct cluster including Leptospira, Mycobacterium, Onchocerca, and chronic candidiasis was uniquely enriched in SjD, suggesting a partially distinct [infection disease] signature,” the researchers wrote.
The findings “support the need for improved infection surveillance and preventive strategies, such as vaccination and early antimicrobial management, particularly in high-risk subgroups,” they said.
Because the analysis could not establish a cause-and-effect relationship between infections and Sjögren’s, additional research is needed to determine whether particular organisms contribute to the disease and whether they could serve as targets for future treatments, they added.
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