BackgroundApart from anti-Ro and/or anti-La positive primary Sjögren’s syndrome (pSS), there is a unique subtype of pSS with anticentromere antibodies (ACA). At the present time salivary gland ultrasonography (SGUS) is widely used to assess the structure of the salivary glands in pSS, but there are few publications about SGUS changes in ACA-positive patients [1].ObjectivesTo investigate SGUS changes in ACA (ACA+) positive pSS patients and compare with ACA-negative (ACA–).MethodsWe examined 141 patients with pSS, including 103 ACA– patients (pSS-ACA–) with the mean age 49,8 ± 14,1 years and 38 ACA+ positive (pSS-ACA+) with the mean age 59,1 ± 10,2 years. All patients underwent standard examination for the diagnosis of pSS (stomatological, ophthalmological, immunological), and SGUS performed using GE LOGIQ 9 of two parotid and two submandibular glands. Ultrasound images were evaluated with the OMERACT SGUS scoring system (SGUS SS) from grades 0 to 3 [2]. Statistical analyses (chi-squared test, p <0.05) were performed using STATISTICA version 12.ResultsCharacteristics of patients with pSS-ACA+ and pSS-ACA– are presented in Table 1.Table 1.ParametersACA–ACA+N%N%Oral dryness8683,53694,7Ocular dryness7673,83078,9Enlargement of parotid salivary glands3634,9718,4Recurrent parotitis2322,3760,5ANA ≥1:32010310038100Stimulated saliva flow test < 2.5 ml/5 min6563,13078,9Sialectasia on parotid sialography10310038100Stimulated Schirmer’s test <10 mm/5 min6765,02668,4Tear breakup time <10 seconds5957,32052,6Focus score ≥ 1foci/4 mm29491,312/1392,3MALT-lymphomas87,7513,1Characteristics of SGUS SS in pSS-ACA+ and pSS-ACA– are shown in Figure 1.Figure 1.We did not find significant differences when comparing SGUS SS in patients with pSS-ACA+ and pSS-ACA–.ConclusionWe did not find significant differences in SGUS and SGUS SS in patients with pSS-ACA+ and pSS-ACA–.ReferencesFURS-2022-003[1]Min HK, Kim SH, Park Y, et al. Ultrasonographic characteristics of major salivary glands in anti-centromere antibody-positive primary Sjögren’s syndrome. PLoS One. 2021;16(11):e0259519. Published 2021 Nov 3. doi:10.1371/journal.pone.0259519[2]Jousse-Joulin, Sandrine et al. “Video clip assessment of a salivary gland ultrasound scoring system in Sjögren’s syndrome using consensual definitions: an OMERACT ultrasound working group reliability exercise.” Annals of the rheumatic diseases vol. 78,7 (2019): 967-973. https://doi:10.1136/annrheumdis-2019-215024Disclosure of InterestsNone declared
BackgroundData from multiple rheumatological cohorts have shown that treatment with rituximab (RTM) is associated with higher COVID-19 morbidity and mortality. Information about the course of COVID-19 in patients (pts) with Sjogren’s syndrome (SjS) is still lacking.ObjectivesTo compare clinical course of COVID-19 in pts with SjS treated with anti-CD20 monoclonal antibody (RTM) and treated with synthetic disease-modifying antirheumatic drugs and low doses of glucocorticoids.MethodsSingle center observational study. Pts with SjS were screened for SARS-CoV-2 infection anamnesis via telephone interview. Diagnosis of SjS was based on ECR/EULAR 2016 criteria. COVID-19 diagnosis was based on positive PCR test and typical clinical features (CT signs, fever and anosmia). RTM was administered as two infusions of 1000 mg each 2 weeks apart, and then 500 mg every 6 months.Results387 pts with SjS were interviewed, 142 of them with confirmed SARS-CoV-2 were included in the study and divided into 2 groups. The first group (gr) consisted of 86 pts (79 women and 7 men) receiving RTM (gr R), median age was 56 years (33-66,5 years), and median rituximab treatment duration was 36 months (12-42 months). Pts in the control gr (gr C), 56 pts did not receive RTM (55 women and 1 man), their median age was 50 years (35-69 years). Median time from last RTM administration to COVID-19 symptoms onset was 4 months (2-6 months). Ten pts had concomitant RA, 4 pts - SLE, 5 pts - Systemic sclerosis. Fifteen pts had MALT-lymphoma anamnesis. Additionally, 15 pts (10.5%) had pulmonary involvement secondary to rheumatic disease. In total 37 pts had chronic ischemic heart disease and/or severe arterial hypertension, diabetes mellitus type 2.In gr R 31 pts (36%), and in gr C 13 (23%) required hospitalization due to marked shortness of breath and long febrile period (р=0,1). Anti-IL6 treatment or/and Jak inhibitors were prescribed to 17 of 31 pts (54.8%) in gr R and to 5 of 13 (38%) in gr C (р=0,1). The risk of hospitalization was slightly higher in pts with comorbidity (p=0.06) and with a history of lymphoma (p=0.056) and didn’t correlate with the following parameters: age, the duration of RTM therapy, lung damage. A high rate of hospitalization correlated with a shorter period between the administration of the RTM and the development of COVID-19 (R=0,387, Spearman`s Rank Correlation). Anti-SARS-CoV-2 IgG were measured in 66 pts, 47 (71%) of them were positive. Positive Anti-SARS-CoV-2 IgG were significantly more often detected in gr C (84% vs. 57,6%). No correlation was found between the formation of antibodies and the duration of RTM therapy or the time from the last RTM administration.ConclusionAccording to our data anti-CD20 therapy doesn’t predispose SjS pts to severe course of COVID-19. Lymphoma anamnesis, cardiovascular diseases and diabetes have greater impact on COVID-19 severity. Obviously, anti-CD20 therapy negatively affected the formation of specific anti-SARS-CoV-2 humoral immunity.Disclosure of InterestsNone declared
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