Difference in clinical presentation between women and men in incident primary Sjögren’s syndrome

Abstract

BackgroundA more severe disease phenotype has been reported in men compared to women in several rheumatic diseases. However, studies have not conclusively established sex-related clinical features in primary Sjögren’s syndrome (pSS). In this study, we therefore investigated the clinical presentation of pSS in women and men at diagnosis.MethodsIncident, treatment naïve patients (n = 199) during a 5-year period in a specified area were prospectively included and examined for items of classification criteria for pSS as well as extraglandular manifestations (EGM). Serum was sampled at the time of diagnosis and anti-Ro52/SSA levels were measured by ELISA. Replication of significant findings was confirmed in an independent cohort of pSS patients (n = 377), and meta-analysis was performed.ResultsAn increased frequency of extraglandular manifestations in men was observed and replicated (p = 0.05, p = 0.0003, and p meta = 0.002). This related to pulmonary involvement, vasculitis, and lymphadenopathy being more common in men, for whom a lower age at diagnosis was observed in the exploratory cohort. Additionally, SSA-positive male patients had significantly higher levels of anti-Ro52 levels than their female counterparts in sera available for analysis (p = 0.02).ConclusionsOur analysis of two independent cohorts of incident pSS demonstrates that the presence and number of EGM are significantly more frequent among men with pSS than women at diagnosis. Importantly, around half of the male patients presented with more than one EGM at diagnosis, supporting the conclusion that pSS in men represents a more severe form of disease, regardless of the lower risk for men to develop pSS.

Articular and Peripheral Nervous System Involvement Are Linked to the Long-Term Outcome in Primary Sjögren's Syndrome: The Relevance of Single Organ Manifestations Rather Than a Composite Score as Predictors

“…Finally, a worse outcome was associated to the male gender in the present study. This observation is consistent with recent published work on sex difference in two independent cohorts of incident primary SS, which demonstrated that the presence and number of extraglandular manifestations are significantly more frequent among men than in women with pSS, (29). This study then confirms that pSS males may suffer from a more severe form of disease.…”

Low Influenza, Pneumococcal and Diphtheria–Tetanus–Poliomyelitis Vaccine Coverage in Patients with Primary Sjögren’s Syndrome: A Cross-Sectional Study

“…In addition, our population was mainly composed of women (93%), as observed in an independent French cohort of pSS (ASSESS) [27]. In other cohorts, men were more represented, which could partly explain the low vaccination coverage in our population [28], as men usually experience more severe disease with shorter follow-up intervals. It is known that patients who are monitored closely have better vaccination coverage than patients who are managed with no specific instructions [29].…”

An Innovative Online Qualitative Study to Explore the Symptom Experience of Patients with Primary Sjögren’s Syndrome

“…Missing data may have arisen based on patients’ willingness or ability to participate fully each day, despite the 2-week period given for responses and multiple probes by a moderator. Males represented only 6% of the study population; however, it is estimated that Sjögren’s syndrome is 9–14 times more prevalent in females than males [ 26 ]. Finally, disease information was provided by patients and not physicians, with no further opportunity to investigate the pSS diagnosis, for instance, in terms of specific extra-glandular manifestations.…”