Factors Associated With Disease Damage in Puerto Ricans With Primary Sjögren Syndrome

Abstract

Objective The aim of this study was to determine the association of demographic parameters, clinical manifestations, disease activity, and pharmacologic therapy with disease damage in a group of Puerto Ricans with primary Sjögren syndrome (pSS). Methods A cross-sectional study was conducted in 100 Hispanics of Puerto Rico with pSS. Patients were 21 years or older and fulfilled the 2012 American College of Rheumatology classification criteria for pSS. Demographic factors, lifestyle behaviors, extraglandular manifestations, serologic tests, comorbidities, pharmacologic therapy, disease activity (per European League Against Rheumatism Sjögren Syndrome Disease Activity Index), and disease damage (per Sjögren Syndrome Disease Damage Index [SSDDI]) were assessed. Patients with disease damage (SSDDI ≥1) and without damage (SSDDI = 0) were compared using bivariate analysis and multivariate regression analysis adjusted for age, sex, and disease duration. Results The mean age of patients was 52.8 years; 94% were women. The mean disease duration was 5.9 years. Thirty-nine patients had disease damage. Disease damage was mainly attributed to pulmonary fibrosis and peripheral neuropathy. In the bivariate analysis, disease damage was associated with low C3 and C4, coronary artery disease, infections, and higher activity index and was more frequently treated corticosteroids and azathioprine. In the multivariate analysis, low C3, disease activity, and corticosteroid exposure retained significance. Conclusions In this population of Puerto Ricans with pSS, C3 and C4 hypocomplementemia, coronary artery disease, infections, and exposure to corticosteroids and azathioprine were associated with damage accrual. Clinicians should be aware of these factors to identify those who may require close follow-up and early therapeutic intervention.

Potentially inappropriate anticholinergic drug prescriptions for patients with Sjögren's syndrome

“…bDMARDs were prescribed to 1.2% of patients with Sjögren's syndrome, similar to that described in Japan (3.1%) [7] , [29] . The most commonly prescribed bDMARD in our report was rituximab (0.3%), which was consistent with what was found in Spain, Puerto Rico, and France but where it was prescribed to a higher percentage of patients (3.1%, 4.0%, and 5.3%, respectively) [7] , [29] , [34] ; in Japan, etanercept was the most prescribed bDMARD (0.95%) [32] . In the same way as the cDMARDs, few biological agents have been rigorously studied, and none have shown significant efficacy in multiple studies, with the exception of rituximab, which could have clinical benefits [12] .…”

“…Artificial tears such as hyaluronate or carboxymethyl cellulose are the first-line treatment for improving xerophthalmia [6] , [11] , [12] and were prescribed to 79% of patients in our study, contrasting with what was found in Japan (52%) [35] . Cyclosporine was prescribed to only 2.7% of patients, while in Puerto Rico, this drug was prescribed to 26% of patients [34] . These differences are probably due to different physician prescription habits, diverse academic training of physicians, and availability of these drugs in the health systems of each country.…”

Empleo del colirio de suero autólogo en el tratamiento de la enfermedad del ojo seco

“…[128][129][130][131] Otra de las variables estudiadas fue el diagnóstico asociado a la DED. El trabajo de Jordán-González P et al 132 muestra que la condición reumatológica que más se asocia a la DED es el SS, pero no podemos olvidar los pacientes de AR y los pacientes de Lupus Eritematoso Sistémico. Song P et al 133 en su estudio también encontraron mayor prevalencia de DED en mujeres mayores de 50 años, con AR y otras enfermedades inmunes.…”

“…El 25% de los pacientes de nuestro estudio presentaba una DED de grado grave, el 75% restante una DED leve o moderada. En nuestro estudio se incluyeron pacientes con DED leve-moderada, a diferencia de otros estudios de la literatura consultada, 132,133 en los que solo se incluyen pacientes con DED grave. Sin lugar a duda, y como veremos más adelante, el tratamiento de la DED con colirio de SA es más eficaz cuanto mayor es la gravedad de la DED, motivo por el cual encontramos diferencias en la clasificación clínica de la DED de nuestra población y la de otros artículos consultados.…”