Subclinical atherosclerosis and impaired bone health in patients with primary Sjogren’s syndrome: prevalence, clinical and laboratory associations

Gravani, Fotini; Papadaki, Ioanna; Antypa, Eleni; Nezos, Adrianos; Masselou, Kyriaki; Ioakeimidis, Dimitrios; Koutsilieris, Michael; Moutsopoulos, Haralampos Μ.; Mavragani, Clio P.

doi:10.1186/s13075-015-0613-6

Cited by 71 publications

(63 citation statements)

References 54 publications

(52 reference statements)

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“…Reduced HRV is a powerful and independent predictor of a cardiac event in the general population [25-27]. Furthermore, recent studies demonstrated that the cardiovascular risk burden in pSS patients is increased compared to that in the general population [28,29]. A long-term follow-up study is needed to explore the relationship between autonomic dysfunction and cardiovascular disease.…”

Section: Discussionmentioning

confidence: 99%

Autonomic dysfunction in primary Sjogren’s syndrome: a prospective cohort analysis of 154 Korean patients

Koh

Kwok

Lee

et al. 2017

Korean J Intern Med

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Background/AimsTo determine the prevalence of autonomic dysfunction among Korean patients with primary Sjogren’s syndrome (pSS) and its associations with the clinical features of pSS.MethodsWe analyzed 154 participants from the Korean Initiative of primary Sjogren’s Syndrome (KISS) as a prospective pSS cohort and 154 age- and sex-matched healthy controls. A standardized 5-minute, supine, resting heart rate variability (HRV) test was performed, and autonomic dysfunction was defined as standard deviation of normal-to-normal RR intervals (SDNN) < 30 ms in patients < 50 years old and SDNN < 20 ms in patients ≥ 50 years old. The associations between autonomic dysfunction and various clinical features of pSS were analyzed.ResultsThe overall autonomic activity in patients with pSS was significantly lower than that in controls. Autonomic dysfunction with the HRV test was observed in 35.7% of the KISS participants and was associated with a higher European League Against Rheumatism Sjogren’s Syndrome Patient Reported Index fatigue score (p = 0.024). Raynaud’s phenomenon was a more frequent clinical presentation in pSS patients with autonomic dysfunction than in those without autonomic dysfunction (29.4% and 14.4%, respectively; p = 0.048). Decreased parasympathetic activity was observed in 41.6% of pSS patients. No differences were found in the oral and ocular signs of pSS according to the decreased parasympathetic activity.ConclusionsIn Korean patients with pSS, decreased and imbalanced autonomic activity is prevalent and is associated with fatigue. However, an association between autonomic dysfunction and glandular manifestations was not detected.

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Section: Discussionmentioning

confidence: 99%

Autonomic dysfunction in primary Sjogren’s syndrome: a prospective cohort analysis of 154 Korean patients

Koh

Kwok

Lee

et al. 2017

Korean J Intern Med

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“…One study has reported a weak association between cigarette smoking and the development of primary SS [25], while most studies reported no significant difference in smoking between primary SS patients and controls [26–28]. The case-control study on cardiovascular diseases even found significantly fewer smokers in the SS patient groups [29, 30].…”

Section: Discussionmentioning

confidence: 99%

Risk of asthma in patients with primary Sjögren’s syndrome: a retrospective cohort study

et al. 2016

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BackgroundSjögren’s syndrome (SS) has been associated with bronchial hyperresponsiveness and asthma; however, no population-based cohort study has been performed. We evaluated the risk of asthma in patients with primary SS in a nationwide population.MethodsWe conducted a retrospective cohort study using data from the National Health Insurance Research Database in Taiwan. The primary SS group included 4725 adult patients diagnosed between 2000 and 2006. Each patient was frequency-matched with four people without SS by sex, age and year of diagnosis. The occurrence and hazard ratio (HR) of asthma was monitored by the end of 2011.ResultsThe overall incidence density of asthma was 1.62-fold higher in the primary SS group than in the non-SS group (9.86 vs. 6.10 per 1000 person-years), with a multivariable Cox proportional hazards model measured adjusted HR of 1.38 [95% confidence interval (CI) = 1.21–1.58]. Stratified analyses by sex, age group, and presence of comorbidity revealed that asthma incidences were all higher in the primary SS group than in the non-SS group, and the relative HRs of asthma associated with primary SS were significant in all subgroups.ConclusionPatients with primary SS are associated with an increased risk of developing asthma. We should pay more attention to this group of individuals and provide them with appropriate support.

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“…In pSS ADMA, right and left PWV and left cIMT resulted higher, whereas CFR resulted lower in comparison with normal subjects. In addition, despite left ventricular systolic and diastolic function being similar in pSS and controls, echocardiographic findings support the presence of myocardial alteration in the former (47)(48)(49)(50). Interestingly, not only the Framingham Risk Score (FRS) but also the SS damage index (SSDI) were independently associated with PWV (48).…”

Section: Reviewmentioning

confidence: 78%

“…In this regard, an increased subclinical atherosclerosis is observed only in pSS patients with a longer disease duration, when the chronic inflammation might have caused a stabilized arterial wall damage. Furthermore, advanced age, higher focus score on minor salivary gland biopsy and reduced salivary flow rates, the presence of Raynaud's syndrome and reduced lymphocyte numbers were predictors of plaque formation (50). Two recent large epidemiological studies attempted to characterize the prevalence of traditional CV risk factors and CV events in pSS patients (51,52).…”

Section: Reviewmentioning

confidence: 99%

The clinical spectrum of primary Sjögren’s syndrome: beyond exocrine glands

et al. 2017

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SUMMARYAlthough primary Sjögren's syndrome (pSS) is a mild indolent chronic disease mainly characterized by mucosal dryness in the majority of cases, a consistent subgroup of patients display extra-glandular manifestations. Virtually any organs and systems can be affected, leading to a more serious disease prognosis. Therefore, the prompt identification of patients at higher risk of extra-glandular manifestations is necessary to start a thorough follow up and an aggressive treatment. The aim of this review article is to provide an overview of epidemiological, clinical and serological features of extra-glandular manifestations in pSS as well as current knowledge about putative biomarkers useful in clinical practice. Key words:Sjögren's syndrome; Extra-glandular manifestations; Cardiovascular risk. Reumatismo, 2017; 69 (3): 93-100 n INTRODUCION P rimary Sjögren's syndrome (pSS) is a complex and heterogeneous chronic autoimmune disease primarily characterized by a focal lymphocytic chronic inflammation of exocrine glands leading to progressive loss of secretory function (1). Therefore, the specific case-history of pSS is dominated by signs and symptoms of mucosal dryness. However, although salivary and lachrymal glands represent the main target of pSS, several other organs and systems may be affected during the disease course in at least one third of patients, resulting in a plethora of systemic clinical manifestations, serological abnormalities and complications (2). The most severe complication of pSS is non-Hodgkin lymphoma occurring in about 5% of patients (3) and dramatically worsening disease prognosis. In this regard, the prompt identification of pSS patients with higher risk of developing extraglandular manifestations is mandatory for correct management. Low C3 and C4 levels, cryoglobulins, monoclonal component, anti-Ro/ SSA, anti-La/SSB, rheumatoid factor and hypergammaglobulinaemia represent poor prognostic serological factors in pSS associated with lymphoma and severe extraglandular features (2). Furthermore, histological features such as the presence of germinal centre-like structures in the minor salivary glands have been associated with higher risk of developing lymphoma (4). The purpose of this review article is to discuss current knowledge of extra-glandular manifestations in pSS not secondary to mucosal dryness, excluding pathogenesis and clinical manifestations of lymphoproliferative disorders. n MUSCULOSKELETAL INVOLVEMENTMusculoskeletal manifestations such as myalgia, arthralgia and morning stiffness are present in as many as 90% of patients, while clinically evident arthritis is found in up to 17%. In a recent study conducted on 17 female patients with pSS and 18 patients with secondary SS (sSS), ultrasonography (US) was used to confirm the non-erosive nature of joint involvement in pSS and to discriminate between pSS and RA-associated SS. Synovitis was commonly detected in pSS, mainly in metacarpophalangeal joints (MCP), wrists, and knees. Bone erosions also may occur. Power Doppler signal ...

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Subclinical atherosclerosis and impaired bone health in patients with primary Sjogren’s syndrome: prevalence, clinical and laboratory associations

Cited by 71 publications

References 54 publications

Autonomic dysfunction in primary Sjogren’s syndrome: a prospective cohort analysis of 154 Korean patients

Autonomic dysfunction in primary Sjogren’s syndrome: a prospective cohort analysis of 154 Korean patients

Risk of asthma in patients with primary Sjögren’s syndrome: a retrospective cohort study

The clinical spectrum of primary Sjögren’s syndrome: beyond exocrine glands

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