Ab1144 prevalence of secondary sjogren’s syndrome in psoriasis and psoriatic arthritis and its relationship with disease characteristics

Background Secondary Sjögren’s syndrome (sSS) accompanies many systemic rheumatic diseases at certain rates, including axial spondyloarthritis (axSpA). [1] There are some case reports in which psoriasis or psoriatic arthritis (PsA) with sSS co-existence. [2] However, the prevalence of sSS in psoriasis (PsO) and PsA is not fully addressed. Additionally, clinical and laboratory features that may be associated with sSS, and whether arthritis and sSS are related are not known. Objectives This study aims to assess the prevalence of sSS in patients with non-arthritic psoriasis and PsA and illuminate disease features associated with sSS. Methods Psoriasis patients diagnosed by a dermatologist and patients classified as PsA who fulfilled the CASPAR criteria were questioned for sicca symptoms consistent with the 2002 American-European Sjogren’s Syndrome Consensus Criteria (AECG). The salivary gland scintigraphy of the patients with oral dryness was performed and the unstimulated salivary flow rate (SFR) was measured. Schirmer’s test was performed on patients with dry eyes. Anti-Ro antibodies were measured and minor salivary gland biopsies were performed in patients with sicca detected by objective measurements. After the evaluation of the patients, the sSS was classified according to the 2002 AECG. The frequency of sSS in non-arthritic psoriasis and PsA patients were compared. In addition, PsA patients were divided into two groups according to the presence and absence of sSS. PsA-specific characteristics in these two groups were compared. Results Of the 184 psoriasis patients who participated in the study, 112 had PsA, and 72 had psoriasis without arthritis. There was no significant age difference between non-arthritic psoriasis and PsA patients (48.3±11.9 and 49.4±13.5, respectively; p=0.59) Similarly, female to male ratio (rates (%): non-arthritic psoriasis: 43/29 (59.7/40.3) PsA: 82/30 (73/27), respectively; p= 0.08) and age of onset of psoriatic skin changes (mean (SD) of non-arthritic psoriasis: 30.3 ±10.9, PsA: 29.4 ±13.2, respectively; p=0.68) did not differ between non-arthritic psoriasis and PsA patients. sSS was more prevalent in PsA patients when compared with the non-arthritic psoriasis group (PsA: 20 (%17.9), non-arthritic psoriasis: 1 (%1.3), p<0.001). None of the patients had a previous diagnosis of sSS. Of the patients with sSS (n=20), 18 had salivary gland involvement detected in salivary gland scintigraphy, four Anti-Ro positivity, and three low unstimulated SFR. All PsA patients with sSS (sSS/PsA) had a positive Schirmer test. sSS/PsA patients were significantly more positive for ANA and had plantar fasciitis more frequently than PsA patients without sSS (Table 1). Although not statistically significant, the age of onset of joint involvement in sSS/PsA patients was higher and was treated less with biological therapy (Table 1). Conclusion Secondary Sjögren’s syndrome is part of the clinical picture in a substantial proportion of PsA patients and its absence in non-arthritic PsO implies that sSS is arthritis associated. Whether the type of arthritis in sSS/PsA patients has a pattern necessitates larger patient numbers. A higher rate of ANA positivity may suggest the role of B lymphocytes in the progression from PsO to PsA. References [1]Brandt et al, 1998 [2]Yamamoto T and Yokoyama A,1996. Table 1 - Comparison of PsA patients with and without sSS Presence of sSS n=20 Absence of sSS n=92 p Age mean (SD) 53.9 48.4 0.09 Female/Male ratio 18/2 61/27 0.08 Age of onset of skin involvements mean (SD) 30.6 29.4 0.74 Age of onset of joint involvements mean (SD) 42.6 37.4 0.09 Axial Involvement n (%) 6 (35.3) 25 (29.4) 0.77 Polyarthritis n (%) 4 (22.2) 11 (14.9) 0.29 Heel Enthesitis n (%) 5 (31.3) 12 (21.4) 0.19 Plantar Fasciitis n (%) 5 (31.3) 6 (9) 0.03 RF positivity n (%) 1 (7.7) 1 (1.9) 0.36 ANA positivity n (%) 10 (55.6) 12 (27.2) 0.04 Biological therapy ever n (%) 10 (50) 63 (72.4) 0.06 sSS: Secondary Sjögren’s syndrome, SD: Standard deviation, RF: Rheumatoid Factor, ANA: Anti-Nuclear Antibody, PsA: Psoriatic Arthritis Acknowledgements: NIL. Disclosure of Interests None Declared.