Abstract
Objective. To investigate whether temporal changes in immunoglobulin (Ig) levels and persistent hypergammaglobulinaemia cause glandular and extraglandular damage in patients with primary Sjögren's syndrome (pSS). Methods. Cumulative demographics and clinical and serological data from pSS patients in the Korean Initiative pSS cohort were evaluated. Persistent hypergammaglobulinaemia was defined as mean IgG levels of =1600 mg/ dL over 3 years. Salivary gland damage was assessed by measuring salivary flow impairment, and lacrimal gland damage was assessed by examining ocular structural abnormalities. Solid organ damage included neurological and pleuropulmonary damage, renal impairment and lymphoproliferative disease. Independent predictors of glandular and extra-glandular damage in the third year were identified by logistic regression. Results. Of 256 patients with pSS (median age, 55 years; 98% female), 47% had hypergammaglobulinaemia at baseline. IgG levels fell during the first 2 years in patients with hypergammaglobulinaemia at baseline, but not in those with normal IgG levels. Changes in IgG levels were associated with hydroxychloroquine and glucocorticoids. In the third year of follow-up, salivary flow impairment and solid organ damage were present in 71% and 9% of patients, respectively. After adjusting for age and medication use, persistent hypergammaglobulinaemia was associated with salivary flow impairment and solid organ damage in the third year. Patients in whom IgG fell by more than 80 mg/dL from baseline over 2 years showed less solid organ damage. Conclusion. Persistent hypergammaglobulinaemia was associated with salivary gland and solid organ damage. Decreased IgG may attenuate progression to solid organ dysfunction.
Original language | English |
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Pages (from-to) | S114-S122 |
Journal | Clinical and Experimental Rheumatology |
Volume | 39 |
Issue number | 6 |
State | Published - 2021 |
Bibliographical note
Funding Information:We thank the KISS cohort team for help with data management and preparation. Statistical consultation was supported by the Department of Biostatistics of the Catholic Research Coordinating Center.
Funding Information:
Funding: this work was supported by the Institute of Clinical Medical Research of Bucheon St. Mary’s Hospital Research Fund, 2021 (to J.H. Koh). The study sponsors played no role in the study design, data collection, analysis or interpretation, or in the writing of the manuscript or the decision to submit the manuscript for publication. Competing interests: none declared.
Publisher Copyright:
© Copyright Clinical and Experimental Rheumatology 2021.
Keywords
- Disease severity
- Immunoglobulins
- Salivary gland
- Sjögren's syndrome