Extraglandular ocular involvement and morbidity and mortality in primary Sjögren's Syndrome

PLoS One. 2020 Sep 25;15(9):e0239769. doi: 10.1371/journal.pone.0239769. eCollection 2020.

Abstract

Purpose: To report the significance of extraglandular ocular involvement and long-term systemic morbidity and mortality in primary Sjögren's Syndrome (SS).

Methods: This retrospective, longitudinal cohort study included consecutive patients with primary SS evaluated at a tertiary referral center. An electronic chart review was performed and all available data were extracted from clinic visits between October 1999 and March 2019. The primary outcome measures included occurrence of extraglandular ocular manifestations of SS, serological markers, prevalence of malignancy, and incidence of death.

Results: One hundred and twenty-six SS patients with minimum 3 years of follow-up (median 9.6, range 3.0-15.9 years, total of 1,235 patient-years) were included. Of those, 10 patients with inflammatory keratolysis or scleritis had 2.3 times greater likelihood of death compared to the rest of the cohort (OR = 2.3, 95% confidence interval [CI] 0.5 to 4.0, p = 0.01) due to SS related complications. The lifetime prevalence of any malignancy in the entire cohort was 15.5%. The most common hematologic malignancy was non-Hodgkin's lymphoma (4.8%) and the most common solid malignancy was breast cancer (6.0%). Men SS patients were more likely to have a history of or concurrent malignancy compared to women (30.0% versus 13.7%, p = 0.16) and double the mortality (OR = 2.1, 95% CI 0.09 to 1.4, p = 0.04), independent of malignancy.

Conclusions: SS patients with serious ocular manifestations, particularly men, may be at greater risk for mortality due to SS complications. The eye seems to be the barometer of systemic disease activity.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Breast Neoplasms / epidemiology*
  • Eye Diseases / epidemiology*
  • Female
  • Humans
  • Lymphoma, Non-Hodgkin / epidemiology*
  • Male
  • Middle Aged
  • Sjogren's Syndrome / complications*
  • Sjogren's Syndrome / epidemiology
  • Sjogren's Syndrome / mortality

Grants and funding

This study was supported in part by one unrestricted grant provided by the Jerome L. Greene Foundation to EKA. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. There was no additional external funding received for this study.