Sjoegren’s syndrome: are liver function tests more frequently altered in the presence of anti-Ro/SSA antibodies?


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A Master's thesis.
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Master (thesis) (master)
Sjoegren’s syndrome: are liver function tests more frequently altered in the presence of anti-Ro/SSA antibodies?
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Université de Lausanne, Faculté de biologie et médecine
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Background: Sjoegren's syndrome (SS) is a chronic autoimmune disease of insidious course with a wide variety of manifestations ranging from general signs with predominant involvement of the exocrine glands, with keratoconjunctivitis sicca and xerostomia, to overt systemic disease with damage to several organs. Antibodies to Ro/SSA can be detected in up to 70% of individuals and, although these antibodies are not specific for SS, their presence is most helpful for diagnosis. The latest classification for SS elaborated in 2016 by the American College of Rheumatology (ACR) and European League Against Rheumatism (EULAR) also relies on the documentation of chronic lymphocytic sialadenitis, most often obtained by biopsy of accessory salivary glands. The classification criteria also take into account signs and symptoms of SS other than dryness of eyes and mouth. The 2016 criteria have improved the diagnosis of SS in recent years, particularly in patients who are seronegative for anti-SSA antibodies and with systemic symptoms as first manifestation. SS often overlaps with other connective tissue diseases, such as systemic lupus erythematosus, rheumatoid arthritis, autoimmune thyroid disease and may present with other autoantibodies and rheumatoid factor (RF). Global disease activity in SS is best assessed by the ESSDAI score. Several studies underline the possibility of liver involvement in SS, with a reported prevalence of abnormal liver function tests (LFT) varying between 10-20% of patients. Hepatic involvement in SS is poorly characterized. Liver involvement does not feature in the ESSDAI, a global disease activity score commonly used in SS. We were interested in the prevalence of altered liver function tests (LFT) in SS at the time of diagnosis and whether this finding was associated with the expression of anti-Ro/SSA antibodies or not.
Methods: Retrospective single-center study in patients diagnosed with SS at the division of immunology and allergy Lausanne University Hospital between 2012 and 2019, after exclusion of known autoimmune liver disease.
Results: Of the 93 patients, 80 were female. Mean age at diagnosis was 51 years. LFT at the time of diagnosis were available in 57 patents and altered in 7. There was no association between altered LFT and seropositivity. Patients expressing anti-SSA antibodies had higher serum immunoglobulin levels, more active disease and had been diagnosed at a younger age.
Conclusions: LFT were normal in 88% of patients at the time of SS diagnosis. Altered LFT were not associated with antibodies to SSA and mostly attributed to non-immune causes. Liver biopsy was performed in only one patient and consistent with non-alcoholic steatohepatitis. Anti-SSA antibodies were associated with an earlier diagnosis, more active disease and hypergammaglobulinemia.
Sjogren’s syndrome, anti-Ro/SSA, liver, hypergammaglobulinemia
Create date
09/09/2021 9:21
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18/11/2022 7:42
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