Prognostic Significance of Lymphocytic Foci Composition in Minor Salivary Gland Biopsies for Severe Disease Flare and Severity in Sjögren's Syndrome: a 3-year Follow-up Cohort Study

Overview

Journal Front Immunol

Specialty Allergy & Immunology

Date 2024 Mar 12

PMID 38469314

Authors

Hye-Sang Park

Laura Martinez-Martinez

Berta Magallares Lopez

Ivan Castellvi

Patricia Moya

Helena Codes-Mendez

Nerea Hernandez Sosa

Cesar Diaz-Torne

Ana Laiz

Luis Sainz

Jose Luis Tandaipan

Anais Mariscal

Teresa Franco-Leyva

Jordi Casademont

Candido Juarez

Hector Corominas

Affiliations

Soon will be listed here.

Abstract

Introduction: This was an ambispective cohort study evaluating the prognostic significance of lymphocytic foci and its lymphoid composition in minor salivary gland biopsy (MSGB) for short-term disease flare and severity in Sjögren's syndrome (SS).

Methods: The inclusion criteria comprised individuals meeting the ACR/EULAR 2016 criteria who underwent MSGB with an infiltration of more than 50 lymphocytes and received clinical diagnosis between September 2017 and December 2018. Patients with inadequate biopsy samples were excluded. The number of lymphocytic foci and their lymphoid composition in MSGB were assessed using immunofluorescence staining. Major organ damage and improvements in the EULAR Sjögren's Syndrome Disease Activity Index (ESSDAI) were measured. Statistical analyses, including Cox and linear regressions, were conducted.

Results: A total of 78 patients with at least one lymphocytic focus were included in the study. The presence of higher T-cell counts in lymphocytic foci in MSGB was associated with severe disease flare, and a logarithmic transformation of T-cell count indicated increased risk (HR 1.96, 95% CI 0.91-4.21). Improvements in the ESSDAI were associated with higher total lymphocyte count and T- and B-cell numbers in the lymphoid composition of the lymphocytic foci. Seropositive patients exhibited higher T CD4+ cell numbers. Correlation analysis showed negative associations between age and lymphocytic foci and the T-cell count. Positive correlations were observed between antinuclear antibody (ANA) titers and total lymphocyte numbers.

Discussion: Patients with a higher number of T cells in the lymphocytic infiltrates of lymphocytic foci may have a two-fold risk of severe disease flare. The number of B cells and T CD4+ cells in the lymphocytic infiltrates of lymphocytic foci showed a weak but positive relation with the ESSDAI improvement during follow-up. Age and seropositivity appeared to influence the lymphoid composition of the lymphocytic foci.

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