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High Prevalence of Serum Metabolic Alterations in Primary Sjögren's Syndrome: Influence on Clinical and Immunological Expression MANUEL RAMOS-CASALS, PILAR BRITO-ZERÓN, ANTONI SISÓ, ALFONSO VARGAS, EMILI ROS, ALBERT BOVE, RAFAEL BELENGUER, JOAN PLAZA, JAUME BENAVENT, and JOSEP FONT ABSTRACT. Objective. To analyze the prevalence and clinical significance of associated metabolic alterations [dyslipidemia, diabetes mellitus (DM), and hyperuricemia] in a large series of unselected patients with primary Sjögren's syndrome (SS). Methods. We analyzed 254 consecutive patients with primary SS who had a complete analytical followup study for at least 5 consecutive years. The control group consisted of 254 age and sex-matched patients without systemic autoimmune diseases consecutively followed during the same period in a primary care center. Results. In comparison with controls, patients with primary SS showed a higher frequency of dyslipidemia (47% vs 33%; p = 0.002), DM (28% vs 18%; p = 0.006), and hyperuricemia (9% vs 4%; p = 0.007). The mean age at SS diagnosis was 10 years greater in patients with DM (p < 0.001) and hyperuricemia (p = 0.009). Hypercholesterolemia was associated with a lower frequency of immunological markers such as anti-Ro/SSA antibodies (p = 0.001), anti-La/SSB antibodies (p = 0.005), low C3 (p = 0.047), and low C4 levels (p = 0.030), while hypertriglyceridemia and DM were associated with a higher prevalence of extraglandular features, especially renal, liver, and vasculitic involvement. A higher prevalence of DM was found in patients treated with corticosteroids (40% vs 19%; p = 0.001). Conclusion. Patients with primary SS showed a higher prevalence of associated dyslipidemia, DM, and hyperuricemia in comparison with an age and sex-matched control group. Metabolic alterations were associated with a differentiated pattern of clinical and immunological SS expression, but not with SS-related therapies (except for the higher frequency of DM observed in patients treated with corticosteroids). (First Release Feb 15 2007; J Rheumatol 2007;34:754-61) Key Indexing Terms:
HYPERCHOLESTEROLEMIA From the Department of Autoimmune Diseases and the Lipid Unit; Department of Medicine, School of Medicine, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic; and Centre d'Assistència Primària ABS Les Corts, Barcelona, Spain. M. Ramos-Casals, MD, PhD; P. Brito-Zerón, MD, PhD; A. Vargas, MD; A. Bove, MD, PhD; R. Belenguer, MD, PhD; J. Plaza, MD, PhD; J. Font, MD, PhD, FRCP, Department of Autoimmune Diseases; E. Ros, MD, PhD, Lipid Unit, Department of Medicine, School of Medicine, University of Barcelona; A. Sisó, MD; J. Benavent, MD, Centre d'Assistència Primària ABS Les Corts. In memoriam, Dr. Josep Font (1953-2006). Address reprint requests to Dr. M. Ramos-Casals, Servei de Malalties Autoimmunes, Hospital Clínic, C/Villarroel, 170, 08036-Barcelona, Spain. E-mail: mramos@clinic.ub.es Accepted for publication December 22, 2006.
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