Objectives To analyze frequency and clinical determinants of SLN-US prescription in clinical practice; to explore patterns of nodal size/location and their clinical significance in Sjögren's syndrome (pSS)
Methods In this retrospective, single center study we included patients with a diagnosis of pSS, regularly followed at our University Hospital in the time frame 2010–2015. Demographic, clinical and serological data were recalled from clinical charts. Patients with lymphadenopathy secondary to infections, malignancy, NHLs were excluded from the study. Variables analyzed included: clinical determinants of SLN-US, number of US evaluation/time, frequency, size and nodal locations of the SLN (axillary, inguinal, cervical, supraclavicular, other).
Results We enrolled in this study 229 (224 F: 5M) patients with pSS (AECG 2002), mean age at diagnosis (DS) 49 yrs (14) and mean follow-up 5.6 yrs (6.6). All the patients included in the study underwent a SLN-US at least once in the time frame 2010–2015. Peripheral lymphoadenopathy was documented in 136/229 (59.4%) patients. The most common site for peripheral lymphadenopathy was the cervical region with the most affected LN groups at this level being the lateral – cervical lymph groups (55.5%). Inguinal LN were involved in the 11.4% of the cases and axillary LN in the 10.9%. In 29 (12.7%) patients, pSS affected simultaneously the LN groups located in several segments. On average, pSS patients underwent an US of SLN every 18 (12) months (mean (SD)) with a negative correlation between the frequency of SLN-US and the duration of follow-up (r=-0.742 p=0.000). Patients underwent a SLN-US either to characterize peripheral LN, palpable at physical examination, or as a routine screening test during the assessment of the disease activity in asymptomatic patients. On the basis of the SLN-US results we distinguished different patient groups: a) 26 patients with palpable LN and pathological SLN-US, b) 110 patients without palpable LN and subcentimer lymphadenopathy at SLN-US and c) 93 patients without palpable LN and normal SLN-US. Patients included in group a) were significantly younger at the diagnosis (p=0.003), more frequently male (p=0.001), had a significantly higher disease activity (p=0.001) and presented more often salivary gland swelling (p=0.007), low C3 levels (p=0.008), hypergammaglobulinemia (p=0.006), anti-Ro/SSA (p=0.000), anti-La/SSB (0.02), Rheumatoid Factor positivity (p=0.003) and cryoglobulins (p=0.02). No significant differences were detected when patients included in the group b) and c) were compared one to each other. No specific association was observed between LN location and disease related clinical and serological manifestations. However, patients with pathological LN located in several segments presented a significantly higher disease activity and a more complex serological profile (p<0.01).
Conclusions Peripheral lymphadenopathy is quite common in pSS patients. However, only patients with palpable lymphadenopathy at clinical examinations or LN located simultaneously in several segments presented a distinguished more severe phenotype. Subcentimer lymphadenopathy tends to remain stable over the time and does not seem to represent a poor prognosis factor in pSS patients.
Disclosure of Interest None declared