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  • In primary Sjögren's syndrome high absolute numbers and proportions of B cells in parotid glands predict responsiveness to rituximab as defined by ESSDAI, but not by SSRI

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In primary Sjögren's syndrome high absolute numbers and proportions of B cells in parotid glands predict responsiveness to rituximab as defined by ESSDAI, but not by SSRI
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  1. Konstantina Delli1,
  2. Erlin A Haacke2,3,
  3. Frans GM Kroese2,
  4. Rodney P Pollard1,
  5. Stephan Ihrler4,
  6. Bert van der Vegt3,
  7. Arjan Vissink1,
  8. Hendrika Bootsma2,
  9. Frederik KL Spijkervet1
  1. 1Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
  2. 2Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
  3. 3Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
  4. 4Laboratory for Dermatohistology and Oral Pathology, Munich, Germany
  1. Correspondence to Dr Konstantina Delli, Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen 9713 GZ, The Netherlands; k.delli{at}umcg.nl

http://dx.doi.org/10.1136/annrheumdis-2016-209317

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    With great interest we have read the letter to the editor by Cornec et al1 regarding our paper ‘Towards personalised treatment in primary Sjögren's syndrome (pSS): baseline parotid histopathology predicts responsiveness to rituximab treatment’.2 In essence, we showed in our paper that absolute numbers of CD20+ cells/mm2 of parenchyma of parotid gland tissue are predictive for the responsiveness of patients with pSS to rituximab (RTX) treatment. Cornec et al argue that there is a discrepancy in outcomes presented in their study and our study,1 as they observed that a high proportion of minor salivary gland B cells predict the absence of a clinical response to RTX.3 As we will show and explain here, there is no inconsistency between the two studies and most of the apparent discrepancy is likely the result of differences in how the tissues are analysed and how the disease activity is established.

    Absolute numbers versus proportions of B cells and technique applied

    A major difference in the two studies is how B cells are assessed in tissue sections of salivary gland biopsies of patients with pSS before (and after) RTX treatment. We measured absolute numbers of CD20+ B cells/mm2 of parenchyma, while Cornec et al assessed the proportion of B cells.1 ,3 Obviously, even when there is a change in absolute numbers of B cells in the tissue, the B/T cell ratio still can remain the same. Thus, although higher numbers of B cells, do not need to be reflected per se in higher proportions of B cells, we also found in our study that patients with higher absolute numbers of B cells in the glandular tissue, had a higher B/B+T cell ratio. Furthermore, responders to RTX, as defined by a decrease in European League Against …

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