Sjögren’s Syndrome: The Clinical Spectrum of Male Patients
Loukas Chatzis, Vasileios C. Pezoulas, Francesco Ferro, Saviana Gandolfo, Valentina Donati, Marco Binutti, Sara Zandonella Callegher, Aliki I. Venetsanopoulou, Evangelia Zampeli, Maria Mavrommati, Ourania D Argyropoulou, Giorgos D. Michalopoulos, Paraskevi V. Voulgari, Themis P. Exarchos, Chiara Baldini, Fotini N. Skopouli, Dimitrios I. Fotiadis, Salvatore De Vita, Haralampos Μ. Moutsopoulos, Athanasios G. Tzioufas, Andreas V. Goules
Abstract
Background: To compare the clinical, serological and histologic features between male and female patients with Sjögren’s syndrome (SS) and explore the potential effect of gender on lymphoma development. Methods: From a multicenter population (Universities of Udine, Pisa and Athens, Harokopion and Ioannina (UPAHI)) consisting of consecutive SS patients fulfilling the 2016 ACR/EULAR criteria, male patients were identified, matched and compared with female controls. Data-driven multivariable logistic regression analysis was applied to identify independent lymphoma-associated factors. Results: From 1987 consecutive SS patients, 96 males and 192 matched female controls were identified and compared. Males had a higher frequency of lymphoma compared to females (18% vs. 5.2%, OR = 3.89, 95% CI: 1.66 to 8.67; p = 0.0014) and an increased prevalence of serum anti-La/SSB antibodies (50% vs. 34%, OR = 1.953, 95% CI: 1.19 to 3.25; p = 0.0128). No differences were observed in the frequencies of lymphoma predictors between the two genders. Data-driven multivariable logistic regression analysis revealed negative association of the female gender with lymphoma and positive association with lymphadenopathy. Conclusion: Male SS patients carry an increased risk of lymphoma development. Although statistics showed no difference in classical lymphoma predictors compared to females, data-driven analysis revealed gender and lymphadenopathy as independent lymphoma-associated features.