José Luis Andreu

To determine incidence of major adverse cardiovascular events (MACE: non-fatal myocardial infarction, non-fatal stroke, or cardiovascular death) in Sjögren’s disease (SjD); identify traditional and disease-specific factors associated with MACE; describe prevalence of cardiovascular risk factors (CVRFs); explore, descriptively, SCORE2-estimated risk by comparing predicted and observed events; estimate cardiovascular mortality; and assess association between MACE and all-cause mortality. Prospective, multicenter cohort study including 314 patients fulfilling 2002 AECG criteria for SjD, followed for median 9.5 years. Clinical, serological, and cardiovascular data were recorded. Factors associated with MACE were evaluated using multivariable logistic regression models. SCORE2 risk was calculated in patients with complete data, and expected events were compared with observed events. Cardiovascular mortality was expressed as crude rates per 1,000 patient-years. Seventeen patients (5.41%) developed MACE: 7 strokes (2.23%), 5 myocardial infarctions (1.59%), and 5 cardiovascular deaths (1.59%). Twelve additional non-MACE cardiovascular events were recorded. In a complete-case SCORE2 analysis including 130 patients, 5.74 events (4.41%) were predicted and 6 (4.62%) observed. In exploratory multivariable analysis, factors associated with MACE were age (OR 1.09), cryoglobulinemia (OR 10.42), and glucocorticoid use (OR 3.61). CVRFs were common, particularly dyslipidemia (33.1%) and hypertension (26.4%). Crude cardiovascular mortality rate was 1.8 per 1,000 patient-years. MACE was associated with higher all-cause mortality in a relative risk analysis (RR 3.49). MACE affected approximately 5% of patients and was associated with a threefold increase in all-cause mortality. Cryoglobulinemia and glucocorticoids were associated with MACE in multivariable analysis. In exploratory complete-case analysis, SCORE2 showed numerical concordance for atherosclerotic events but did not capture disease-specific risk. These findings support tailored cardiovascular risk assessment and prevention strategies in SjD.

Objective: To identify key clinical and therapeutic predictors of malignancy in a well‐characterized, multicenter Spanish cohort of patients with Sjögren's disease (SjD). Methods: A retrospective, cross‐sectional study was conducted using data from the SjögrenSER‐TRANS registry, a national cohort of 437 SjD patients from 33 Spanish hospitals who fulfilled the 2002 AECG classification criteria. Clinical, serological, and treatment‐related variables were systematically collected. Descriptive statistics were used to summarize demographic and clinical characteristics. Bivariate analysis (chi‐squared for categorical variables and t ‐tests for continuous variables) was performed to identify associations with malignancy ( p < 0.05), followed by multivariate logistic regression to determine independent predictors. Results: Malignancy was identified in 30 patients (6.86%), with gynecological cancers (30%) and lymphomas (23.3%) being the most common types. Independent predictors of malignancy included older age (OR 1.042, 95% CI 1.007–1.079), glandular inflammation (OR 2.888, 95% CI 1.281–6.512), and rituximab use (OR 3.959, 95% CI 1.461–10.730). Conclusion: This study underscores the role of older age, glandular inflammation, and rituximab use as key risk factors for malignancy in SjD. However, the association with rituximab should be interpreted with caution, as indication bias cannot be ruled out. These findings emphasize the need for improved risk stratification and targeted surveillance strategies to facilitate early detection and enhance malignancy management in clinical practice. Prospective studies are warranted to refine monitoring protocols and optimize patient outcomes.

We sincerely thank Coppi at al for their interest in our study, "Mortality in patients with Sjögren disease: a prospective cohort study identifying key predictors,"¹ and for their thoughtful remarks on the prognostic significance of cardiopulmonary complications in Sjögren disease (SjD).²

This study aimed to evaluate the standardized incidence ratios (SIRs) of non-Hodgkin lymphoma (NHL) in patients with Sjögren’s disease (SjD) compared to the general population. Additionally, it sought to identify independent predictors of lymphoma and estimate both the relative risk (RR) and the etiologic fraction in exposed individuals (EFE) to assess the contribution of lymphoma to mortality in this population. This observational, multicenter, prospective study was conducted using data from a well-characterized Spanish cohort of patients with SjD. SIRs were calculated using data from the National Cancer Registry, and independent predictors of lymphoma were identified through multivariate Cox regression models. The RR was employed to assess the impact of lymphoma on mortality. A total of 314 patients with SjD were followed for a median of 9.5 years (range: 9.2–9.9). Eleven patients (3.5%) developed NHL, resulting in an SIR of 15.36 (95% CI: 15.32–15.40) compared to the general population. Cryoglobulinemia was identified as the strongest independent predictor of lymphoma (HR: 11.07; 95% CI: 1.18–103.75).Patients with SjD face a markedly elevated risk of NHL, primarily driven by cryoglobulinemia. These findings underscore the need for vigilant risk stratification, early detection, and tailored interventions to reduce lymphoma-related mortality in this population. Future studies should validate these results in diverse cohorts and explore targeted therapeutic strategies.

Objective: We aimed to quantify the mortality risk in a large, well-characterized cohort of patients with Sjögren disease (SjD) and to identify independent predictors of mortality in this population.Methods: We included 314 patients diagnosed with SjD according to the 2002 American-European Consensus Group criteria from a prospective, multicenter SjögrenSER Prospective cohort. Detailed data on systemic manifestations, serological markers, disease activity, and mortality were collected after a median of 9.5 (IQR 9.2-9.9) years of follow-up. The primary outcome was overall mortality, and secondary analyses aimed to identify independent predictors of mortality using Cox proportional hazards models. Standardized mortality ratios were calculated by comparing the observed deaths in the SjD cohort to the expected deaths in an age- and sex-matched general population.Results: The study identified a 70% increased mortality risk in the SjD cohort compared to the general population, with a standard mortality ratio of 1.7. Infections (35.7%), malignancies (23.8%), and cardiovascular disease (CVD; 7.1%) were the most common causes of death. Multivariate analysis revealed that older age (HR 1.11/year, 95% CI 1.07-1.15), C4 hypocomplementemia (HR 3.75, 95% CI 1.55-9.06), elevated erythrocyte sedimentation rate (ESR; HR 1.01, 95% CI 1.00-1.03), history of heart failure (HR 4.24, 95% CI 1.02-17.58), and pulmonary involvement (HR 3.31, 95% CI 1.39-7.88) were independent predictors of mortality.Conclusion: This study found a significantly increased mortality risk in SjD, with infections, malignancies, and CVD as leading causes of death. Independent predictors of mortality include advanced age, C4 hypocomplementemia, elevated ESR, heart failure, and pulmonary involvement, underscoring the need for proactive, individualized management.

Background: Carpal Tunnel Syndrome (CTS) is a prevalent entrapment neuropathy that significantly impacts patients' quality of life. Traditional treatment modalities include local corticosteroid injections (I) and surgery (S), with varying degrees of efficacy reported in the literature. Despite numerous studies, the relative effectiveness of these treatments in routine clinical practice remains inadequately explored. Objective: To compare the effectiveness of local injections versus surgery in the treatment of CTS within a primary care context, emphasizing the outcomes in a real-world clinical setting. Methods: This prospective observational study included 160 naïve patients with idiopathic CTS treated in the 4th Sanitary Area of Madrid. Participants were allocated to receive either local injections of triamcinolone acetonide (I) or surgical treatment (S) based on patient-physician consensus. The primary outcomes measured were changes in the Visual Analogue Scale (VAS) for pain, Functional Status Scale, and Symptoms Severity Scale from baseline to 6 and 26 weeks post-treatment. Statistical significance was determined using Student's T-test and paired samples T-test. Results: At baseline, both groups were comparable in terms of demographic and clinical characteristics. By the 6-week follow-up, the I group demonstrated a significant reduction in pain VAS (56.2, CI 50.9–61.6, p<0.001), improved functional status (1.25, CI 1.08–1.43, p<0.001), and decreased symptoms severity (1.97, CI 1.79–2.16, p<0.001) compared to the S group. However, at the 26-week follow-up, there were no significant differences between the two groups in pain VAS reduction (I: 52.8, CI 46.1–59.4 vs. S: 46.3, CI 39.3–53.3, p=0.196), functional status improvement (I: 1.16, CI 0.95–1.36 vs. S: 1.24, CI 0.99–1.48, p=0.601), or symptoms severity decrease (I: 1.88, CI 1.64–2.13 vs. S: 1.96, CI 1.70–2.21, p=0.662). Conclusion: In the short term, local corticosteroid injections offer a significant advantage over surgery in alleviating the symptoms of CTS, as evidenced by improvements in pain, functional status, and symptoms severity. However, these differences diminish over time, with both treatments showing comparable effectiveness at 26 weeks. These findings highlight the importance of personalized treatment strategies in managing CTS and underscore the potential for early intervention in a primary care setting to effectively address this condition.