José Rosas

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: Sjögren disease (SjD) is a systemic autoimmune condition that frequently involves the salivary glands. Salivary gland ultrasound (SGUS) has emerged as a promising noninvasive tool, and the Outcome Measures in Rheumatology (OMERACT) group has proposed a standardized semiquantitative scoring system. The aim of this study was to evaluate the diagnostic accuracy of OMERACT SGUS in routine clinical practice, using the 2016 American College of Rheumatology/European Alliance of Associations for Rheumatology (ACR/EULAR) criteria as the gold standard for diagnosis, and to compare its performance with salivary flow and Schirmer test. Methods: A prospective study was conducted including 103 consecutive outpatients referred for dryness evaluation. Two blinded sonographers performed SGUS of parotid glands (PGs) and submandibular glands (SMGs), applying the OMERACT 0-3 scale. Positivity was defined as a score ≥ 2 in at least 1 gland. Results: Among 103 participants, 51 fulfilled the 2016 ACR/EULAR criteria. Overall, SGUS achieved sensitivity of 66.7% and specificity of 76.9%. PG analysis showed high specificity (92.3%) but lower sensitivity (49%), whereas SMGs demonstrated higher sensitivity (58.8%) but lower specificity (78.8%). Schirmer test and unstimulated whole salivary flow rate (UWSFR) showed sensitivities of 49% and 52.9%, respectively. Stimulated whole salivary flow rate had very high specificity (94.2%) but poor sensitivity (17.6%). In patients aged < 40 years, UWSFR sensitivity dropped markedly to 20% (vs age ≥ 40 years: 57.1%), whereas SGUS maintained stable performance. Conclusion: In real-world settings, SGUS using the OMERACT score demonstrates high specificity, particularly in PGs, and moderate sensitivity, outperforming UWSFR in younger patients. These findings support SGUS as a practical adjunct to established diagnostic tests and reinforce its potential role in refining the diagnostic workup of suspected SjD.

To assess the prevalence and persistence of self-reported depression and its associated factors in patients with systemic lupus erythematosus (SLE), using

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.

Introduction: Diffuse alveolar hemorrhage (DAH) is a rare complication with high mortality in patients with systemic lupus erythematosus (SLE). Early diagnosis and treatment are essential to improve patient prognosis. To determine the characteristics of patients with DAH and their mortality in a Spanish cohort of patients with SLE. Methods: Patients from the RELESSER (Spanish Society of Rheumatology Lupus Register) who had had at least one confirmed episode of DAH were included. Epidemiological, clinical, and laboratory characteristics were analyzed. Results: 4024 patients were included in the RELESSER register, 37 (0.9%), had at least one recorded episode of DAH. Only further data for 14 patients could be analyzed. In total, 92.9% were women, and for 4 (28.6%) DAH coincided with the debut of SLE. More than 80% of patients had renal involvement and thrombocytopenia. The most frequent manifestations were dyspnea (85.7%) and hypoxemia (100%), with the classic triad of hemoptysis, anemia and pulmonary infiltrates, appearing in 6 (46.2%) patients. The most frequently used treatments were glucocorticoids (85.7%) and cyclophosphamide (69.2%); plasmapheresis was utilized in 5 patients (35.7%) and 8, (57.1%) received intravenous immunoglobulins; 12 (85.7%) patients required admission to the ICU and 5 (35.7%) died. Tobacco use, history of lupus nephritis (LN), concomitant infection, and treatment with cyclophosphamide were more frequent in patients who died. Conclusions: DAH is rare in patients with SLE; in up to one-third of patients, it may appear at the onset of the disease. Some factors, such as smoking, a history of LN, treatment with cyclophosphamide, or concomitant infection, are more prevalent in patients with an unfavorable outcome.