Gender differences in patients with Sjögren’s syndrome: A 10-year single centre experience

Daniela Marasović Krstulović, Ivana Irma Lerotić, Dijana Perković, Katarina Borić, Dušanka Martinović Kaliterna

Objectives: The objective of this study was to examine the differences in clinical manifestations and comorbidities in men and women with Sjögren’s syndrome (SS) treated at the University Hospital Centre Split. Methods: The data were collected from outpatient clinics, inpatient facilities and the day hospital of the Department of Rheumatology and Clinical Immunology of the Department for Internal Medicine of the University Hospital Centre Split. By inspecting the protocol and archive of the medical history of the disease, we have collected various data such as the demographic characteristics and the accompanying clinical manifestations and comorbidities. The SPSS 20 software for Windows (IBM, New York, USA), χ2 test, Fisher’s test, Fisher-Freeman-Halton test, univariate logistic regression, Firth univariate logistic regression and multivariate logistic regression were used in the statistical analysis. Results: Out of a total of 317
patients with SS, there were 17 (5.4%) men and 300 (94.6%) women. The median age of the patients was 64 (min-max: 19–89 years of age, Q1- Q3: 54–2 years of age). We have obtained a statistically significantly higher chance of developing lung diseases, vasculitis and lymphoma in men, and a statistically significantly higher chance of developing hypothyroidism in women. By using the Fisher-Freeman-Halton test we have proved a statistically significant association of the younger age group with thrombocytopenia and APS. In multivariate logistic regression in which age and gender were taken as independent variables, we have confirmed the association of the primary SS (pSS) with the male gender and the younger age group. Conclusion: Our study showed that men with Sjögren’s disease had a higher incidence of lymphoma, vasculitis and lung involvement, while women had a higher incidence of hypothyroidism. Furthermore, thrombocytopenia and APS were more common in younger patients. In contrast, cardiovascular diseases, hypertension,
diabetes, dyslipidemia, osteoporosis, rheumatoid arthritis (RA ), systemic sclerosis (SSc) and secondary SS (sSS) were characteristically more common in elderly patients. Despite the fact that men are less likely to develop pSS, our research shows that at the time of diagnosis, male patients have a more serious form of the disease than women. Nevertheless, in order to draw precise conclusions on this issue, it is necessary to include the wider population in this research and perform its follow-up over a longer time period.

Cilj istraživanja: Cilj istraživanja bio je ispitati razlike u kliničkim manifestacijama i komorbiditetima između muškaraca i žena oboljelih od Sjögrenova sindroma (SS) liječenih u KBC-u Split. Materijali i metode: Podatci su prikupljeni iz ambulanta, stacionara i dnevne bolnice Zavoda za reumatologiju i kliničku imunologiju Klinike za unutarnje bolesti KBC-a Split. Iz arhive medicinske dokumentacije prikupljena su demografska obilježja te popratne kliničke manifestacije i komorbiditeti. U statističkoj analizi korišten je paket SPSS 20 for Windows (IBM, New York, SAD), χ2 test, Fisherov test, Fisher-Freeman-Haltonov test, univarijantna logistička regresija, Firth univarijantna logistička regresija i multivarijantna logistička regresija. Rezultati: Istraživanje je obuhvatilo 317 ispitanika s dijagnozom SS-a: 17 (5,4%) muškaraca i 300 (94,6%) žena. Medijan životne dobi ispitanika iznosio je 64 godine (min-maks: 19 – 89 god., Q1-Q3: 54 – 72 god.). Dobili smo statistički značajno veće izglede za nastanak plućnih bolesti, vaskulitisa i limfoma u muškaraca te statistički značajno veće izglede za pojavnost hipotireoze u žena. Fisher-Freeman-Haltonovim testom dokazali smo statistički značajnu povezanost mlađe dobne skupine s trombocitopenijom i antifosfolipidnim sindromom (APS). Multivarijantnom logističkom regresijom u kojoj smo kao nezavisne varijable uzeli dob i spol, potvrdili smo povezanost primarnog SS-a (pSS) s muškim spolom i mlađom dobnom skupinom. Zaključci: Istraživanje je pokazalo da je u muškaraca sa SS-om bila veća pojavnost limfoma, vaskulitisa i zahvaćenosti pluća, dok je u žena bila veća učestalost hipotireoze. Trombocitopenija i APS češće su se javljali u bolesnika mlađe životne dobi. Nasuprot tomu, kardiovaskularne bolesti, hipertenzija, šećerna bolest, dislipidemija, osteoporoza, reumatoidni artritis (RA ), sistemska skleroza (SSc) i sekundarni SS (sSS) karakteristično su bili češći u bolesnika starije životne dobi. Unatoč činjenici da su muškarci manje skloni razvoju pSS-a, naše istraživanje pokazuje da muškarci imaju veći izgled za ozbiljniji oblik bolesti naspram žena. Ipak, za preciznije zaključke potrebno bi bilo obuhvatiti širu populaciju i pratiti je tijekom duljeg razdoblja.