1383: Obesity in Primary Sjogren’s Disease

Background/Purpose: Obesity is an excessive fat accumulation that presents a risk to health. Little is known about the relationship between obesity and Sjögren’s disease (SjD). We evaluated the prevalence of obesity in a cohort of patients with primary SjD, as measured by anthropometric indices such as body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), as well as with a body composition variable, the fat mass index (FMI). We also assessed the association of obesity with clinical and serologic features, disease activity, damage, and symptoms (sicca/fatigue/pain).

Methods: We included 91 patients with SjD. We registered demographics, comorbidities, glandular/ extraglandular and serologic variables. We assessed the Schirmer-I test and non-stimulated salivary flow, and scored the cumulative ESSDAI, SSDDI and ESSPRI scores. We measured the body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR). We defined obesity as a BMI ≥30 kg/m². Central obesity was defined as WC >90 cm and >80 cm; or by a WHR >0.90 and >0.85, for men and women, respectively. All patients underwent bioimpedance analysis (BIA) to measure body fat mass index (FMI). An elevated/high FMI according to BIA definitions was classified as obese (≥9.3 kg/m² for women and ≥6.2 kg/m² for men).

Results: 97.8% were women with a mean age of 54.4±12.8 years, and a median disease duration of 10 years. The prevalence of obesity was 19.7%, 52.7%, 52.7% and 40.6%, according to the BMI, WC, WH, and FMI, respectively. When we compared obese vs non-obese patients according to BMI, the first group had a higher prevalence of anti-Ro/SSA antibodies (90.4% vs 66.7%), and were more likely to have hypertension (25% vs 6.7%).

When we compared obese vs non-obese patients according to their WC, the obese group had a longer disease duration (13 vs 9 years) and a higher cumulative ESSDAI score (12 vs 6.5 points). They were also more likely to have parotid gland enlargement (58.1% vs 34.5%), and higher globulin levels (3.9 vs 3.5 g/dL). In logistic regression analysis, the variables that remained associated with obesity were disease duration (OR 1.06 95% CI 0.99-1.1, p=0.05) and the SSDDI score (OR 1.36, 95% CI 1.04-1.7, p=0.02). A similar finding was observed when we compared obese patients according to the WHR with their counterpart (SSDDI score OR 1.31, 95% CI 1.01-1.69, p=0.03)

Patients with obesity according to the FMI were more likely to have parotid gland enlargement (54.1% vs. 31.4%), neurologic involvement (35.1 vs 13.5%), higher cumulative ESSDAI scores (11 vs 7 points) , higher SSDDI scores ( 3 vs 2 points), and higher globulin levels (3.8 vs 3.6 g/dL). These patients were also more likely to have hypertension (24.3% vs 9.3%). In the logistic regression analysis, the variable that was again associated with obesity was the SSDDI score (OR 1.50, 95% CI 1.1-1.9, p=0.005).

Conclusion: According to BMI, at least 20% of patients were obese, this prevalence increased to 40% when BIA was used, with a higher prevalence found in central obesity. Obesity was associated with accrual damage. Our results may have implications for weight reduction in this patient group.