Clinical Characterization of Autoimmune Hepatic Involvement in Sjogren’s Disease: A Retrospective Cohort Study in Korea
Abstract
1. Introduction
2. Results
2.1. Patient Characteristics and Comparison by Hepatic Involvement
2.2. Extraglandular Manifestations
2.3. Factors Associated with Hepatic Involvement: Univariable and Multivariable Analyses
2.4. Clinical Features by Subtype of Hepatic Involvement
3. Discussion
4. Materials and Methods
4.1. Study Design and Population
4.2. Definition of Autoimmune Hepatic Involvement
4.3. Data Collection
4.4. Statistical Analysis
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
SjD | Sjogren’s disease |
EGMs | Extraglandular manifestations |
PBC | Primary biliary cholangitis |
AIH | Autoimmune hepatitis |
AMA | Anti-mitochondrial antibody |
ASMA | Anti-smooth muscle antibody |
ACA | Anti-centromere antibody |
ANA | Antinuclear antibody |
ESSDAI | EULAR Sjögren’s Syndrome Disease Activity Index |
IFI-HEp-2 | Indirect immunofluorescence on HEp-2 cells |
OR | Odds ratio |
CI | Confidence interval |
ALT | Alanine aminotransferase |
gGTP | Gamma-glutamyl transpeptidase |
ALP | Alkaline phosphatase |
LKM1 | Liver-Kidney Microsomal type 1 |
UDCA | Ursodeoxycholic acid |
References
- Mariette, X.; Criswell, L.A. Primary Sjögren’s Syndrome. N. Engl. J. Med. 2018, 378, 931–939. [Google Scholar] [CrossRef] [PubMed]
- Kwon, E.J.; Park, Y.; Kwok, S.K.; Ju, J.H. Clinical characteristics of chronic sclerosing sialadenitis as a distinctive entity from primary Sjögren’s syndrome. J. Rheum. Dis. 2024, 31, 230–243. [Google Scholar] [CrossRef]
- Brito-Zerón, P.; Baldini, C.; Bootsma, H.; Bowman, S.J.; Jonsson, R.; Mariette, X.; Sivils, K.; Theander, E.; Tzioufas, A.; Ramos-Casals, M. Sjögren syndrome. Nat. Rev. Dis. Primers 2016, 2, 16047. [Google Scholar] [CrossRef]
- Trevisani, V.F.M.; Pugliesi, A.; Pasoto, S.G.; Lopes, M.L.L.; Guedes, L.K.N.; Miyamoto, S.T.; Fernandes, M.; Fialho, S.; Pinheiro, A.C.; Dos Santos, L.C.; et al. Recommendations for evaluation and diagnosis of extra-glandular manifestations of primary sjogren syndrome: Results of an epidemiologic systematic review/meta-analysis and a consensus guideline from the Brazilian Society of Rheumatology (articular, pulmonary and renal). Adv. Rheumatol. 2022, 62, 18. [Google Scholar] [PubMed]
- Zeron, P.B.; Retamozo, S.; Bové, A.; Kostov, B.A.; Sisó, A.; Ramos-Casals, M. Diagnosis of Liver Involvement in Primary Sjögren Syndrome. J. Clin. Transl. Hepatol. 2013, 1, 94–102. [Google Scholar]
- Ramos-Casals, M.; Sánchez-Tapias, J.M.; Parés, A.; Forns, X.; Brito-Zerón, P.; Nardi, N.; Vazquez, P.; Vélez, D.; Arias, I.; Bové, A.; et al. Characterization and differentiation of autoimmune versus viral liver involvement in patients with Sjögren’s syndrome. J. Rheumatol. 2006, 33, 1593–1599. [Google Scholar] [PubMed]
- Lindgren, S.; Manthorpe, R.; Eriksson, S. Autoimmune liver disease in patients with primary Sjögren’s syndrome. J. Hepatol. 1994, 20, 354–358. [Google Scholar] [CrossRef]
- Kaplan, M.J.; Ike, R.W. The liver is a common non-exocrine target in primary Sjögren’s syndrome: A retrospective review. BMC Gastroenterol. 2002, 2, 21. [Google Scholar] [CrossRef]
- Montaño-Loza, A.J.; Crispín-Acuña, J.C.; Remes-Troche, J.M.; Uribe, M. Abnormal hepatic biochemistries and clinical liver disease in patients with primary Sjögren’s syndrome. Ann. Hepatol. 2007, 6, 150–155. [Google Scholar] [CrossRef]
- Seror, R.; Bowman, S.J.; Brito-Zeron, P.; Theander, E.; Bootsma, H.; Tzioufas, A.; Gottenberg, J.E.; Ramos-Casals, M.; Dörner, T.; Ravaud, P.; et al. EULAR Sjögren’s syndrome disease activity index (ESSDAI): A user guide. RMD Open 2015, 1, e000022. [Google Scholar] [CrossRef]
- Jeong, S.H. Current epidemiology and clinical characteristics of autoimmune liver diseases in South Korea. Clin. Mol. Hepatol. 2018, 24, 10–19. [Google Scholar] [CrossRef] [PubMed]
- Hennes, E.M.; Zeniya, M.; Czaja, A.J.; Parés, A.; Dalekos, G.N.; Krawitt, E.L.; Bittencourt, P.L.; Porta, G.; Boberg, K.M.; Hofer, H.; et al. Simplified criteria for the diagnosis of autoimmune hepatitis. Hepatology 2008, 48, 169–176. [Google Scholar] [CrossRef]
- Liberal, R.; Grant, C.R.; Sakkas, L.; Bizzaro, N.; Bogdanos, D.P. Diagnostic and clinical significance of anti-centromere antibodies in primary biliary cirrhosis. Clin. Res. Hepatol. Gastroenterol. 2013, 37, 572–585. [Google Scholar] [CrossRef]
- Cancado, E.L.; Harriz, M. The Importance of Autoantibody Detection in Primary Biliary Cirrhosis. Front. Immunol. 2015, 6, 309. [Google Scholar] [CrossRef] [PubMed]
- Al-Handola, R.; Chinnappan, J.; Hussain, M.; Mahgoub, A.; Bachuwa, G. Antimitochondrial Antibody-Negative Primary Biliary Cholangitis: A Retrospective Diagnosis. Cureus 2023, 15, e36309. [Google Scholar] [CrossRef]
- Park, Y.; Lee, J.; Koh, J.H.; Choe, J.Y.; Sung, Y.K.; Lee, S.S.; Kim, J.M.; Park, S.H.; Kwok, S.K. Clinical influences of anticentromere antibody on primary Sjögren’s syndrome in a prospective Korean cohort. Korean J. Intern. Med. 2021, 36, 1492–1503. [Google Scholar] [CrossRef]
- Trevisani, V.F.M.; Pinheiro, A.C.; de Magalhães Souza Fialho, S.C.; Fernandes, M.; Pugliesi, A.; Pasoto, S.G.; Lopes, M.L.L.; Guedes, L.K.N.; Miyamoto, S.T.; Dos Santos, L.C.; et al. Recommendations for evaluation and diagnosis of extra-glandular manifestations of primary Sjögren syndrome: Results of an epidemiologic systematic review/meta-analysis and a consensus guideline from the Brazilian society of rheumatology (hepatic, gastrointestinal and pancreatic). Adv. Rheumatol. 2022, 62, 35. [Google Scholar]
- European Association for the Study of the Liver. EASL Clinical Practice Guidelines: Management of cholestatic liver diseases. J. Hepatol. 2009, 51, 237–267. [Google Scholar] [CrossRef] [PubMed]
- Lindor, K.D.; Gershwin, M.E.; Poupon, R.; Kaplan, M.; Bergasa, N.V.; Heathcote, E.J. Primary biliary cirrhosis. Hepatology 2009, 50, 291–308. [Google Scholar] [CrossRef]
- Shiboski, C.H.; Shiboski, S.C.; Seror, R.; Criswell, L.A.; Labetoulle, M.; Lietman, T.M.; Rasmussen, A.; Scofield, H.; Vitali, C.; Bowman, S.J.; et al. 2016 American College of Rheumatology/European League Against Rheumatism Classification Criteria for Primary Sjögren’s Syndrome: A Consensus and Data-Driven Methodology Involving Three International Patient Cohorts. Arthritis Rheumatol. 2017, 69, 35–45. [Google Scholar] [CrossRef]
- Caraba, A.; Roman, D.; Crișan, V.; Iurciuc, S.; Iurciuc, M. Salivary Flow Rate in Patients with Sjögren’s Syndrome: Correlations with Salivary Gland Ultrasound Findings and Biomarkers of Disease Activity. Int. J. Mol. Sci. 2024, 26, 101. [Google Scholar] [CrossRef] [PubMed]
Overall, n = 1119 | With Hepatic Involvement, n = 51 | Without Hepatic Involvement, n = 1068 | p Value | |
---|---|---|---|---|
Age at diagnosis, years | 51 (41–59) | 55 (50–62) | 51 (41–58) | 0.003 |
Sex, female | 1097 (98.0) | 50 (98.0) | 1047 (98.0) | >0.999 |
Body mass index, kg/m2 | 21.7 (19.8–23.2) | 21.8 (20.8–23.5) | 21.8 (20.1–23.4) | 0.342 |
Dry eyes | 971 (86.8) | 41 (80.4) | 935 (87.5) | 0.200 |
Dry mouth | 995 (88.9) | 46 (90.2) | 953 (89.2) | 0.988 |
Focus score | 2 (1–4) | 2 (2–2) | 2 (2–2) | 0.836 |
ESSDAI total score | 2 (1–5) | 2 (1–5) | 3 (1–6) | 0.692 |
Leukopenia | 288 (25.7) | 11 (21.6) | 277 (25.9) | 0.594 |
Anemia | 208 (18.6) | 10 (19.6) | 198 (18.5) | 0.994 |
Thrombocytopenia | 81 (7.2) | 11 (21.6) | 70 (6.6) | <0.001 |
IFI-HEp-2 positivity | 1041 (93.0) | 51 (100) | 990 (92.7) | 0.085 |
IFI-HEp-2 titer | 400 (200–1280) | 800 (400–2560) | 400 (200–800) | <0.001 |
High IFI-HEp-2 titer (>1:640) | 490 (43.8) | 36 (70.6) | 454 (42.5) | <0.001 |
Anti-Ro antibody positivity | 882 (78.8) | 38 (74.5) | 851 (79.7) | 0.474 |
Anti-La antibody positivity | 359 (32.1) | 14 (27.5) | 345 (32.3) | 0.568 |
Anti-centromere antibody positivity | 100 (8.9) | 14 (27.5) | 86 (8.1) | <0.001 |
Rheumatoid factor positivity | 612 (54.7) | 26 (51.0) | 586 (54.9) | 0.688 |
Low C3 | 157 (14.0) | 3 (5.9) | 154 (14.4) | 0.383 |
Low C4 | 46 (4.1) | 2 (3.9) | 44 (4.1) | >0.999 |
Hypergammaglobulinemia | 400 (35.7) | 22 (43.1%) | 378 (35.4) | 0.328 |
Cryoglobulin | 5 (0.4) | 0 (0.0) | 5 (0.5) | >0.999 |
Overall, n = 1119 | With Hepatic Involvement, n = 51 | Without Hepatic Involvement, n = 1068 | p Value | |
---|---|---|---|---|
Arthralgia/arthritis | 472 (42.2) | 17 (33.3) | 455 (42.6) | 0.244 |
Raynaud’s phenomenon | 187 (16.7) | 9 (17.6) | 178 (16.7) | >0.999 |
Lymphadenopathy | 108 (9.7) | 4 (7.8) | 104 (9.7) | 0.838 |
Lymphoma | 9 (0.8) | 0 (0.0) | 9 (0.8) | >0.999 |
Splenomegaly | 3 (0.3) | 2 (3.9) | 1 (0.1) | <0.001 |
Pulmonary involvement | 76 (6.8) | 2 (3.9) | 74 (6.9) | 0.583 |
Cutaneous vasculitis | 102 (9.1) | 3 (5.9) | 99 (9.3) | 0.567 |
Myositis | 2 (0.2) | 1 (2.0) | 1 (0.1) | 0.165 |
Peripheral neuropathy | 46 (4.1) | 2 (3.9) | 44 (4.1) | >0.999 |
Central nervous system disease | 9 (0.8) | 1 (2.0) | 8 (0.7) | 0.885 |
Autoimmune thyroid disease | 128 (11.4) | 10 (19.6) | 118 (11.0) | 0.099 |
Kidney involvement | 21 (1.9) | 1 (2.0) | 20 (1.9) | >0.999 |
Univariable OR (95% CI) | p Value | Multivariable OR * (95% CI) | p Value | |
---|---|---|---|---|
Age at diagnosis | 1.03 (1.00–1.06) | 0.003 | 1.06 (0.98–1.15) | 0.144 |
Thrombocytopenia | 3.92 (200–8.08) | <0.001 | 2.27 (0.80–6.42) | 0.122 |
IFI-HEp-2 titer | 1.00 (1.00–1.00) | <0.001 | 1.00 (1.00–1.00) | 0.031 |
High IFI-HEp-2 titer | 3.25 (1.74–5.84) | <0.001 | 1.37 (0.55–3.42) | 0.504 |
Anti-centromere antibody positivity | 4.39 (2.30–8.37) | <0.001 | 2.58 (1.22–5.42) | 0.012 |
Splenomegaly | 35.94 (4.65–277.60) | <0.001 | 31.19 (2.36–411.34) | 0.008 |
PBC, n = 14 | AIH, n = 33 | Combined, n = 4 | |
---|---|---|---|
Age at diagnosis of liver involvement, years | 56 (51–64) | 60 (51–64) | 55 (46–58) |
Diagnosis of liver involvement | |||
Simultaneously | 3 (21.4) | 3 (9.1) | 0 (0.0) |
Prior to SjD | 5 (35.7) | 16 (48.5) | 4 (100.0) |
After SjD | 6 (42.9) | 14 (42.4) | 0 (0.0) |
Time to liver involvement after SjD diagnosis, months | 2 (0–10) | 8 (1–50) | |
ALT elevation | 5 (35.7) | 22 (66.7) | 2 (50.0) |
ALP elevation | 5 (35.7) | 15 (45.5) | 2 (50.0) |
gGTP elevation | 7 (50.0) | 21 (63.6) | 4 (100.0) |
Dominant IFI-HEp-2 pattern | |||
Speckled | 5 (35.7) | 17 (51.5) | 1 (25.0) |
Cytoplasmic | 4 (28.6) | 5 (15.2) | 1 (25.0) |
Centromere | 5 (35.7) | 8 (24.2) | 2 (50.0) |
Homogeneous | 0 (0.0) | 3 (9.1) | 0 (0.0) |
Anti-mitochondrial antibody positivity | 10 (71.4) | 5/32 (15.6) | 4 (100.0) |
Anti-LKM1 antibody positivity | 0/8 (0.0) | 0/19 (0.0) | 0/3 (0.0) |
Anti-smooth muscle antibody positivity | 0/9 (0.0) | 4/26 (15.4) | 0 (0.0) |
ANCA positivity | 1/11 (9.1) | 6/28 (21.4) | 0 (0.0) |
Anti-centromere antibody positivity | 6 (42.9) | 6/29 (20.7) | 2/3 (66.7) |
Treatment | |||
Steroid and/or immunosuppressants | 1 (7.1) | 13 (39.4) | 0 (0.0) |
Hepatoprotective agents * | 12 (85.7) | 31 (93.9) | 4 (100.0) |
Response, resolution | 1/1 (100.0) | 12/13 (92.3) | |
Fibrosis | 3 (23.1) | 5 (15.2) | 0 (0.0) |
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Park, Y.; Lee, J.J.; Ju, J.H.; Kim, W.-U.; Park, S.-H.; Kwok, S.-K. Clinical Characterization of Autoimmune Hepatic Involvement in Sjogren’s Disease: A Retrospective Cohort Study in Korea. Int. J. Mol. Sci. 2025, 26, 5734. https://doi.org/10.3390/ijms26125734
Park Y, Lee JJ, Ju JH, Kim W-U, Park S-H, Kwok S-K. Clinical Characterization of Autoimmune Hepatic Involvement in Sjogren’s Disease: A Retrospective Cohort Study in Korea. International Journal of Molecular Sciences. 2025; 26(12):5734. https://doi.org/10.3390/ijms26125734
Chicago/Turabian StylePark, Youngjae, Jennifer Jooha Lee, Ji Hyeon Ju, Wan-Uk Kim, Sung-Hwan Park, and Seung-Ki Kwok. 2025. "Clinical Characterization of Autoimmune Hepatic Involvement in Sjogren’s Disease: A Retrospective Cohort Study in Korea" International Journal of Molecular Sciences 26, no. 12: 5734. https://doi.org/10.3390/ijms26125734
APA StylePark, Y., Lee, J. J., Ju, J. H., Kim, W.-U., Park, S.-H., & Kwok, S.-K. (2025). Clinical Characterization of Autoimmune Hepatic Involvement in Sjogren’s Disease: A Retrospective Cohort Study in Korea. International Journal of Molecular Sciences, 26(12), 5734. https://doi.org/10.3390/ijms26125734