Background: Patients with primary Sjögren’s syndrome (pSS) are at elevated risk for cardiovascular (CV) and cerebrovascular (CVB) events [1]. However, data on diagnostic tools to effectively screen for CV and CVB risk in this group remain limited [2]. In the general population, surrogate markers have proven valuable in improving risk stratification, with several endorsed by the European Society of Cardiology (ESC) for clinical use [3]. Among these, aortic stiffness and carotid artery sonography stand out, supported by robust evidence of their predictive value in assessing both CV and CVB risks.

Objectives: This study aimed to evaluate, for the first time, a combined approach using oscillometric methods, greyscale, and novel color-Doppler ultrasound (US) indices to assess carotid and aortic damage in patients with pSS. Additionally, the study sought to explore associations between these imaging markers and patient characteristics, disease parameters, and traditional CV risk scores, including the SCORE and its EULAR-modified version (mSCORE).

Methods: Color-Doppler US indices, including resistance index (RI) and pulsatility index (PI), as well as greyscale atherosclerosis markers such as carotid intima-media thickness (cIMT), plaques, and cumulative calcification surface, were evaluated in the common (CCA) and internal (ICA) carotid arteries of pSS patients and healthy controls. Additionally, the gold-standard oscillometric marker of aortic stiffness, carotid-femoral pulse wave velocity (cfPWV), and the traditional SCORE/mSCORE were assessed.

Results: 119 pSS-patients and 97 controls were consecutively recruited. Patients exhibited significantly higher cfPWV ( p _adj =0.025 ), cIMT ( p _adj <0.001 ), and calcification area ( p=0.013 ), compared to controls. According to mSCORE, 5.7% of the patients had high CV risk. However, cfPWV and carotid-sonography revealed increased aortic stiffness in 45.4% and carotid atherosclerosis in 69.2% , respectively. Among pSS-patients, cfPWV correlated with C-reactive-protein ( rho=0.325, p<0.001 ), erythrocyte-sedimentation-rate ( rho=0.271 , p=0.003 ), and traditional CV-risk factors (age, cholesterol, systolic blood pressure: all; p<0.01 ). ICA-RI and ICA-PI were higher in patients with further (non-rheumatological) autoimmune diseases (both; p<0.05 ).

Conclusion: This study represents one of the most comprehensive investigations into CV surrogate markers in pSS. We found significantly higher aortic stiffness and carotid atherosclerosis in patients compared to controls. Furthermore, the mSCORE identified only a small proportion of pSS patients as high-risk, underscoring a significant discrepancy with the examined surrogate markers and with existing registry data. Importantly, we were able to identify key patient- and disease-related characteristics that serve as predictors of impaired CV/CVB surrogates in this population. Overall, the examined markers offer valuable insights into the patients‘ arterial tree and could help guide screening for vascular damage and CV/CVB risk in pSS.

Figure 1.

Distribution of surrogate marker values in control subjects and pSS patients. A. cfPWV; B. cIMT; C. calcification area. All; p<0.05* .

pSS: primary Sjogren´s Syndrome, cfPWV: carotid-femoral pulse wave velocity, cIMT: carotid intima media thickness.

REFERENCES: [1] Beltai A, et al. Cardiovascular Morbidity and Mortality in Primary Sjogren’s Syndrome: A Systematic Review and Meta-Analysis. Arthritis Care Res (Hoboken). 2020;72(1):131.

[2] Triantafyllias K, et al. Arterial Stiffness as a Surrogate Marker of Cardiovascular Disease and Atherosclerosis in Patients with Arthritides and Connective Tissue Diseases: A Literature Review. Diagnostics (Basel). 2023 May 26;13(11):1870.

[3] Triantafyllias K, et al. Possible misclassification of cardiovascular risk by SCORE in antisynthetase syndrome: results of the pilot multicenter study RI.CAR.D.A. Rheumatology (Oxford) 2021;60(3):1300-1312.

Acknowledgements: NIL.

Disclosure of Interests: Konstantinos Triantafyllias Chugai, Pfizer, BMS, Novartis, Janssen, UCB, Sanofi, Galapagos, GSK, Boehringer, Novartis, Janssen, Galapagos, Pfizer, Galapagos, Novartis, GSK, Mirjam Bach: None declared , Sebastian Boegel: None declared , Muthuraman Muthuraman: None declared , George K. Bertsias: None declared , Dimitrios Boumpas: None declared , Raoul Bergner: None declared , Markus Schepers: None declared , Andreas Schwarting: None declared .

© The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ). Neither EULAR nor the publisher make any representation as to the accuracy of the content. The authors are solely responsible for the content in their abstract including accuracy of the facts, statements, results, conclusion, citing resources etc.