Profiles of Sjögren’s syndrome in rheumatologic consultation in Guinea

Abstract

Background: Sjögren Syndrome (SS) is a chronic autoimmune epithelitis, characterised by lymphocytic infiltration of the exocrine glands, mainly lacrimal and salivary. It is the second autoimmune disease after Rheumatoid Arthritis (RA). This connectivitis has not been studied extensively in sub-Saharan Africa.
Objective: To determine the epidemiological, clinical, paraclinical and therapeutic characteristics of SS in Guinea.
Design: Descriptive cross-sectional study.
Methods: The study involved all hospitalised and/or consulted patients in the Rheumatology Department of the Ignace Deen National Hospital, Conakry, Guinea from 1st March 2019 to 31st August 2020. Patients with Sjogren’s syndrome meeting the 2002 AECG criteria were included in the study. Patients were divided according to the presence of primary Sjögren’s syndrome (SSp) or secondary Sjögren’s syndrome (SSs).
Results: Thirty-one patients recruited, who included 27 (87.1%) women, for a hospital prevalence of 3.9%. The middle age was 53.2 ± 14.6 years. The average diagnostic delay of SS was 6 ± 3.1 years. Clinic manifestations were dominated by ocular and oral sicca syndrome (100%), and arthralgia (77.4%). Neither renal involvement nor cutaneous vasculitis was noted in this study. However, one case of lymphomatous transformation was reported during regular follow-up. The immunological profile showed SSA-positive antibodies in 19.4% of cases and SSB-positive antibodies in 32.3% of cases. Schirmer’s test was positive in 15 (48.4% patients. Labial Salivary Gland Biopsy (LSGB) was contributive in 17 (54.8%) patients, of which eight were at stage 3 of Chisholm and Mason (25.8%) and nine were at stage 4 of Chisholm and Mason (29.0%). SSp was diagnosed in 38.7% of patients against 61.3% with SSs, mainly in a context of RA (78.9%). Therapeutically, all patients received hydroxychloroquine and 74.2% of patients were treated by methotrexate. The ESSPRI score at admission showed unbearable symptoms in most patients and the ESSDAI score showed moderate disease activity in 38.5% of cases.
Conclusion: Sjögren Syndrome (SS) was frequent in hospital consultations and dominated by secondary SS. More detailed studies would make it possible to better describe all aspects.

Key words: Sjögren syndrome, Connectivitis, ESSPRI, ESSDAI, Sub-Saharan Africa, Guinea