More severe parotid gland histopathology in paediatric-onset than in adult-onset Sjögren’s disease

Author:

Legger Geertje ElizabethORCID,Nakshbandi UzmaORCID,van Ginkel Martha SORCID,Liefers Silvia C,de Wolff LisetteORCID,Stel Alja J,Armbrust Wineke,Spijkervet Fred K L,Vissink Arjan,Arends SuzanneORCID,Bootsma Hendrika,van der Vegt Bert,Verstappen Gwenny M,Kroese Frans G M

Abstract

ObjectivesThe aim of this study was to assess the histopathological features of the parotid glands in patients with paediatric-onset Sjögren’s disease (pedSjD) in comparison to patients with adult-onset Sjögren’s disease (adSjD).MethodsThis study was performed in Groningen, the Netherlands. Patients with pedSjD from a diagnostic paediatric cohort (n=19), patients with adSjD from a diagnostic adult cohort (n=32) and patients with adSjD who participated in a clinical trial (n=42) with a baseline parotid gland biopsy were included. Parotid gland biopsies were analysed after (immuno)histological staining for SjD-related histopathological markers and compared between groups.ResultsAll characteristic histopathological features of adSjD were also observed in pedSjD. There were no significant differences in lymphoepithelial lesions or immunoglobulin A (IgA)/IgG plasma cell shift between the pedSjD and the adSjD cohorts. However, compared with the diagnostic adSjD cohort (with comparable total EULAR Sjögren’s Syndrome Disease Activity Index (ESSDAI) scores), pedSjD showed more severe lymphocytic infiltration as reflected by a higher focus score (p=0.003), a higher relative surface area of CD45+ infiltrate (p=0.041), higher numbers of B and T lymphocytes/mm2(p=0.004 and p=0.029, respectively), a higher B/T lymphocyte ratio (p=0.013), higher numbers of CD21+ follicular dendritic cell networks/mm2(p=0.029) and germinal centres (GC)/mm2(p=0.002). Compared with the trial adSjD cohort, with significant higher total ESSDAI scores (p=0.001), only the B/T lymphocyte ratio and numbers of GC/mm2were significantly higher in the pedSjD cohort (p=0.023 and p=0.018, respectively).ConclusionPatients with pedSjD exhibit more pronounced histopathological features compared with patients with adSjD at diagnosis. Notably, the histopathology of patients with pedSjD aligns more closely with that observed in an adSjD clinical trial cohort, with even stronger B lymphocyte involvement.

Funder

ASAP-II

Dutch Research Council

Bristol-Myers Squibb

Publisher

BMJ

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