PO:24:061 | Allodynia is highly prevalent in patients with Sjögren’s disease and correlates with immunobiological disease markers: preliminary results from the sjnapse project

Flavia Riccio¹, Maria Chiara Visconti¹, Corrado Parlati¹, Nicola Della Rossa¹, Sabrina Marrone¹, Enrico Tirri², Francesco Ciccia¹, Saviana Gandolfo² | ¹UOC di Reumatologia, Università degli Studi della Campania Luigi Vanvitelli, Napoli; ²UO di Reumatologia, Ospedale del Mare, Napoli, Italy

Background. Neurological involvement in Sjögren’s disease (SjD) is frequently underdiagnosed due to the extreme variability and heterogeneity of clinical manifestations, the lack of standardized diagnostic criteria, and the absence of anti-SSA/anti-SSB autoantibodies in a substantial proportion of patients. The SjNAPSE Project (Sjögren’s Neuroinflammation Assessment, Pain, and Symptoms Evaluation) is a prospective, multicenter study designed to investigate neurological involvement in patients with SjD without a previous diagnosis of neuro-Sjögren and in the absence of comorbidities that could account for neurological manifestations.

Materials and Methods. A total of 100 patients (95 females, 95%) fulfilling the 2016 ACR/EULAR classification criteria for SjD were consecutively enrolled. All participants completed the following questionnaires: Neuropathic Pain Symptom Inventory (NPSI), Patient Health Questionnaire-9 (PHQ-9), PainDetect Questionnaire (PD-Q), VAS pain, VAS fatigue, and VAS sicca. Sensory assessments for allodynia were performed according to the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS), administered by the same examiner in each participating center. Patients who did not report pain or presented neurological involvement attributable to other known conditions were excluded.

Results. Sixty-five patients (63 females, 96.92%) met the inclusion criteria. Among these, 40 patients (61.53%) tested positive for allodynia. The presence of allodynia showed a positive correlation with the scores of all administered questionnaires. Moreover, significant correlations were found between allodynia and rheumatoid factor (r = 0.85; p = 0.032), focus score (r = 0.47; p = 0.02), VAS pain (r = 0.64; p < 0.001), VAS fatigue (r = 0.55; p < 0.001), and ESSPRI (r = 0.50; p < 0.001). No significant correlation was observed with ESSDAI, although a positive trend was noted. An inverse trend was also observed between the presence of allodynia and anti-SSA antibody positivity. Only 5 patients (7.69%) with allodynia fulfilled the diagnostic criteria for concomitant fibromyalgia.

Conclusions. According to the preliminary clinical results of the SjNAPSE Project, the presence of allodynia, objectively confirmed by sensory testing, is highly prevalent among patients with SjD and shows a positive correlation with multiple patient-reported symptom measures, including neuropathic pain, fatigue, depression, and anxiety. The correlation between allodynia and disease activity markers such as focus score and rheumatoid factor suggests a complex pathogenic substrate underlying patient-reported symptoms, warranting further investigation. Future aims include expanding the patient cohort and identifying potential biomarkers of neurological involvement to improve diagnostic accuracy.