Sjögren’s and Lupus: New Insights on Remission

A recent study published in Frontiers in Immunology examined how systemic lupus erythematosus (SLE) overlapping with Sjögren’s disease affects long-term outcomes, especially the likelihood of reaching low disease activity or remission. Sjögren’s disease is the most common connective tissue disease to co-occur with SLE, appearing in roughly 6.5% to 14.5% of patients (as noted by the authors).

Using data from 626 adults in the Peking University First Hospital SLE cohort, followed for a median of 4.3 years, researchers found that 12.3% (77 patients) also had Sjögren’s disease. These patients were further categorized by immunological profile: anti-SSA positivity alone, combined anti-SSA/SSB positivity (“double-positive” Sjögren’s), and baseline hypergammaglobulinemia. Hypergammaglobulinemia refers to elevated IgG levels and often reflects high B-cell activity in autoimmune disease.

To fairly compare outcomes with SLE-only patients, the researchers used propensity score matching to adjust for key confounders, including age of onset, disease duration, organ involvement, serology, and baseline treatment. They then applied time-to-event modeling to assess how each Sjögren’s subtype influenced the likelihood of achieving lupus low disease activity state (LLDAS) or remission on treatment (RONT).

Overall, overlapping Sjögren’s disease was associated with a 24% higher likelihood of achieving LLDAS, meaning these patients were somewhat more likely to reach a stable low-activity state. However, it also significantly reduced the probability of achieving remission by 29% for clinical remission and 38% for complete remission, depending on the definition. This pattern was driven largely by challenges achieving normal serology (anti-dsDNA and complement), which is required for complete remission and was consistently harder for patients with overlap.

Subtype analysis revealed important differences. Patients with anti-SSA/SSB double positivity had the poorest remission outcomes, with up to a 50% reduction in the chance of achieving remission and a 35–36% reduction in achieving normal serology. Meanwhile, patients with baseline hypergammaglobulinemia showed a protective association: they were more likely to reach LLDAS and, in some analyses, more likely to reach clinical or complete remission. Anti-SSA single-positive Sjögren’s disease did not have a clear independent effect.

These findings reinforce that SLE patients with overlapping Sjögren’s disease are not a uniform group. Their immunological profiles meaningfully shape treatment trajectories. For clinicians, the authors note that double-positive (SSA/SSB) patients may require closer monitoring and potentially more intensive therapy. Conversely, patients with elevated IgG levels may respond more readily to treat-to-target strategies, though the biological reasons for this pattern require further study.

Citation

Zhang, H., Zhang, H., Gao, D., Ji, L., Hao, Y., & Zhang, Z. (2025). Impact of Sjögren’s disease and its immunological characteristics on reaching remission or low disease activity state in systemic lupus erythematosus patients: a propensity score-matched longitudinal study. Frontiers in immunology, 16, 1639252. https://doi.org/10.3389/fimmu.2025.1639252