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Arthritis Res Ther. 2017 Oct 24;19(1):237. doi: 10.1186/s13075-017-1446-2.

Severe intestinal dysbiosis is prevalent in primary Sjögren's syndrome and is associated with systemic disease activity.

Author information

1
Section of Rheumatology, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden. Thomas.mandl@med.lu.se.
2
Department of Rheumatology, Skane University Hospital Malmö, Inga Marie Nilssons gata 32, S-205 02, Malmö, Sweden. Thomas.mandl@med.lu.se.
3
Department of Gastroenterology, Skane University Hospital, Lund, Sweden.
4
Immunology Section, Department of Experimental Medical Science, Lund University, Lund, Sweden.
5
Section of Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
6
Section of Rheumatology, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
7
Section of Internal Medicine, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
8
Section of Rheumatology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.

Abstract

BACKGROUND:

Altered microbial composition of the intestine, commonly referred to as dysbiosis, has been associated with several autoimmune diseases including primary Sjögren's syndrome (pSS). The aims of the current study were to study the intestinal microbial balance in pSS and to identify clinical features associated with dysbiosis.

METHODS:

Forty-two consecutive pSS patients and 35 age-matched and sex-matched control subjects were included in the study in an open clinic setting. Stool samples were analyzed for intestinal dysbiosis using a validated 16S rRNA-based microbiota test (GA-map™ Dysbiosis Test; Genetic Analysis, Oslo, Norway). Dysbiosis and severe dysbiosis were defined in accordance with the manufacturer's instructions. Patients were evaluated with regard to disease activity (European League Against Rheumatism (EULAR) Sjögren's Syndrome Disease Activity Index (ESSDAI) and Clinical ESSDAI (ClinESSDAI)). In addition, patients were examined for laboratory and serological features of pSS as well as fecal calprotectin levels. Furthermore, patients were investigated regarding patient-reported outcomes for pSS (EULAR Sjögren's Syndrome Patient Reported Index (ESSPRI)) and irritable bowel syndrome (IBS)-like symptoms according to the Rome III criteria.

RESULTS:

Severe dysbiosis was more prevalent in pSS patients in comparison to controls (21 vs 3%; p = 0.018). Subjects with pSS and severe dysbiosis had higher disease activity as evaluated by the ESSDAI total score (13 vs 5; p = 0.049) and the ClinESSDAI total score (12 vs 5; p = 0.049), lower levels of complement component 4 (0.11 vs 0.17 g/L; p = 0.004), as well as higher levels of fecal calprotectin (110 vs 33 μg/g; p = 0.001) compared to the other pSS patients. In contrast, severe dysbiosis among pSS patients was not associated with disease duration, IBS-like symptoms, or the ESSPRI total score.

CONCLUSIONS:

Severe intestinal dysbiosis is a prevalent finding in pSS and is associated both with clinical and laboratory markers of systemic disease activity as well as gastrointestinal inflammation. Further studies are warranted to elucidate a potential causative link between dysbiosis and pSS.

KEYWORDS:

Disease activity; Dysbiosis; Gastrointestinal; Microbiome; Primary Sjögren’s syndrome

PMID:
29065905
PMCID:
PMC5655865
DOI:
10.1186/s13075-017-1446-2
[Indexed for MEDLINE]
Free PMC Article

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