title: Asymptomatic Atherosclerosis in Primary Sjögren Syndrome: Correlation Between Low Ankle Brachial Index and Autoantibodies Positivity.
abstract: BACKGROUND
  Primary Sjögren syndrome is a chronic inflammatory autoimmune disease. The delay in diagnosis allows the establishment of a chronic inflammatory state, which makes primary Sjögren syndrome an interesting model for the study of atherosclerosis.
  
  
  OBJECTIVE
  The aim of this study was to evaluate subclinical atherosclerosis in 49 patients with Sjögren syndrome using noninvasive methods.
  
  
  METHODS
  We assessed traditional risk factors such as hypertension, diabetes, dyslipidemia, smoking, and family history of atherosclerosis. Patients with prior cardiovascular events and a history of atherosclerosis were excluded. Clinical and laboratory features were recorded, as well as the European League Against Rheumatism Sjögren's Syndrome Activity Index calculation. The atherosclerosis evaluation was done by carotid intima-media thickness, measured by ultrasonography, and ankle-brachial index (ABI).
  
  
  RESULTS
  Fifteen patients (31%) had at least 1 traditional risk factor, and 65.3% had a European League Against Rheumatism Sjögren's Syndrome Activity Index score from mild to moderate. Only 2 patients had increased carotid intima-media thickness. However, 59% presented ABI alterations. Multiple correspondence analysis showed a clear correlation between low ABI and the positivity of autoantibodies (antinuclear antibodies, anti-SSA, rheumatoid factor).
  
  
  CONCLUSIONS
  The subgroup of patients with positive autoantibodies showed low ABI, which may represent a higher risk of early atherosclerosis and indicate the need for more careful monitoring in this group.
authors.affiliation: From the *Department of Medicine, Discipline of Health-Based Evidence, and †Department of Diagnostic Imaging, Universidade Federal de São Paulo; and ‡Universidade de Santo Amaro, São Paulo, Brazil.
authors.forename: Ana Beatriz Andrêo
authors.initials: AB
authors.lastname: Garcia
authors.forename: Luciana Paula
authors.initials: LP
authors.lastname: Dardin
authors.forename: Paulo Alexandre
authors.initials: PA
authors.lastname: Minali
authors.forename: Adriano
authors.initials: A
authors.lastname: Czapkowsky
authors.forename: Sergio Aron
authors.initials: SA
authors.lastname: Ajzen
authors.forename: Virginia Fernandes Moça
authors.initials: VF
authors.lastname: Trevisani
mesh_terms: D000328:Adult; D055109:Ankle Brachial Index / Q000379:methods*; D058070:Asymptomatic Diseases / Q000453:epidemiology; D050197:Atherosclerosis / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D001323:Autoantibodies / Q000097:blood*; D001938:Brazil; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000473:pathology; D059168:Carotid Intima-Media Thickness; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062072:Patient Acuity; D012307:Risk Factors; D012859:Sjogren's Syndrome / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D013223:Statistics as Topic; D018608:Ultrasonography, Doppler / Q000379:methods
chemical_list: D001323:Autoantibodies