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SARS-CoV-2 infection in 898 patients with Sjögren’s syndrome: characteristics associated with poor outcomes

Flores-Chavez et al., Clinical and Experimental Rheumatology, doi:10.55563/clinexprheumatol/pt3syo
Sep 2022  
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HCQ for COVID-19
1st treatment shown to reduce risk in March 2020
*, now with p < 0.00000000001 from 411 studies, recognized in 46 countries.
No treatment is 100% effective. Protocols combine treatments. * >10% efficacy, ≥3 studies.
4,400+ studies for 79 treatments.
Retrospective 898 patients with Sjögren’s disease, showing a lower risk of worse outcomes with HCQ compared to corticosteroids, immunosuppressive agents, and B-cell depleting agents.
Flores-Chavez et al., 1 Sep 2022, Double Blind Randomized Controlled Trial, placebo-controlled, Italy, peer-reviewed, survey, mean age 56.0, 1 author.
This PaperHCQAll
Congress Chairperson
Salvatore De Vita, Young Co-Chairpersons, L Quartuccio, Italy M Ramos Casals, Spain E Treppo, Italy A G Tzioufas, Italy Greece A Zabotti, Italy A Zabotti, Italy E Treppo, Italy V Manfrè, Italy C Fabro, Italy E Bartoloni Bocci, Italy F Conti, Italy R Gerli, Italy R Priori, Italy G Valesini, Italy Italy C Vitali, F B Vivino, Usa M Wahren-Herlenius, Bartoloni Bocci, Pinheiro Lopes, Van Roon, Martin -Gutierrez, Van Der, Rönnblom L 10, Mariette X 11, Ng W F 12, Sivils K 13, Nordmark G 10, Tsao B 14, C J Lessard, Van Der Vegt, H P Lozac, Chao De, La Barca, A D Farris, Remmen H Van, Rönnblom L 10, Alarcón-Riquelme M E 12, Ng W F 13, Guern V Le, J E Gottenberg, Marcelli C 10, Larroche C 11, M.S Van Ginkel, D ' Agostino, Keen H 10, Iagnocco A 11, Hanova P 12, W A Schmidt, Mumcu G 13, Bruyn G A 14, A Flores-Chavez, Hernandez-Molina G 18, Robles A 10, Akasbi M 11, Brito-Zerón P 12 , Lopez-Dupla, Retamozo S 14, Bandeira M 15, Romão V C 16, Mariette X 17, Horváth F I 18, Li X 19, Rasmussen A 20, Dong X 21, Priori R 22, Olsson P 23, Baldini C 24, Seror R 25, Armagan B 26, Kruize A 27 , Hernandez-Molina, G 28, Danda D 29, Inanc N 30, E 31, Quartuccio L 32, Romão V C 33, Rischmueller M 34, Suzuki Y 35, Kwok S 36, Kvarnstrom M 37, Solans R 38, Pasoto S G 39, Galisteo C 40, Sene D 41, Moça Trevisani, V 42, Isenberg D 43, Hofauer B 10, Shimizu T 44, Nordmark G 45, Valim V 46, Carubbi F 47, Garcia A Gonzalez, Retamozo S 48, Melchor Devauchelle-Pensec V 11, Díaz S 12, Brito-Zerón P 13 , López-Dupla, M 49, Fonseca-Aizpuru E 50 , Sánchez-Berná, I 51, Morel J 14, Giacomelli R 52, Atzeni F 15, Consani S 16, Vazquez M 17, Alves Ribeiro
Introduction. Increased CCL5 expression and CD8 T cells have been shown to be pivotal regulators of immunopathology in primary Sjögren's syndrome (pSS) and pSS-like disease. Increased CCL5 expression by CCR9 + CD4 T cells has previously been implicated as a contributor to immunopathology in pSS. The role of CD8 T cells and in particular CCR9+ CD8 T cells and their potential to secrete CCL5 has not previously been studied in pSS. In this study we investigated both CCR9 and CCL5 expression by CD8 T cells in pSS patients compared to healthy controls (HC). Methods. CCR9 expression on CD8 T cells from peripheral blood was compared between patients with pSS and HC by flow cytometry. Intracellular CCL5 expression by naive, memory and effector CCR9-and CCR9 + CD8 T cells was assessed. In addition, the capacity and pace of CCL5 release upon T cell activation was determined for all subsets and compared with CD4 T cells. Results. The frequency of circulating CCR9 + CD8 T cells in pSS patients is increased compared to HC. Antigen-experienced CD8 T cells, especially CCR9 + effector CD8 T cells, express the highest CCL5 levels, and release the highest levels of CCL5 upon activation. Memory and effector CD8 T cells of pSS patients express significantly less CCL5 and subsequently release less CCL5 upon stimulation compared to HC. CCR9 + CD8 T cells rapidly release CCL5 and significantly more than CCR9 + CD4 T cells. Conclusions. CCR9+ CD8 T cells express more CCL5 than CCR9-CD8 T cells. CCL5 is rapidly released upon activation, resulting in reduced intracellular expression. Reduced CCL5 expression by an elevated number of antigen-experienced CCR9-expressing CD8 T cells in pSS patients points towards increased release in vivo. This suggests that CCL5 release by CCR9+ CD8 T cells contributes to immunopathology in pSS.
Poster 77 DRY EYE SYMPTOMS STRONGLY CORRELATE WITH OCULAR AND EXTRAOCULAR PAIN IN PRIMARY SJÖGREN'S SYNDROME. INTERIM REPORT OF A PILOT CROSS-SECTIONAL MONOCENTRIC STUDY. Moroni L. 1 , Ferrari G. 2,3 , Bonelli F. 3 , Batani V.* 1 , Bellone M. 1 , Dagna L. 1 1 Unit of Immunology, Rheumatology, Allergy and Rare Diseases, Ospedale San Raffaele; Vita-Salute San Raffaele University, Milan, Italy, 2 Cornea and Ocular Surface Unit, Ospedale San Raffaele; Eye Repair Lab, Ospedale San Raffaele, Milan, Italy, 3 Eye Repair Lab, Ospedale San Raffaele, Milan, Italy Background. Ocular involvement in primary Sjögren's Syndrome (pSS) has been traditionally assessed by Schirmer's test, Tear Break Up Time (TBUT) and Ocular Staining Score (OSS) 1 . The role of Ocular Surface Disease Index (OSDI), Visual Function Questionnaire-25 (VFQ-25) and Numerical Rating Scale (NRS) in measuring ocular pain and discomfort in pSS have not been investigated in detail. Objectives. In this ongoing cross-sectionally study, we aim at exploring the prevalence of ocular pain in patients with pSS. Moreover, we investigated the potential correlations between dry eye, ocular pain, extraocular patientreported outcomes and disease activity. Methods. OSDI, VFQ-25 and NRS were administered to 19 consecutive patients with a definite diagnosis of pSS at our outpatient clinic. All patients signed an informed consent for the study. Pearson coefficients were obtained to assess correlation among EULAR Sjögren's Syndrome (SS)..
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