{
  "abstract": "Introduction Primary Sjögren’s disease (SD) is a systemic autoimmune disorder causing glandular dysfunction, sicca symptoms and extraglandular manifestations, which impair quality of life. Data on early irreversible damage and its predictors remain limited.Methods We conducted a multicentre retrospective cohort study of 429 adult patients with SD from the Gruppo Italiano di Ricerca in Reumatologia Clinica e Sperimentale network with ≥1 year of follow-up. Baseline assessments included disease activity (European League Against Rheumatism (EULAR), Sjögren’s Syndrome Disease Activity Index (ESSDAI)), patient-reported symptoms (EULAR Sjögren’s Syndrome Patient Reported Index (ESSPRI)), C reactive protein (CRP), Schirmer’s test (ST) and autoantibody status. Irreversible damage was evaluated using the Sjögren’s Syndrome Damage Index (SSDI) across ocular, oral and systemic domains. Predictors of damage accrual were analysed using Cox proportional hazards models and Kaplan-Meier curves. Exploratory Least Absolute Shrinkage and Selection Operator (LASSO) and principal component analysis (PCA) analyses assessed domain-specific contributions and relationships between subjective and objective measures.Results At baseline, 48% of patients had SSDI≥1: ocular 25.4%, systemic 22.5% and oral 14.3%. After 5 years, 65% had cumulative damage: ocular 34.2%, oral 21.7% and systemic 40.8%. Higher baseline ESSDAI predicted damage across all domains. Elevated ESSPRI was associated with oral damage, while abnormal ST strongly predicted ocular damage. Anti-Ro/La antibodies, elevated CRP and recurrent oral infections were linked to higher domain-specific damage. LASSO analyses showed glandular, peripheral nervous system and pulmonary ESSDAI domains independently contributed to systemic damage. PCA confirmed that patient-reported symptoms and systemic activity represent complementary, independent dimensions.Conclusion Irreversible damage in SD occurs early, often present at diagnosis and affects multiple organ domains. Early identification of high-risk patients, based on clinical, serological and patient-reported measures, may enable timely interventions to prevent further damage, guide treatment and improve long-term outcomes.",
  "authors": [
    {
      "affiliations": [
        "Clinical Unit of Immunorheumatology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy",
        "Life Science, Health and Health Profession Department, Link Campus University, Roma, Italy"
      ],
      "name": "Onorina Berardicurti"
    },
    {
      "affiliations": [
        "Clinical Unit of Immunorheumatology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy",
        "Research Unit of Immunorheumatology Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy"
      ],
      "name": "Annalisa Marino"
    },
    {
      "affiliations": [
        "Clinical Unit of Immunorheumatology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy",
        "Research Unit of Immunorheumatology Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy"
      ],
      "name": "Luca Navarini"
    },
    {
      "affiliations": [
        "Clinical Unit of Immunorheumatology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy",
        "Research Unit of Immunorheumatology Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy"
      ],
      "name": "Andrea Pilato"
    },
    {
      "affiliations": [
        "Clinical Unit of Immunorheumatology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy",
        "Research Unit of Immunorheumatology Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy"
      ],
      "name": "Marta Vomero"
    },
    {
      "affiliations": [
        "Clinical Unit of Immunorheumatology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy",
        "Research Unit of Immunorheumatology Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy"
      ],
      "name": "Letizia Pia Di Corcia"
    },
    {
      "affiliations": [
        "Clinical Unit of Immunorheumatology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy",
        "Research Unit of Immunorheumatology Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy"
      ],
      "name": "Irene Genovali"
    },
    {
      "affiliations": [
        "Clinical Unit of Immunorheumatology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy",
        "Research Unit of Immunorheumatology Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy"
      ],
      "name": "Damiano Currado"
    },
    {
      "affiliations": [
        "Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Rheumatology Section, University of Palermo, Palermo, Italy"
      ],
      "name": "Lidia La Barbera"
    },
    {
      "affiliations": [
        "Department of Precision Medicine, Università Degli Studi Della Campania, Naples, Italy"
      ],
      "name": "Rosaria Irace"
    },
    {
      "affiliations": [
        "Dipartimento di Medicina dei Sistemi, Reumatologia, Allergologia e Immunologia Clinica, Università di Roma Tor Vergata, Rome, Italy"
      ],
      "name": "Paola Conigliaro"
    },
    {
      "affiliations": [
        "Unit of Rheumatology, Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy"
      ],
      "name": "Victoriya Pavlych"
    },
    {
      "affiliations": [
        "Academic Rheumatology Centre, AO Mauriziano Torino, DSCB Università degli Studi di Torino, Turin, Italy"
      ],
      "name": "Valeria Guardo"
    },
    {
      "affiliations": [
        "Servizio di Reumatologia, DSS Casarano e Gallipoli, ASL Lecce, Foggia, Italy"
      ],
      "name": "Giorgio Carlino"
    },
    {
      "affiliations": [
        "Dipartimento di Medicina dei Sistemi, Reumatologia, Allergologia e Immunologia Clinica, Università di Roma Tor Vergata, Rome, Italy"
      ],
      "name": "Sara Ferrigno"
    },
    {
      "affiliations": [
        "Rheumatology Research Unit, Department of Health Sciences, University of Catanzaro Magna Graecia, Catanzaro, Italy"
      ],
      "name": "Rosa Daniela Grembiale"
    },
    {
      "affiliations": [
        "Academic Rheumatology Centre, AO Mauriziano Torino, DSCB Università degli Studi di Torino, Turin, Italy"
      ],
      "name": "Annamaria Iagnocco"
    },
    {
      "affiliations": [
        "Unit of Rheumatology, Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy"
      ],
      "name": "Piero Ruscitti"
    },
    {
      "affiliations": [
        "Unit of Rheumatology, Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy"
      ],
      "name": "Paola Cipriani"
    },
    {
      "affiliations": [
        "Dipartimento di Medicina dei Sistemi, Reumatologia, Allergologia e Immunologia Clinica, Università di Roma Tor Vergata, Rome, Italy"
      ],
      "name": "Maria Sole Chimenti"
    },
    {
      "affiliations": [
        "Department of Precision Medicine, Università Degli Studi Della Campania, Naples, Italy"
      ],
      "name": "Francesco Ciccia"
    },
    {
      "affiliations": [
        "Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Rheumatology Section, University of Palermo, Palermo, Italy"
      ],
      "name": "Giuliana Guggino"
    },
    {
      "affiliations": [
        "Clinical Unit of Immunorheumatology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy",
        "Research Unit of Immunorheumatology Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy"
      ],
      "name": "Roberto Giacomelli"
    }
  ],
  "title": "Real-world damage accrual in Sjögren’s disease: a 5-year multicentre GIRRCS cohort analysis",
  "uid": "8eeaad9a-4f2d-500d-8ec0-5a19630b8c07"
}