ABS0773 FIBROMYALGIA AND ESSDAI ARTICULAR DOMAIN ARE PREDICTORS FOR FATIGUE IN SJÖGREN'S DISEASE: DATA FROM BRAZILIAN (BRAS) AND PORTUGUESE (PORTRESS-REUMA-PT) REGISTRIES OF SJÖGREN'S DISEASE

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Background: A significant number of patients with Sjögren's disease (SjD) experience fatigue, which is recognized as a crucial predictor of worse quality of life. Objectives: To evaluate the frequency and the predictors of fatigue in the Brazilian and Portuguese cohorts of SjD. Methods: This cross-sectional study included patients with SjD from the Brazilian Registry of Sjögren's Disease (BRAS) and the Portuguese Registry of Sjögren's Disease (PORTRESS-REUMA-PT) who met the 2002 AECG and/or 2016 ACR-EULAR classification criteria. We collected demographic data (age, gender, ethnicity, occupation, and marital status) and clinical data (body mass index, comorbidities, medications, ocular and oral tests, presence of cryoglobulins, anti-SSA/Ro and anti-SSB/La antibodies, and immunological tests. We also noted initial and current systemic manifestations (Sjogren's Syndrome Disease Activity Index, ESSDAI), damage (Sjögren's Syndrome Disease Damage Index, SSDDI), anxiety and depression status (Hospital Anxiety and Depression Scale, HADS), and quality of life (EuroQoL-5 dimension, EQ-5D. Fatigue was assessed using the Sjogren's Syndrome Patient Reported Index (ESSPRI) with a fatigue score of ≥5, and the Physical and Mental Profile of Fatigue and Discomfort (PROFAD) with scores of ≥4. Descriptive and comparative analyses of the populations were performed. Variables with statistical significance at the 5% level in univariate analysis were included in the multiple regression model to evaluate fatigue determinants. A p-value of ≤0.05 was significant. Results: In the study, 1,082 patients with SjD were analyzed in the BRAS cohort, and 863 in the PORTRESS-REUMA-PT cohort. The prevalence of fatigue was 61.0% and 66.1% (p=0.140) based on the ESSPRI fatigue score of ≥5, 50.4% and 58.2% (p=0.056) from the physical PROFAD score of ≥4, and 47.2% and 56.1% (p=0.023) from the mental PROFAD score of ≥4, respectively. Further analysis indicated that the physical PROFAD score was lower in the Brazilian cohort compared to the Portuguese cohort (3.7 ± 2.1 vs. 4.1 ± 2.0, p=0.037). No significant differences were observed in ESSPRI fatigue (5.5 ± 3.1 vs. 5.6 ± 3.0, p=0.629) or mental PROFAD (3.4 ± 2.3 vs. 3.7 ± 2.2, p=0.287). Comparative and descriptive analysis of the population, and differences in ESSPRI fatigue scores, are shown in the Table 1. In multiple regression analysis, fibromyalgia (OR=2.404, IC95%=1.168-4.948, p=0.017) and the articular ESSDAI domain (OR=1.333, IC95%=1.036-1.716, p=0.026) emerged as predictors for ESSPRI fatigue. Delay in diagnosis (OR=1.123, IC95%=1.013-1.246, p=0.027), extreme pain/discomfort (OR=9.676, IC95%=1.144-81.833, p=0.037), and moderate anxiety/depression (OR=4.454, IC95%=1.493-13.288, p=0.007) were identified as predictors for mental PROFAD fatigue, while the glandular ESSDAI domain appeared to be protective (OR:-0.573, IC95%=1.367-0.893, p=0.014). The regression models incorporating the physical PROFAD did not reach significance. Conclusion: The prevalence of fatigue was similar in both Brazilian and Portuguese cohorts, at 61.0% and 66.1%, respectively. Fibromyalgia and the articular domain were independent predictors of fatigue. Delayed diagnosis, extreme pain/discomfort, and anxiety/depression were predictors for mental fatigue. These findings suggest that early diagnosis and treatment could reduce fatigue in SjD patients. REFERENCES: NIL . Table 1Descriptive and comparative analysis of the population.BRASPORTRESS-REUMA-TPBRAS versus PORTRESS-REUMA-PTESSPRI fatigue ≥5ESSPRI fatigue <5p-valueESSPRI fatigue ≥5ESSPRI fatigue <5p-valueESSPRI fatigue ≥5ESSPRI fatigue <5Age, years*54.4 (12.9)(n=422/ 693)54.4 (13.5)(n=271/693)NS63.1 (13.4)(n=184/ 279)62.5 (15.9)(n=95/279)NS<0.001<0.001Female Gender#412 (97.2)257 (94.8)NS177 (95.7)86 (90.5)NSNSNSBody mass index, kg/m 2 *28.1 (5.8)(n=400/642)26.5 (5.0)(n=242/642)<0.00126.8 (5.4)(n=129/167)26.0 (4.4)(n=38/167)NS0.009NSTime of disease, years*6.9 (6.4)(n=414/ 678)6.7 (5.8)(n=264/678)NS5.0 (6.7)(n=160/245)5.1 (6.7)(n=85/245)NS<0.001<0.001Delay in diagnosis, years*4.0 (5.2)(n=395/643)3.4 (2.1)(n=248/643)0.0145.7 (6.4)(n=156/239)4.1 (5.5)(n=83/239)0.030.0010.01Dry mouth over 3 months#336 (96.0)194 (87.8)<0.001150 (90.9)66 (75.0)0.0010.020.005Dry eyes over 3 months#329 (94.0)196 (87.9)0.01135 (82.3)64 (70.3)0.03<0.001<0.001Anti-Ro, positive#295 (77.6)194 (80.2)NS156 (84.8)89 (93.7)0.030.0460.003Anti-La, positive#115 (35.6)94 (45.0)0.03107 (79.3)46 (66.7)0.049<0.0010.002Cryoglobulins, positive#10 (2.5)8 (3.1)NS8 (11.6)4 (15.4)NS<0.0010.003C3, mg/dL*122.4 (30.1)(n=311/506)122.4 (32.3)(n=195/506)NS83.5 (5.9)(n=15/19)77.8 (15.4)(n=4/19)NS<0.0010.005C4, mg/dL*26.7 (15.5)(n=317/520)25.7 (12.6)(n=203/520)NS7.8 (1.9)(n=4/6)5.5 (4.9)(n=2/6)NS0.0010.025IgG, mg/dL*1517.5 (536.1)(n=161/269)1577.1 (565.3)(n=108/269)NS2191.5 (772.5)(n=57/77)2323.1 (848.1)(n=20/77)NS<0.001<0.001VHS*31.7 (27.3)(n=341/553)29.4 (27.6)(n=212/553)NS31.7 (23.2)(n=80/111)24.5 (15.8)(n=31/111)NSNSNSCRP*4.0 (8.2)(n=337/549)3.7 (8.6)(n=212/549)NS6.3 (22.5)(n=79/110)2.4 (3.3)(n=31/110)NS0.008NSGammaglobulin*1.5 (0.6)(n=299/468)1.6 (0.9)(n=169/468)NS2.1 (0.4)(n=62/87)2.1 (0.4)(25/87)NS<0.001<0.001Fibromyalgia#141 (33.3)32 (13.0)<0.00133 (22.9)8 (12.3)NS0.007NSDiabetes#57 (13.6)33 (12.4)NS7 (4.9)6 (9.2)NS0.004NSHypertension#152 (36.3)98 (36.8)NS13 (9.0)8 (12.3)NS<0.001<0.001Cardiovascular disease#26 (6.5)15 (6.1)NS1 (0.7)0NSNSNSLymphoma#14 (3.5)5 (2.1)NS00-0.021NSHypothyroidism#94 (23.2)55 (22.4)NS9 (6.3)3 (4.6)NS<0.0010.001Chronic renal failure#11 (2.7)21 (8.5)0.0012 (1.4)0NSNS0.02NS: non-Significant. * Mean (SD). # n(%) Acknowledgements: To the BRAS and PORTRESS-REUMA-PT registries task-forces. Disclosure of Interests: None declared . © The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Neither EULAR nor the publisher make any representation as to the accuracy of the content. The authors are solely responsible for the content in their abstract including accuracy of the facts, statements, results, conclusion, citing resources etc.

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