OBJECTIVE To investigate sex-related differences in the clinical characteristics of primary Sjögren’s syndrome (pSS) from the perspectives of both Western medicine and traditional Chinese medicine (TCM).

METHODS Patients with pSS who attended China-Japan Friendship Hospital from January 2017 to September 2023 were enrolled. Clinical data and disease activity were collected. Patients were grouped by sex and further stratified by disease duration to explore sex-related differences in clinical characteristics from both Western medicine and TCM perspectives.

RESULTS A total of 1 006 patients with pSS were included, comprising 153 men (15.2%) and 853 women (84.8%). Compared with women, men were older and had a shorter disease duration (P<0.001), and were more likely to have cough, dyspnea, and interstitial lung disease (P<0.05, P<0.001). In contrast, women were more likely to present with xerostomia and arthralgia (P<0.05), and had higher positivity rates for antinuclear antibodies (ANA), anti-SSA antibodies, and anti-Ro52 antibodies, as well as higher frequencies of hypocomplementemia, low complement C4 levels, and the TCM syndrome of dryness-stasis complex （P<0.05， P<0.001）, and higher ANA antibody titers（P<0.05）. Subgroup analysis showed that in the short-disease-duration subgroup, men had a higher proportion of elevated C-reactive protein and high disease activity (P<0.01, P<0.001), and higher ESSDAI scores than women (P<0.05), whereas women more frequently exhibited fatigue, morning stiffness, rampant caries, and leukopenia (P<0.05, P<0.01). In the long-disease-duration subgroup, xerophthalmia was more common in women (P<0.001).

CONCLUSION Male patients with pSS are older, have a shorter disease duration, and are more likely to present with ILD, whereas sicca symptoms, the dryness-stasis pattern, and autoantibody positivity are less common in men than in women. These characteristics appear to be largely independent of disease duration. However, in the short-disease-duration subgroup, men show higher disease activity, whereas in the long-disease-duration subgroup, xerophthalmia is more common in women. These findings may provide a basis for more refined and individualized diagnostic and therapeutic strategies for pSS.