Arthritis in primary Sjögren's syndrome: Characteristics, outcome and treatment from French multicenter retrospective study

Abstract

BackgroundThe aims of our study were to describe the characteristics and the outcome of primary Sjögren Syndrome (pSS) associated arthritis and to compare the efficacy of different therapeutic regimen, like hydroxychloroquine (HCQ), methotrexate (MTX) and rituximab (RTX). Patients MethodsWe conducted a retrospective study using Club Rhumatisme and Inflammation (CRI) and French Internal Medicine Society (SNFMI) networks. All patients with a diagnosis of primary Sjögren's Syndrome (pSS) and at least one clinical and/or echographic synovitis were included. Patients with synovitis (cases) were compared to pSS patients without synovitis (controls). Results57 patients (93% women) were included with a median age of 54 years [45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63]. Patients with synovitis had more frequently lymph node enlargement (12.3% vs. 1.8%, p=0.007). There was no difference concerning other pSS systemic manifestations, CRP levels, rheumatoid factor and CCPantibodies positivity. Among 57 patients with synovitis, 101 lines of various treatments have been used during the follow-up of 40 [22.5-77] months. First line treatment consisted in steroids alone (3.5%), steroids in association (79%) with HCQ (49%), MTX (35%), RTX (5.3%) or other immunosuppressive drugs (7%). HCQ, MTX, and RTX were associated with a significant reduction of tender and swollen joint count, and a significant steroids-sparing effect. No difference could be shown for the joint response between these treatment regimens. ConclusionpSS articular manifestations may include synovitis which could mimic rheumatoid arthritis but differ by the absence of structural damage. Even if the use of HCQ, MTX, and RTX seem to be effective for joint involvement, the best regimen remains to be determined.

Potentially inappropriate anticholinergic drug prescriptions for patients with Sjögren's syndrome

“…Patients diagnosed with Sjögren's syndrome had a mean age of 64.6 years, similar to that found in the United States (65.8 years) [1] but higher than what has been documented in several countries in Europe (51–55 years) [7] , [25] , [26] , [27] , [28] , [29] , Asia (48.3–60.8 years) [30] , [31] , [32] , and another report from Colombia (51.3 years) [33] . Sjögren's syndrome predominated in females (75.7%) but in a lower proportion than that described in the United States (96%) [30] , Greece (95.2%) [26] , Japan (94.2%) [32] , Spain (93–95.1 years) [2] , [27] , [29] , Iran (90.4%) [1] , and France (89.9–93%) [7] , [25] , as well as in local studies (82–97.3%) [5] , [33] .…”

“…Sjögren's syndrome is the second most frequent autoimmune rheumatic disease [1] , [2] , [3] , characterized by lymphocytic infiltration of salivary and tear glands and other exocrine glands, which generates dryness of the skin and mucous membranes, especially of the mouth (xerostomia) and eyes (dry eye), known as sicca symptoms [2] , [4] , [5] . The disease can progress and affect other organs, such as the lungs, kidneys, gastrointestinal tract, musculoskeletal system, vessels, and central and peripheral nervous system [4] , [6] , [7] . Its prevalence is variable: 0.06% for primary Sjögren's syndrome and 4.8% for primary and secondary forms combined [1] , [8] .…”

Dental implants in patients with Sjögren’s syndrome: a case series and a systematic review

“…40 Moreover, corticosteroids increase the life span of osteoclasts 41 and suppress bone formation via the osteoclast. 42 Besides corticosteroids, methotrexate 43 and biological-targeted therapies, including TNF-α inhibitors and rituximab, 44 have been used in patients with primary SS-associated inflammatory arthritis. Methotrexate has been shown to be a potent inhibitor of osteoblast's proliferation and mitochondrial metabolism in vitro, 45 and to have the potential to interfere with the osseointegration process.…”

Plasma α‐L‐fucosidase‐1 in patients with Sjögren's syndrome and other rheumatic disorders

“…With the help of different diametric, round‐ended ophthalmologic lacrimal sac probes first used by our group, parotid sialography with the use of 1.5‐2 mL Dionosyl‐F‐Aquosum, water‐solvent contrast substance, was carried out. In those patients with SS, we reinforced the diagnosis at the fulfillment of a least 4 criteria in accordance with current diagnostic consensus guidelines and following recommendations to avoid misdiagnosis with other disorders including RA, particularly in children …”

“…In those patients with SS, we reinforced the diagnosis at the fulfillment of a least 4 criteria in accordance with current diagnostic consensus guidelines and following recommendations to avoid misdiagnosis with other disorders including RA, particularly in children. [20][21][22][23][24][25] The plasma enzyme activity of α-L-FUCA-1 was investigated in the Laboratory of the Pediatrics Department with a fluorimetric method. 26 The blood specimens were processed within 1-2 hours from the withdrawal and using sterile disposable plastic ware.…”