Concurrence of Sjögren's Syndrome in a Patient with Chlamydia-induced Reactive Arthritis; An Unusual Finding

Abstract

A 40-year-old Korean man presented with painful swelling and tenderness of both ankle joints as well as the plantar surfaces of both feet, along with inflammatory back pain, and a purulent discharge from the urethral orifice. The patient also complained of sicca-like symptoms including dry eyes and dry mouth. An immunological analysis revealed a high titer of rheumatoid factor, positive results for antinuclear antibody and anti-Ro antibody, and a positive result for HLA-B27. An antibody titer for Chlamydia was also significantly increased. Positive results of the Schirmer's test and for keratoconjunctivitis sicca were confirmed by an ophthalmologist. These clinical manifestations were compatible with Chlamydia-induced reactive arthritis (ReA) accompanied by Sjögren's syndrome (SS). This is the first report of the combination of these two distinct disease entities in the Korean population.

Prevalence of inflammatory back pain and radiologic sacroiliitis is increased in patients with primary Sjögren’s syndrome

“…However, IBP is not among the expected findings of SS. Coexistence of IBP and SS in a patient was first described by Chang et al who assessed this condition as an abnormal finding [ 10 ]. Afterwards, Golstein et al described 2 cases having SS and AS concurrently for the first time.…”

Primary Sjogren's syndrome with tuberculous arthritis of left knee

“…We searched Pubmed for SS and osteoarticular tuberculosis or tuberculous arthritis in English literature, which only yielded two case reports, one in symphysis pubis and the other in left ankle 18 19. Even reactive arthritis seemed to be rare in association with pSS, with only one report on chlamydia-induced reactive arthritis 20. But when it comes to SLE patients, it was suggested that they were at a particular risk of developing osteoarticular tuberculosis 21.…”