Brown Lindsay E, Frits Michelle L, Iannaccone Christine K, Weinblatt Michael E, Shadick Nancy A, Liao Katherine P
Department of Medicine, Massachusetts General Hospital and Division of Rheumatology, Department of Medicine, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA.
Department of Medicine, Massachusetts General Hospital and Division of Rheumatology, Department of Medicine, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA
Rheumatology (Oxford). 2015 May;54(5):816-20. doi: 10.1093/rheumatology/keu400. Epub 2014 Oct 13.
Secondary SS (sSS) is a common extra-articular manifestation of RA. There are conflicting data regarding the association of sSS with worse joint damage. This study aims to characterize sSS patients in an RA cohort and study the association between sSS and joint damage.
We conducted a cross-sectional study of RA patients with ≥1 year of follow-up at a large academic centre. Subjects with co-morbid diseases that can also result in sicca symptoms were excluded from the analysis. Subjects were considered to have sSS if they were reported as having sSS by their rheumatologist at recruitment into the cohort and had the diagnosis confirmed by chart review. The primary outcome was Sharp score using bilateral hand radiographs at recruitment. We constructed a linear regression model to determine the association of sSS status and Sharp score adjusted by age, gender, disease duration and ACPA and RF status.
We studied 829 RA subjects, mean age 57 years, 83% female, mean RA duration 13 years, 74% seropositive; 85 subjects (10.3%) had sSS. We observed a female predominance (95.3%), longer mean disease duration (16.9 years) and higher frequency of RF or ACPA positive among patients with sSS and RA. Having sSS at baseline was associated with higher Sharp scores (P = 0.03), independent of age, gender, RA disease duration and seropositive disease.
In our RA cohort, RA subjects with sSS had worse joint damage, suggesting that sSS is a marker of more aggressive disease.
继发性干燥综合征（sSS）是类风湿关节炎（RA）常见的关节外表现。关于sSS与更严重关节损伤之间的关联，数据存在冲突。本研究旨在对一个RA队列中的sSS患者进行特征描述，并研究sSS与关节损伤之间的关联。
我们在一个大型学术中心对随访≥1年的RA患者进行了一项横断面研究。分析中排除了也可导致干燥症状的合并疾病患者。如果受试者在纳入队列时被其风湿病学家报告患有sSS且经病历审查确诊，则被认为患有sSS。主要结局是入组时使用双侧手部X线片的Sharp评分。我们构建了一个线性回归模型，以确定经年龄、性别、疾病持续时间以及抗环瓜氨酸肽抗体（ACPA）和类风湿因子（RF）状态调整后的sSS状态与Sharp评分之间的关联。
我们研究了829例RA受试者，平均年龄57岁，83%为女性，平均RA病程13年，74%为血清学阳性；85例受试者（10.3%）患有sSS。我们观察到sSS合并RA的患者中女性占优势（95.3%）、平均病程更长（16.9年）且RF或ACPA阳性频率更高。基线时患有sSS与更高的Sharp评分相关（P = 0.03），独立于年龄、性别、RA病程和血清学阳性疾病。
在我们的RA队列中，患有sSS的RA受试者关节损伤更严重，提示sSS是疾病更具侵袭性的一个标志物。
