Service de médecine interne, Hôpital Saint-Antoine, APHP, Paris, France; Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine (CRSA), F-75012 Paris, France.
Service de rhumatologie, Hôpital du Kremlin-Bicêtre, APHP, Bicêtre, France.
Autoimmun Rev. 2019 Jan;18(1):9-14. doi: 10.1016/j.autrev.2018.06.015. Epub 2018 Nov 5.
To describe the characteristics and the outcome of primary Sjögren Syndrome (pSS) associated arthritis and to compare the efficacy of different therapeutic regimen.
We conducted a retrospective study using Club Rhumatisme and Inflammation (CRI) and French Internal Medicine Society (SNFMI) networks. All patients with a diagnosis of pSS and at least one episode of clinical and/or echographic synovitis were included. Patients with synovitis (cases) were compared to pSS patients without synovitis (controls).
57 patients (93% women) were included with a median age of 54 years [45-63]. Patients with synovitis had more frequently lymph node enlargement (12.3% vs. 1.8%, p = .007) and a higher ESSDAI score (8 [6-12] vs. 2 [1-4], p < .0001). There was no difference concerning CRP levels, rheumatoid factor and cyclic citrullinated peptide (CCP)-antibodies positivity. Among 57 patients with synovitis, 101 various treatment courses have been used during the follow-up of 40 [22.5-77] months. First treatment course consisted in steroids alone (3.5%), steroids in association (79%) with hydroxychloroquine (HCQ) (49%), methotrexate (MTX) (35%), rituximab (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.
pSS 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.
描述原发性干燥综合征（pSS）相关关节炎的特征和转归，并比较不同治疗方案的疗效。
我们进行了一项回顾性研究，使用了 Club Rhumatisme 和 Inflammation（CRI）和法国内科医师学会（SNFMI）网络。所有诊断为 pSS 且至少有一次临床和/或超声滑膜炎发作的患者均纳入研究。将有滑膜炎的患者（病例组）与无滑膜炎的 pSS 患者（对照组）进行比较。
共纳入 57 例（93%为女性）患者，中位年龄 54 岁[45-63]。有滑膜炎的患者更常出现淋巴结肿大（12.3% vs. 1.8%，p=0.007）和更高的 ESSDAI 评分（8[6-12] vs. 2[1-4]，p<0.0001）。两组患者的 CRP 水平、类风湿因子和环瓜氨酸肽（CCP）抗体阳性率无差异。在 57 例有滑膜炎的患者中，在 40[22.5-77]个月的随访期间共使用了 101 种不同的治疗方案。第一个治疗方案为单独使用类固醇（3.5%），联合使用类固醇（79%）联合羟氯喹（HCQ）（49%）、甲氨蝶呤（MTX）（35%）、利妥昔单抗（RTX）（5.3%）或其他免疫抑制剂（7%）。HCQ、MTX 和 RTX 与压痛和肿胀关节数的显著减少以及类固醇的显著节约作用相关。这些治疗方案之间的关节反应无差异。
pSS 的关节表现可能包括滑膜炎，滑膜炎可能类似于类风湿关节炎，但不同之处在于不存在结构损伤。尽管 HCQ、MTX 和 RTX 似乎对关节受累有效，但最佳方案仍有待确定。
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