P.A. Jarrot, MD, PhD, R. Cauchois, MD, G. Kaplanski, MD, PhD, Department of Internal Medicine and Clinical Immunology CHU Conception, AP-HM, and Center for Cardiovascular and Nutrition Research, INRA 1260, INSERM UMR_S1263, Aix-Marseille University;
R. Arcani, MD, O. Darmon, MD, K. Mazodier, MD, R. Jean, MD, Department of Internal Medicine and Clinical Immunology CHU Conception, AP-HM.
J Rheumatol. 2021 Jul;48(7):1037-1046. doi: 10.3899/jrheum.200189. Epub 2020 Jul 15.
To assess the prevalence of axial articular manifestations (AAMs) in patients with primary Sjögren syndrome (pSS), to investigate whether these symptoms reveal an associated spondyloarthritis (SpA), and to assess their therapeutic management.
Among 148 consecutive patients with pSS fulfilling European League Against Rheumatism (EULAR)/American College of Rheumatology 2019 classification criteria followed between 2010 and 2018, we selected those who presented with AAMs. The association with SpA was retained when patients fulfilled Assessment of SpA international Society criteria.
A total of 29 patients (20%, 28 women) with a median age of 43 years (range 15-65 yrs), were identified. The main extraglandular features were peripheral arthralgia and arthritis in 93% and 90% of patients, respectively. Positive anti-Ro/SSA (anti-SSA) antibody was reported in 62%. AAMs were inaugural in 7%, delayed from the diagnostic of pSS in 7%, and occurred concomitantly in 86% of patients. AAMs were not associated to multisystemic involvement of pSS. Radiographic sacroiliitis was mentioned in 65%, and HLA-B27 was positive in 13%. The diagnosis of SpA was retained in 23/29 patients (79%), among which 74% and 26% fulfilled psoriatic arthritis and ankylosing spondylitis criteria, respectively. There was no phenotypic difference according to the anti-SSA antibody status. With a median follow-up of 60 months (range: 5-96), 61% of patients with associated SpA required biotherapies, mainly of anti-tumor necrosis factor-α or anti-interleukin 17A molecules with a good clinical outcome in 64% and no effect on pSS.
AAMs are not uncommon in patients with pSS and may reveal an associated SpA. Treatment of AAMs, especially when clearly associated with SpA, may necessitate biologics, following SpA-management therapeutic guidelines.
评估原发性干燥综合征（pSS）患者的轴性关节表现（AAMs）的患病率，探讨这些症状是否提示相关的脊柱关节炎（SpA），并评估其治疗管理。
在 2010 年至 2018 年间随访的 148 例符合欧洲抗风湿病联盟（EULAR）/美国风湿病学会 2019 分类标准的 pSS 连续患者中，我们选择了出现 AAMs 的患者。当患者符合 SpA 国际学会评估标准时，保留与 SpA 的关联。
共确定了 29 例患者（20%，28 名女性），中位年龄为 43 岁（15-65 岁）。主要的关节外表现分别为 93%和 90%的患者外周关节痛和关节炎。62%的患者抗 Ro/SSA（抗 SSA）抗体阳性。AAMs 首发于 7%的患者，在 pSS 诊断后延迟出现于 7%的患者，同时发生于 86%的患者。AAMs 与 pSS 的多系统受累无关。65%的患者提到放射性骶髂关节炎，13%的患者 HLA-B27 阳性。29 例患者中有 23 例（79%）诊断为 SpA，其中 74%和 26%分别符合银屑病关节炎和强直性脊柱炎的标准。根据抗 SSA 抗体状态，表型无差异。中位随访时间为 60 个月（5-96 个月），伴相关 SpA 的 61%患者需要生物治疗，主要是抗肿瘤坏死因子-α或抗白细胞介素 17A 药物，64%的患者临床疗效良好，对 pSS 无影响。
AAMs 在 pSS 患者中并不少见，可能提示存在相关的 SpA。AAMs 的治疗，特别是与 SpA 明确相关时，可能需要根据 SpA 管理治疗指南使用生物制剂。
