Department of Medicine, ASL1 Avezzano-Sulmona-L'Aquila, L'Aquila, Italy.
Rheumatology Unit, Department of Medicine, University of Perugia, Italy.
Clin Exp Rheumatol. 2020 Jul-Aug;38 Suppl 126(4):166-173. Epub 2020 Sep 22.
Articular manifestations (AMs) are observed in a large proportion of patients with primary Sjögren's syndrome (pSS) and can occur at the time of pSS diagnosis or during the disease course. Although in the majority of cases AMs are mild and self-limiting, some patients may experience chronic polyarthritis requiring treatment with DMARDs. Ultrasonography (US) and magnetic resonance imaging (MRI) can help assessing the extent of articular involvement and guide the treatment. The aim of this study was to describe clinical, serological, and histological picture of a cohort of pSS patients with AMs.
Clinical and serological records were retrospectively evaluated and either US or MRI were performed to evaluate AMs and their features were described according to the OMERACT scoring systems.
One hundred and thirty-three pSS patients were enrolled, of whom 115 (86%) with articular involvement. In particular, 91 patients (68%) displayed AMs at the time of pSS diagnosis while 24 patients (32%) during the course of the disease. Patients with AMs during the disease course were diagnosed with pSS at a younger age and reported a higher VAS dryness compared to patients displaying AMs at pSS onset. Hands and wrists were the most frequently involved sites followed by knees, shoulders and ankles. Overall, a consistent number of abnormalities were detected, more by MRI than US. Hands and wrists were the most frequently evaluated sites and the prevalence of all MRI abnormalities was similar between the different sites and comparable between the groups.
pSS AMs encompass a wide disease spectrum ranging from arthralgia to erosive arthritis resembling RA and therefore represent an important determinant of patients' quality of life. Imaging techniques such as US and MRI may be useful in the follow-up of pSS patients for prompt identification of AMs, for the quantification of their extent and ultimately for providing guidance on treatment and improving patient care.
原发性干燥综合征（pSS）患者中很大一部分存在关节表现（AMs），这些表现可以在 pSS 诊断时或疾病过程中出现。尽管在大多数情况下 AMs 是轻度和自限性的，但有些患者可能会出现需要 DMARDs 治疗的慢性多关节炎。超声（US）和磁共振成像（MRI）有助于评估关节受累程度并指导治疗。本研究旨在描述一组有 AMs 的 pSS 患者的临床、血清学和组织学特征。
回顾性评估临床和血清学记录，并进行 US 或 MRI 检查以评估 AMs，并根据 OMERACT 评分系统描述其特征。
共纳入 133 例 pSS 患者，其中 115 例（86%）存在关节受累。具体来说，91 例（68%）在 pSS 诊断时出现 AMs，24 例（32%）在疾病过程中出现。在疾病过程中出现 AMs 的患者被诊断为 pSS 的年龄较小，且 VAS 干燥评分高于在 pSS 发病时出现 AMs 的患者。手部和腕部是最常受累的部位，其次是膝关节、肩部和踝关节。总的来说，MRI 检测到的异常数量较多，且多于 US。手部和腕部是最常评估的部位，不同部位之间所有 MRI 异常的患病率相似，且两组之间相似。
pSS AMs 涵盖了广泛的疾病谱，从关节痛到类似于 RA 的侵蚀性关节炎，因此是患者生活质量的重要决定因素。超声和 MRI 等影像学技术可用于 pSS 患者的随访，以便及时发现 AMs，量化其程度，并最终为治疗提供指导，改善患者护理。
