Aradi Zsófia, Nagy Gábor, Horváth Ildikó Fanny, Antal-Szalmás Péter, Szántó Antónia
Division of Clinical Immunology, Institute of Internal Medicine, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary.
Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary.
Diagnostics (Basel). 2024 Jul 11;14(14):1494. doi: 10.3390/diagnostics14141494.
Aim of the study was to investigate the demographic data and disease course characteristics of patients with Sjögren's syndrome (SS) and inflammatory joint pain of various origins and to search for factors that might help with the distinction of polyarthritis as an extraglandular manifestation and rheumatoid arthritis as an associated systemic autoimmune disorder. A total of 355 patients were retrospectively analyzed, 128 of whom served as controls (SS-C), while 159 had polyarthritis as an extraglandular symptom of Sjögren's syndrome (SS-pa) and 68 were diagnosed as having associated rheumatoid arthritis (SS-RA). The patients without any inflammatory joint manifestations were significantly older than the SS-pa patients, while, for the SS-RA group, the difference was not significant. The onset of joint pain appeared significantly earlier in the SS-RA patients. Regarding either extraglandular manifestations or associated autoimmune disorders, there were significant differences between the controls and both SS-pa and SS-RA groups, while no significant difference was found between the SS-pa and SS-RA groups. Thus, laboratory and imaging methods should be used to differentiate between the two conditions, but laboratory biomarkers are even more important for early diagnosis. A ROC curve analysis showed an acceptable diagnostic accuracy in differentiating between SS-pa and SS-RA patients using a binary logistic regression model, where highly positive rheumatoid factor (RF) and anti-cyclic citrullinated peptide (CCP) values, kidney involvement, and anti-Ro/SS-A positivity were shown to significantly raise the odds of having RA, whereas anti-La/SS-B positivity seemed to have a protective role, since it significantly decreased the odds of having it. Further biomarkers are needed to better classify SS patient cohorts with inflammatory joint pain of different origins and, consequently, different management requirements.
本研究的目的是调查干燥综合征（SS）合并各种原因引起的炎性关节痛患者的人口统计学数据和疾病病程特征，并寻找有助于区分作为腺外表现的多关节炎和作为相关系统性自身免疫性疾病的类风湿关节炎的因素。总共对355例患者进行了回顾性分析，其中128例作为对照（SS-C），159例有多关节炎作为干燥综合征的腺外症状（SS-pa），68例被诊断为合并类风湿关节炎（SS-RA）。没有任何炎性关节表现的患者明显比SS-pa患者年龄大，而对于SS-RA组，差异不显著。关节痛的发作在SS-RA患者中出现得明显更早。关于腺外表现或相关自身免疫性疾病，对照组与SS-pa组和SS-RA组之间均存在显著差异，而SS-pa组和SS-RA组之间未发现显著差异。因此，应使用实验室和影像学方法来区分这两种情况，但实验室生物标志物对早期诊断更为重要。ROC曲线分析显示，使用二元逻辑回归模型区分SS-pa和SS-RA患者具有可接受的诊断准确性，其中类风湿因子（RF）和抗环瓜氨酸肽（CCP）值高度阳性、肾脏受累以及抗Ro/SS-A阳性被证明显著增加患RA的几率，而抗La/SS-B阳性似乎具有保护作用，因为它显著降低了患RA的几率。需要进一步的生物标志物来更好地对具有不同原因引起的炎性关节痛、因而有不同管理需求的SS患者队列进行分类。
