Horai Yoshiro, Kurushima Shota, Shimizu Toshimasa, Nakamura Hideki, Kawakami Atsushi
Department of Rheumatology, Sasebo City General Hospital, Sasebo 857-8511, Japan.
Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8523, Japan.
J Clin Med. 2025 Jan 17;14(2):568. doi: 10.3390/jcm14020568.
Rheumatoid arthritis (RA) is an immune-mediated disease characterized by polyarthritis that affects the small joints of the bilateral upper and lower extremities. RA shares several common clinical symptoms with Sjögren's syndrome (SS), another rheumatic disease caused by the lymphocytic infiltration of exocrine glands, with dry eye and dry mouth being the two most common symptoms. Anti-Ro/SS-A antibodies, a diagnostic biomarker of SS, are positive in patients with RA at a certain rate. The coexistence of SS and/or positivity for anti-Ro/SS-A antibodies in patients with RA influences disease activity and the effectiveness of several classes of disease-modifying antirheumatic drugs (DMARDs). Furthermore, RA, SS, and certain DMARDs, including methotrexate, are associated with the onset of lymphoproliferative disorders (LPD). In contrast, several biological DMARDs, such as tocilizumab and rituximab, are plausible options without the risk of LPD relapse. Considering the results of the studies introduced in this article, RA with SS and/or positivity for anti-Ro/SS-A antibodies could be considered a phenotype different from isolated RA from the perspective of refractoriness to DMARD therapy and LPD risk. Hence, rheumatologists should observe caution when choosing DMARDs. Further studies are needed to establish the appropriate treatment for patients with RA, SS, and/or the presence of anti-Ro/SS-A antibodies.
类风湿关节炎（RA）是一种免疫介导的疾病，其特征为多关节炎，累及双侧上肢和下肢的小关节。RA与干燥综合征（SS）有一些共同的临床症状，SS是另一种由外分泌腺淋巴细胞浸润引起的风湿性疾病，干眼和口干是最常见的两种症状。抗Ro/SS-A抗体是SS的一种诊断生物标志物，在一定比例的RA患者中呈阳性。RA患者中SS的共存和/或抗Ro/SS-A抗体阳性会影响疾病活动度以及几类改善病情抗风湿药（DMARDs）的疗效。此外，RA、SS以及某些DMARDs，包括甲氨蝶呤，都与淋巴增殖性疾病（LPD）的发生有关。相比之下，几种生物DMARDs，如托珠单抗和利妥昔单抗，是没有LPD复发风险的合理选择。考虑到本文介绍的研究结果，从对DMARD治疗的难治性和LPD风险的角度来看，伴有SS和/或抗Ro/SS-A抗体阳性的RA可被视为一种不同于孤立性RA的表型。因此，风湿病学家在选择DMARDs时应谨慎。需要进一步研究以确定针对RA、SS和/或存在抗Ro/SS-A抗体的患者的适当治疗方法。
