BackgroundThe aims of our study were to describe the characteristics and the outcome of primary Sjögren Syndrome (pSS) associated arthritis and to compare the efficacy of different therapeutic regimen, like hydroxychloroquine (HCQ), methotrexate (MTX) and rituximab (RTX).
Patients MethodsWe conducted a retrospective study using Club Rhumatisme and Inflammation (CRI) and French Internal Medicine Society (SNFMI) networks. All patients with a diagnosis of primary Sjögren's Syndrome (pSS) and at least one clinical and/or echographic synovitis were included. Patients with synovitis (cases) were compared to pSS patients without synovitis (controls).
Results57 patients (93% women) were included with a median age of 54 years [45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63]. Patients with synovitis had more frequently lymph node enlargement (12.3% vs. 1.8%, p=0.007). There was no difference concerning other pSS systemic manifestations, CRP levels, rheumatoid factor and CCPantibodies positivity. Among 57 patients with synovitis, 101 lines of various treatments have been used during the follow-up of 40 [22.5-77] months. First line treatment consisted in steroids alone (3.5%), steroids in association (79%) with HCQ (49%), MTX (35%), 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.
ConclusionpSS 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.