ACPA-positive primary Sjögren's syndrome: true primary or rheumatoid arthritis-associated Sjögren's syndrome?

Abstract

ObjectivesAnticyclic citrullinated protein antibodies (ACPA) are highly specific of rheumatoid arthritis (RA). However, they have also been detected in 5–10% of primary Sjögren's syndrome (pSS). We compared ACPA-positive and negative patients with pSS and assessed the risk of evolution to RA.Patients and methodsACPA-positive and negative patients with pSS were included in this study. For ACPA-positive patients, clinical and radiological re-evaluation was systematically performed after at least 5 years of follow-up. Diagnosis was reassessed at the end of the follow-up to identify patients that developed RA according to the American College of Rheumatology 1987 classification criteria.ResultsAt inclusion in the cohort 16 patients with pSS were ACPA positive and 278 were ACPA negative. ACPA-positive patients, had more frequently arthritis (43.7% vs 12.2%; p=0.003) but not arthralgias. They also had more frequent lung involvement (25% vs 8.1%; p=0.05). After median follow-up of 8 (5–10) years, 7/16 (43.8%) patients developed RA including 5 (31.25%) with typical RA erosions. Elevation of acute phase reactants at inclusion was the only parameter associated with progression to erosive RA.ConclusionsMedian term follow-up of ACPA-positive patients with pSS showed that almost half of them developed RA, particularly in the presence of elevation of acute phase reactants. These results support the usefulness of a close radiological monitoring of these patients for early detection of erosive change not to delay initiation of effective treatment. Indeed, number of these patients with ACPA-positive pSS may actually have RA and associated SS.

Arthritis in primary Sjögren's syndrome: Characteristics, outcome and treatment from French multicenter retrospective study

“…A cryoglobulinemia was detected in 3 (5%) patients. Initial median ESSDAI score was 8 [6][7][8][9][10][11][12]. Sixteen (28%) patients, including all 6 patients with ACPA, had radiological evaluation at the end of follow-up (32.5 [22.5-49.8] months), and no patient had structural damage.…”

“…At baseline, the number of tender and swollen joint counts tended to be more important before HCQ and MTX in comparison to RTX initiation, whereas ESSDAI and C-reactive protein levels were similar ( Table 2). Only HCQ treatment was associated with a decrease in tender (0 vs. 7 [3][4][5][6][7][8][9][10] at baseline; p=0.0004) and swollen (0 [0-1] vs. 2 [1-5] at baseline; p<0.0001) joint counts.…”

“…Despite the presence of anti-Citrullinated-Peptide Antibodies (ACPA) in 5 to 10% of pSS, but there is usually no joint erosion during the course of pSS (4)(5)(6). However, in at least half of these cases with ACPA, there was an evolution towards rheumatoid arthritis (RA) (7).…”

Abatacept for Rheumatoid Arthritis: A Novel Formulation, New Mechanisms, New Possibilities

“…Например, в пользу назначения АБЦ при РА могут свидетельствовать клинические данные о его эф-фективности при синдроме Шегрена [189,190], который нередко сочетается с РА, особенно у АЦЦП-позитивных пациентов [191], при ревматоидном васкулите [192], бо-лезни Стилла взрослых [193,194], у пациентов с РА, име-ющих избыточную массу тела (в отличие от ингибиторов ФНОα) [195], а также с сахарным диабетом 1-го типа [196], риск развития которого повышен при РА. При вы-боре терапевтической тактики необходимо принимать во внимание, что АБЦ относится к числу наиболее «безо-пасных» ГИБП, особенно в отношении риска инфекци-онных осложнений [38,[197][198][199], реактивации латент-ной туберкулезной инфекции [200] и обострения интер-Л И Т Е Р А Т У Р А стициального заболевания легких (характерное систем-ное проявление РА) [201][202][203].…”

Serological markers in the diagnosis of rheumatoid arthritis — a clinician’s perspective

“…Presence of anti-CCP autoantibodies in various clinical groups[19, 22,[35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54] …”