Background/Purpose: Sjögren’s disease (SjD) is a chronic multisystem autoimmune condition characterized by sicca syndrome and inflammatory arthralgia, more common in women. Bone involvement can result in osteoporosis and fragility fractures, with peripheral joint erosions present but less frequent and smaller than in rheumatoid arthritis (RA). No studies have evaluated the relationship between joint erosions, bone microarchitecture, and parameters of disease activity and accumulated damage. This study aims to evaluate the association between bone erosion in metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints, bone microarchitecture, systemic disease activity, and damage index in women with SjD, and to assess the association between systemic bone involvement and SjD activity and damage indices.

Methods: This prospective study selected adult women with SjD according to the American College of Rheumatology and EULAR criteria, without conditions and/or medication use affecting bone metabolism or immobility. Joint erosions and osteophytes were evaluated by high-resolution peripheral quantitative computed tomography (HR-pQCT) and ultrasound (US); bone microarchitecture by HR-pQCT; bone mineral density and trabecular bone score (TBS) of the lumbar spine by dual-energy X-ray absorptiometry (DXA); systemic disease activity, symptom score, and damage index by EULAR Sjögren’s Syndrome Disease Activity Index (ESSDAI), EULAR Sjögren’s Syndrome Patient Reported Index (ESSPRI), and Sjögren’s Syndrome Disease Damage Index (SSDI), respectively.
 

Results: Of the 368 patients assessed, 106 were included. Mean age was 49.6 ± 9.2 years, body mass index (BMI) 28.5 ± 5.5 kg/m², and 49% identified as white. Disease duration was 7 (4–14) years, with ESSDAI 1 (0–3), ESSPRI 5.3 (3.3–7.0), and SSDI 2 (1–3). HR-pQCT showed 55 (56.7%) patients with joint erosions, predominantly in MCP and PIP joints, with the third metacarpal head being the most frequent site (74.4%). DXA did not indicate osteopenia or densitometric osteoporosis, with TBS 1.420 ± 0.09. In US, 47% had erosions and 32% had osteophytes, mainly in PIP and DIP joints, with synovitis in 58%. No correlation between erosion presence and disease activity or damage indices. SSDI inversely related to the following structural parameters: cortical volumetric bone mineral density [Ct.vBMD] of the radius (ρ -0.24; P = 0.018) and tibia (ρ -0.38; P < 0.001); cortical area (ρ -0.30; P = 0.003) and trabecular number [tTb.N] (ρ -0.25; P = 0.016) of the tibia. Cortical porosity of the radius (ρ 0.33; P < 0.001) and tibia (ρ 0.38; P < 0.001), as well as pore diameter (ρ 0.29; P = 0.003) and trabecular separation [tTb.Sp] (ρ 0.24; P = 0.019) of the tibia were greater in patients with higher disease damage, considering age, disease duration, and cumulative glucocorticoid dose. HR-pQCT identified more joint erosions than US (56.7% vs. 47%, P = 0.00317).

Conclusion: HR-pQCT is a valuable tool for identifying joint erosions and bone microarchitecture changes in SjD patients. Joint erosion is common in SjD. Systemic bone involvement correlates with the disease damage index, highlighting the importance of detailed bone assessment for better management and treatment.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/association-of-bone-erosion-and-microarchitecture-with-disease-activity-and-damage-in-sjogrens-disease/