Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: primary Sjogren’s syndrome (pSS) articular manifestations include often tender joints and more rarely synovitis. The main objective of this study was to describe characteristics, treatment and outcome of patients presenting pSS-related joint involvement with synovitis.
Methods: we performed a French multicentric retrospective study including all cases of adult-onset pSS (AECG criteria) with at least one clinical and/or echographic synovitis from 1998 to 2015. Data concerning clinical, biological and radiological findings were collected, as well as treatments. Disease activity was assessed using ESSDAI scale. Complete treatment response for joint involvement was defined as disappearance of all signs and synovitis, partial response as more than 50% improvement. Controls with pSS without synovitis were used to determine the factors associated with joint involvement.
Results: we identified 57 patients (93% women) with median age at the diagnosis of joint involvement of 54 years-old (45-63). The number of tender joint was 8 (4-12) with 4 (2-6) swollen joints. Synovitis was clinical in 65.3% patients, and 26 (44.7%) patients had MRI or echographic confirmation of synovitis. No erosion was seen on X-ray in all cases. The more frequent articular finding was a symmetric polyarthritis (68.4%) and the predominant swollen joints were metacarpophalangeal joint (67.9%). C-reactive protein was 5 (3-9.3) mg/l at the time of synovitis diagnosis. Rheumatoid factor and CCP-antibodies were present in 44.9% and 13.7% patients, respectively. Median ESSDAI scale was 7 (5-9). All patients received at least one therapeutic line. Steroids were used alone in 6 (10.5%) cases, in association with hydroxychloroquine (HCQ) in 19 (33.3%) cases, and in association with methotrexate (MTX) in 18 (31.6%) cases. A second line was initiated for 31 (54%) with HCQ in 13 (41.9%) cases, MTX for 14 (43.6%) patients, and rituximab (RTX) for 10 (34.5%) patients. Thirteen (23%) patients received a third line with MTX in 9 (69.2%) cases, and RTX in 6 (46.2%) cases. In this 101 therapeutic lines, steroids were used in 78 (77.2%) lines with a median amount of 10 (7-12.5) mg/day, HCQ in 57 (57%) lines with a daily dose of 400 mg, MTX in 44 (44%) lines with a weekly-dose of 15 (15-20) mg. RTX was used in 19 (18,8%) lines and TNFa antagonists in 4 (4%) cases. Number of swollen joints, ESSDAI score and steroids dose significantly decreased from the baseline considering HCQ alone (35 lines), MTX (17 lines), and significant ESSDAI score and steroids dose decrease was noted under RTX (19 lines). Number of swollen joints, ESSDAI score or steroids dose reduction decrease was similar considering patients treated by HCQ, MTX or RTX. Comparing 57 pSS with synovitis with 104 pSS controls without joint involvement, cases were younger (54 [23-81] vs. 55 [18-81] years, p < 0.05), with more frequent lymph nodes (12.3% vs 1.8%, p = 0.007). Patients with joint involvement and synovitis were treated more frequently with HCQ (67% vs. 15%, p < 0.0001), steroids (75% vs. 6%, p < 0.0001), and methotrexate (37% vs. 0.8%, p < 0.0001).
Conclusion: the pSS articular manifestations may include synovitis. Even the use of HCQ, MTH, and RTX seem to be effective for joint involvement, the best regimen remain to be determined.
To cite this abstract in AMA style:Mirouse A, seror R, Mariette X, Dougados M, Fauchais AL, Deroux A, Costedoat-Chalumeau N, Sellam J, Arlet JB, Lavigne C, Fischer-Dumont D, Mékinian A, Fain O. Characteristics, Treatment and Outcome of Joint Involvement with Synovitis in Primary SjöGren’s Syndrome: French Multicentric Retrospective Case-Control Study [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/characteristics-treatment-and-outcome-of-joint-involvement-with-synovitis-in-primary-sjogrens-syndrome-french-multicentric-retrospective-case-control-study/. Accessed September 28, 2020.
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