Background/Purpose: Primary Sjögren’s syndrome (pSS) is an autoimmune disease characterized by lymphocyte infiltration of various exocrine glands, often associated with joint involvement traditionally described as non-erosive. On the other hand, patients with secondary Sjogren’s syndrome (sSS) to rheumatoid arthritis (RA) can show a pattern of arthritis indistinguishable from that observed in patients with RA without SS associated. The description of these differential patterns of disease activity was described by plain X-ray films. The advent of new imaging techniques such as magnetic resonance imaging (MRI) and musculoskeletal ultrasound (MSUS) have changed paradigms of subclinical structural damage in various rheumatic diseases. Objective: To characterize by MSUS the morphologic and structural changes in the joints of the hands of patients with SS.

Methods: Patients with the diagnosis of pSS according to the European-American criteria for the classification of Sjögren’s syndrome and sSS patients with associated AR as a control group. A Siemens Acuson Antares ® MSUS equipment was used, using a hockey stick type probe (7-12 MHz) images were obtained from the carpal recess, metacarpal and interphalangeal joints of both hands. The presence of synovitis (synovial hypertrophy or joint effusion), erosions and Doppler signal were intentionally sought. MSUS pathology definitions were used as described by the OMERACT group study.

Results: Seventeen patients with pSS and 18 sSS were evaluated, mean age of 60.2 ± 11.91 years. Time evolution of the disease in pSS group was 3 years and 9 years for sSS. Fourteen patients (82%) of the pSS group were positive for rheumatoid factor compared with one hundred percent of individuals with sSS (p= ns). Anti-Ro/SSA antibody was positive in 59% (10) of patients with the primary presentation of the syndrome, unlike the secondary form which was only found in 2% (11) (p = 0.004). Anti-La/SSB antibody was positive in 6 patients with pSS (35%) compare to 0% (0) from the sSS group (p = 0,007). Anti-cyclic citrullinated protein antibodies were positive in most patients with the secondary form of SS (72%), while only 1 out of 17 patients with pSS were positive (6%) (p = <0.001). None of the patients evaluated in this study were positive for anti-Sm antibody. Synovitis of the radiocarpal and midcarpal recesses were found in 62% (21) of the 34 wrists evaluated in pSS group and 81% (29/36) of sSS,; erosions were found in 3 (9%) wrists of patients with pSS and in 14 (39%) of sSS (p = 0.004). Synovitis was present in several joints (wrists, MCP and PIP) in both groups of patients evaluated (Fig.1), predominantly the 2nd and 4th MCP joints of patients with sSS (p < 0.05).

Conclusion: High resolution MSUS confirms that pSS arthropathy is as inflammatory as sSS associated with RA, however is clearly not as erosive.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/ultrasonographic-evaluation-of-the-hands-of-patients-with-primary-and-secondary-sjogrens-syndrome/