Clinical characteristics and risk factors for overlapping rheumatoid arthritis and Sj\xf6gren\u2019s syndrome

Huaxia Yang,Hua Chen,Yan Zhao,Fengchun Zhang,Sainan Bian,Xiaofeng Zeng,Lidan Zhao,Xuan Zhang,Li Wang

doi:10.1038/s41598-018-24279-1

Abstract

This study investigated the clinical characteristics and risk factors for overlapping rheumatoid arthritis and Sjögren’s syndrome (RA/SS). Patients with RA/SS in Peking Union Medical College Hospital from January 2012 to January 2017 were retrospectively analysed and compared to those of sex- and age–matched RA or SS controls. Logistic regression analysis was used to identify risk factors. Altogether, 105 consecutive patients with RA/SS were enrolled. Ninety-seven (92.4%) of them were female, with a mean age of 51.5 ± 13.3 years or 45.2 ± 14.7years at the diagnosis of SS or RA, respectively. In addition to arthritis and Sicca symptom, patients with RA/SS had more visceral involvements including interstitial lung disease (ILD), and haematologic involvement, and received more glucocorticoid treatments than controls (p < 0.05). RA-onset, simultaneous-onset and SS-onset patients had significant differences in age at RA diagnosis, fever and thrombocytopenia (p < 0.05). Multivariate logistic analysis indicated that arthritis (OR = 44.804), rheumatoid factor (RF) (OR = 5.973), and anti-CCP (OR = 2.545) were independent risk factors for SS overlapping with RA. Xerostomia (OR = 3.960), ILD (OR = 6.210), and anti-SSA (OR = 24.640) were independent predictors of RA overlapping with SS. RA/SS patients have more visceral involvements. Our findings highlight the roles of arthritis/RF/anti-CCP and xerostomia/ILD/anti-SSA in the development of this overlapping disease.

Highlights

Sjögren syndrome (SS) is a progressive autoimmune disease with the hallmark manifestation of Sicca symptom and systemic manifestations[1]
Hand arthritis and bone erosion were observed in 99.0%, 98.1% and 100% of these patients, respectively 86 patients with Rheumatoid arthritis (RA) and SS (RA/SS) had erosion of the joints in posterior–anterior X-radiographs of the hands, while 19 patients with RA/SS showed joint surface destruction in magnetic resonance imaging (MRI) of the hands
Most of them were female with typical erosive arthritis, Sicca symptom, and visceral involvements

Summary

Introduction

Sjögren syndrome (SS) is a progressive autoimmune disease with the hallmark manifestation of Sicca symptom and systemic manifestations[1]. Positive rheumatoid factor (RF) is sometimes accompanied by the joint signs in SS patients[2]. When consistent with RA, the SS patients had distinctive phenotypes other than joint involvements. He et al noted its predilection for more complications and systemic involvement[4,5,6,7]. The risk factors for RA/SS have not been identified. We aimed in this study to describe the baseline characteristics and risk factors of patients with RA/SS in a tertiary medical centre in China. Based on the comparative results of RA/SS with RA or pSS controls, risk factors for RA developing SS and SS developing RA were further identified. Patients with SS-onset RA, RA-onset SS, and simultaneous RA and SS were analysed and compared

Methods

Results

Conclusion