FRI0158 CLINICAL AND IMAGING FEATURES OF ARTICULAR MANIFESTATIONS IN PRIMARY SJÖGREN’S SYNDROME: SIMILARITIES AND DIFFERENCES ACCORDING TO THE TIME OF ONSET
Authors: F. Carubbi, A. Alunno, P. Cipriani, E. Bartoloni Bocci, A. Conforti, I. DI Cola, R. Gerli, R. Giacomelli
Journal: Annals of the Rheumatic Diseases (2020)

Background: Articular manifestations (AMs) are observed in a large proportion of patients with primary Sjögren’s syndrome (pSS) and can occur at the time of pSS diagnosis or during the disease course. Although in the majority of cases AMs are mild and self-limiting, some patients may experience chronic polyarthritis requiring treatment with DMARDs. However to date no specific discriminating biomarkers have been identified. Magnetic resonance imaging (MRI) can help assessing the extent of articular involvement and guide the treatment. Objectives: To describe clinical and serological features of patients with pSS developing articular involvement along with the MRI findings of affected joints. Methods: Clinical records were retrospectively evaluated and MRI was performed to evaluate AMs. Disease activity was assessed with the EULAR SS disease activity index (ESSDAI) and its clinical version without the biological domain (ClinESSDAI). Patient-reported symptoms were assessed with the EULAR SS Patient Reported Index (ESSPRI). MRI features were described according to the OMERACT rheumatoid arthritis (RA) MRI scoring system. Values are displayed as mean ± standard error of the mean or number and percentages. Patients were tested for autoantibodies such as anti-cyclic citrullinated peptide, anti-citrullinated α enolase and anti-carbamylated proteins with commercially available ELISA kits. Results: 45 pSS patients were included. 29 patients (64%) displayed AMs at pSS onset while 15 (36%) at a later stage (6.7±1 years after pSS diagnosis). Besides AMs, at the time of pSS diagnosis the two cohorts were comparable with regard to other ESSDAI domains. Interestingly, all patients with anti-SSA and anti-/SSB had AMs at the time of pSS diagnosis (p=0.05) while those developing AMs in the disease course were more likely single positive for anti-SSA (p=0.04). When comparing the clinical and serological features of both groups of patients at the time of overt AMs (Tables 1-2), patients that displayed AMs in the course of the disease have a significantly higher ESSPRI compared to patients that display AMs at pSS onset. With regard to MRI, 80% of patients with AM displayed signs of synovitis, 59% bone erosions, 59% joint space narrowing and 50% bone marrow oedema. To note, 60% of patients displaying AMs at pSS onset show bone marrow oedema while this is present in only 27% of patients developing AMs at a later stage (p&lt;0.05). Anti-cyclic citrullinated peptide, anti-citrullinated α enolase, anti-carbamylated proteins were undetectable in all patients. Conclusion: Our results confirm the relevance of AMs in pSS, particularly because of the high prevalence of RA-like MRI features. MRI assessment in patients with pSS is advisable to identify more severe AMs in the spectrum of pSS disease and guide the therapeutic approach. Table 1. Clinical and serological features at the time of overt AMs. Categoric variables All AMs (N=44) AMs at pSS onset (n=29) AMs in the course of disease (N=15) N % N % N % p value ESSDAI domains Constitutional 3 7 3 10 0 0 0.54 Lymphadenopathy 15 34 7 24 8 53 0.09 Glandular 9 20 5 17 4 27 0.46 Articular 44 100 29 100 15 100 na Cutaneous 6 14 2 7 4 27 0.15 Pulmonary 6 14 5 17 1 7 0.65 Renal 0 0 0 0 0 0 na Muscular 0 0 0 0 0 0 na PNS 6 14 4 14 2 13 1 CNS 1 2 0 0 1 7 0.34 Hematological 10 23 8 28 2 13 0.45 Biological 5 11 1 3 4 27 0.04 Morning stiffness 44 100 29 100 15 100 na Small joints 29 66 17 59 12 80 0.31 Large joints 3 7 2 7 1 7 1 Both 12 27 10 34 2 13 0.17 Table 2. Clinical and serological features at the time of overt AMs. Continuous variables All AMs (N=44) AMs at pSS onset (n=29) AMs in the course of disease (N=15) p value MEAN±SEM MEAN±SEM MEAN±SEM Years from pSS diagnosis 2.3±0.6 0 6.7±1 na VAS pain 8.4±0.3 7.7±0.4 9.7±0.15 0.001 VAS dryness 7±0.4 5.6±0.5 7.5±0.6 0.02 VAS fatigue 6.3±0.4 6.3±0.5 8.5±0.7 0.02 ESSPRI 7.2±0.3 6.5±0.4 8.6±0.4 0.001 ESSDAI 18±1.6 16.8±1.8 20.2±3 0.32 ClinESSDAI 17.5±1.6 16.4±1.8 19.6±3 0.35 N of involved joints 5.5±4 6.3±0.8 4±0.5 0.06 Disclosure of Interests: Francesco Carubbi Speakers bureau: Francesco Carubbi received speaker honoraria from Abbvie and Celgene outside this work., Alessia Alunno: None declared, Paola Cipriani Grant/research support from: Actelion, Pfizer, Speakers bureau: Actelion, Pfizer, Elena Bartoloni Bocci: None declared, Alessandro Conforti: None declared, Ilenia Di Cola: None declared, Roberto Gerli: None declared, Roberto Giacomelli Grant/research support from: Actelion, Pfizer, Speakers bureau: Abbvie, Roche, Actelion, BMS, MSD, Ely Lilly, SOBI, Pfizer