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Characterizing hand and wrist ultrasound pattern in primary Sjögren’s syndrome: a case-control study

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Abstract

Introduction/objectives

To evaluate the clinical relevance of high-resolution hand and wrist ultrasound (US) findings and their possible associations with anti-citrullinated peptide antibodies in primary Sjögren’s syndrome (pSS).

Methods

Ninety-seven consecutive pSS patients (American-European Consensus Group, 2002) without meeting the American College of Rheumatology (ACR) criteria (1987) for rheumatoid arthritis (RA); 20 RA patients (ACR/European League Against Rheumatism (EULAR) criteria, 2010); and 80 healthy individuals with comparable age, gender, and ethnicity were enrolled in a case-control study. Disease activity was assessed by EULAR Sjögren’s Syndrome Disease Activity Index (ESSDAI). US was performed by one expert blinded to anti-CCP, anti-MCV, and IgM rheumatoid factor tested by ELISA.

Results

Frequencies of grade 3 synovitis (9.3 vs. 0%, p = 0.004), tenosynovitis (36.1 vs. 3.8%, p < 0.001), and erosions (27.8 vs. 7.5%, p = 0.001) on US were higher in pSS patients than in healthy controls. ESSDAI presented a moderate correlation with the synovitis number (p = 0.001) and tenosynovitis (p < 0.001). Most pSS patients with erosions on US (81.5%) had negative anti-CCP. Nevertheless, anti-CCP ≥ 3× cut-off value was associated with the presence of erosions in pSS (p = 0.026). Erosions in pSS were mainly small size contrasting with moderate/large size in RA (p < 0.001), and positive power Doppler synovitis predominated in RA (p < 0.001).

Conclusions

US identified significant frequencies of grade 3 synovitis, tenosynovitis, and erosions in pSS. Synovitis and tenosynovitis numbers were correlated with ESSDAI. Association between erosions on US and anti-CCP (high titers) in pSS possibly identifies a subgroup with severe arthritis. These findings suggest that US is a useful method for assessing joint involvement in pSS.

Key Points

• US identified significant frequencies of grade 3 synovitis, tenosynovitis, and erosions in pSS patients in comparison with age- and race-healthy individuals.

• Numbers of synovitis and tenosynovitis on US were correlated with ESSDAI values.

• Most pSS patients with erosions on US were negative for anti-CCP, but anti-CCP ≥ 3× cut-off value was associated with the presence of erosions in this disease.

• Erosions in pSS were mainly small size contrasting with moderate/large size in RA, and positive power Doppler synovitis predominated in RA.

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Funding

This study was supported by grants from the Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) (#2010/10013-4) and Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPQ) (#305068/2014-8 to EB).

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Authors and Affiliations

  1. Rheumatology Division, Hospital das Clinicas, Faculdade de Medicina da Universidade de Sao Paulo (HCFMUSP), Av. Dr. Arnaldo, 455, 3° andar, sala 3190, Cerqueira Cesar, Sao Paulo, SP, 01246-903, Brazil

    L. K. N. Guedes, E. P. Leon, T. S. Bocate, K. R. Bonfigliolli, E. Bonfa & S. G. Pasoto

  2. Department of Dermatology, Medical School, University of Sao Paulo, Sao Paulo, Brazil

    S. V. Lourenço

Authors
  1. L. K. N. Guedes
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  2. E. P. Leon
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  3. T. S. Bocate
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  4. K. R. Bonfigliolli
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  5. S. V. Lourenço
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  6. E. Bonfa
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  7. S. G. Pasoto
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Correspondence to S. G. Pasoto.

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The project was approved by the local Ethics Committee (05204912.7.0000.0068), and all patients and healthy individuals signed the informed consent form.

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Guedes, L.K.N., Leon, E.P., Bocate, T.S. et al. Characterizing hand and wrist ultrasound pattern in primary Sjögren’s syndrome: a case-control study. Clin Rheumatol 39, 1907–1918 (2020). https://doi.org/10.1007/s10067-020-04983-y

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