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

Associations of local bone involvement with disease activity, damage and functional disability in Sjögren's disease: A cross-sectional study

BACKGROUND

Sjögren's disease (SjD) arthritis is non-erosive, but joint involvement in this disease remains unclear. This study investigated the association between bone erosions and clinical parameters using high-resolution peripheral quantitative computed tomography (HR-pQCT) in patients with SjD.

METHODS

In this cross-sectional study at a quaternary hospital in Brazil, 106 female patients with SjD, aged 18-65 years, who met ACR/EULAR 2016 criteria were evaluated. Exclusion criteria were the use of osteoporosis medication and other bone or autoimmune diseases. Disease activity, damage, functional disability, and laboratory tests were assessed. HR-pQCT was used to identify bone erosions and osteophytes in the 2nd and 3rd metacarpophalangeal and proximal interphalangeal joints, and functional impairment was measured by the handgrip test. Associations between bone erosions, osteophytes, and clinical indices were analysed using logistic regression and generalised linear models.

FINDINGS

Between July 2022 and October 2023, 368 patients were screened, and 106 were included. Bone erosions were present in 56.7 % of patients, predominantly in the 3rd metacarpal head, with a mean volume of 5.71 mm³. Osteophytes were identified in 7.2 % of cases. Erosion volume was significantly higher in older and postmenopausal women, in those with greater damage and in those with osteophytes. Erosion volume increased by 7 % per year of age, and postmenopausal women had a 3.54-fold increase in erosion volume compared to premenopausal women. No significant associations were observed between erosions and disease indices or clinical outcomes.

INTERPRETATION

This study shows a higher prevalence of bone erosions in SjD than previously described, particularly in older, postmenopausal women. These findings highlight the potential of HR-pQCT as a sensitive tool to detect joint damage in SjD, challenging its non-erosive classification.

Exploring hand function in newly diagnosed primary Sjögren's syndrome: Clinical, radiographic, and ultrasonographic insights

BACKGROUND

Primary Sjögren's syndrome (pSS) is a chronic, systemic autoimmune disease. Musculoskeletal and neurological system involvement occurs in patients with pSS, which may lead to impairment in hand function. Hand dysfunction and its underlying causes remain an underexplored area in pSS.

PURPOSE

This study aims to evaluate hand function in patients with newly diagnosed pSS, exploring the associations with disease activity, clinical parameters, and radiographic and ultrasonographic findings.

STUDY DESIGN

Cross-sectional.

METHODS

Fifty patients with newly diagnosed pSS and 50 healthy controls were recruited in this study. Hand functions were evaluated using the Duruöz Hand Index (DHI) and hand grip strength measurements. Detailed hand physical examination was made. Carpal tunnel syndrome (CTS) was assessed with the CTS -6 questionnaire and electrodiagnostic methods. Hands A-P radiography was evaluated for joint erosion, joint space narrowing. Ultrasonographic assessment of hand was made for intercarpal and metacarpophalangeal joint synovitis and extensor tenosynovitis. Additional evaluations included the Hospital Anxiety and Depression Scale (HADS), Short Form-36 (SF-36), Fatigue severity scale (FSS) and the European League Against Rheumatism (EULAR) Sjögren's Syndrome Disease Activity Index (ESSDAI).

RESULTS

Patients with pSS exhibited significantly higher DHI scores compared to controls (p = 0.027, r = 0.22) and lower non-dominant hand grip strength (p = 0.016, r = 0.30), while dominant hand grip strength did not differ significantly (p = 0.520, r = 0.08). Higher HADS anxiety (p < 0.001, r = 0.63) and depression scores (p < 0.001, r = 0.55) were noted in pSS patients. Additionally, these patients had reduced SF-36 scores (p < 0.001, r = 0.53). DHI scores were significantly correlated with ESSDAI (ρ = 0.413, p = 0.003), SF-36 (ρ = -0.605, p < 0.001), HADS (**ρ = 0.307 for anxiety, p = 0.030; ρ = 0.286 for depression, p = 0.044), hand grip strength (ρ = -0.298 for dominant hand, p = 0.036; ρ = -0.280 for non-dominant hand, p = 0.049), Health Assessment Questionnaire (HAQ) (ρ = 0.893, p < 0.001), and FSS (ρ = 0.378, p = 0.007). Ultrasonographic evaluations revealed synovitis and/or tenosynovitis in 18% of patients, while CTS was detected in 32%.

CONCLUSIONS

This study highlights significant hand function impairments in newly diagnosed pSS patients, with DHI scores correlating with disease activity, psychological well-being, and general health. These findings underscore the importance of early and comprehensive hand assessments using advanced diagnostic tools to improve patient outcomes.

Recommendations on neurologic, cognitive, and psychiatric manifestations in patients with Sjögren's disease by the Brazilian Society of Rheumatology

BACKGROUND

Neurological and psychiatric manifestations occur in patients with primary Sjogren's disease (SjD) with a wide-ranging clinical presentation, affecting quality of life, social participation, and prognosis. Despite this, neither central nor peripheral neurological symptoms are systematically evaluated in the context of autoimmunity or identified as manifestations of SjD. The EULAR Sjogren's Syndrome Disease Activity Index (ESSDAI) covers only part of them in the neurological domain.

METHODS

We performed a systematic review of the diagnosis and prevalence of central, peripheral, and autonomic nervous system manifestations in primary SjD, following the recommendations proposed by the Cochrane Collaboration Handbook. Observational studies were included when their main issue was the diagnosis and the prevalence of the manifestations individually. We employed a generalized linear mixed model (GLMM) method with a random-effects model, and the results were computed using logit transformation, implemented through the 'meta' and 'metafor' packages in the R software (version 3.6.1). To present these recommendations, agreement among experts was investigated using the Delphi method in in-person meetings.

RESULTS

We propose ten recommendations regarding the investigation and management of neurological involvement in SjD that had 100% agreement among participants.

CONCLUSION

These recommendations add to the literature on the clinical care of patients with SjD.

The Spectrum of Extraglandular Manifestations in Primary Sjögren's Syndrome

Extraglandular manifestations (EGMs) in primary Sjogren's syndrome (pSS) represent the clinical expression of the systemic involvement in this disease. EGMs are characterized by a wide heterogeneity; virtually any organ or system can be affected, with various degrees of dysfunction. The existing gaps of knowledge in this complex domain of extraglandular extension in pSS need to be overcome in order to increase the diagnostic accuracy of EGMs in pSS. The timely identification of EGMs, as early as from subclinical stages, can be facilitated using highly specific biomarkers, thus preventing decompensated disease and severe complications. To date, there is no general consensus on the diagnostic criteria for the wide range of extraglandular involvement in pSS, which associates important underdiagnosing of EGMs, subsequent undertreatment and progression to severe organ dysfunction in these patients. This review article presents the most recent basic and clinical science research conducted to investigate pathogenic mechanisms leading to EGMs in pSS patients. In addition, it presents the current diagnostic and treatment recommendations and the trends for future therapeutic strategies based on personalized treatment, as well as the latest research in the field of diagnostic and prognostic biomarkers for extraglandular involvement in pSS.

Recommendations for evaluation and diagnosis of extra-glandular manifestations of primary sjogren syndrome: results of an epidemiologic systematic review/meta-analysis and a consensus guideline from the Brazilian Society of Rheumatology (articular, pulmonary and renal)

Sjogren's Syndrome (SS) is an autoimmune disease characterized by lymphocytic infiltration of the exocrine glands and other organs, associated with sicca syndrome but also with systemic involvement with varying degrees of severity. Despite their importance, these systemic manifestations are not routinely evaluated and there is no homogenous approach to their diagnosis or evaluation. To close this gap, a panel of experts from the Brazilian Society of Rheumatology conducted a systematic review and meta-analysis on the identification of epidemiologic and clinical features of these manifestations and made recommendations based on the findings. Agreement between the experts was achieved using the Delphi method. The first part of this guideline summarizes the most important topics, and 11 recommendations are provided for the articular, pulmonary, and renal care of SS patients.

The EFSUMB Guidelines and Recommendations for Musculoskeletal Ultrasound - Part II: Joint Pathologies, Pediatric Applications, and Guided Procedures

The second part of the Guidelines and Recommendations for Musculoskeletal Ultrasound (MSUS), produced under the auspices of EFSUMB, following the same methodology as for Part 1, provides information and recommendations on the use of this imaging modality for joint pathology, pediatric applications, and musculoskeletal ultrasound-guided procedures. Clinical application, practical points, limitations, and artifacts are described and discussed for every joint or procedure. The document is intended to guide clinical users in their daily practice.

Musculoskeletal Manifestations in Sjogren's Syndrome: An Orthopedic Point of View

Sjogren's syndrome (SS) is a frequent entity with a broad symptomatology spectrum, mainly affecting the salivary and lachrymal glands. The disease also affects the musculoskeletal system targeting bones, specific joints, muscles, and the peripheral nerve system. Disease related clinical manifestations canhave an accumulative impact, as the syndrome is commonly associated with other rheumatic diseases. A literature review was performed with the aim to assess the in-depth association of Sjogren's syndrome and its treatment agents with the musculoskeletal system and further investigate its potential relevance with common orthopedic postoperative complications.