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Jarrot PA, Arcani R, Darmon O, Roudier J, Cauchois R, Mazodier K, Jean R, Balandraud N, Kaplanski G. Axial Articular Manifestations in Primary Sjögren Syndrome: Association With Spondyloarthritis. J Rheumatol 2020; 48:1037-1046. [PMID: 32669446 DOI: 10.3899/jrheum.200189] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the prevalence of axial articular manifestations (AAMs) in patients with primary Sjögren syndrome (pSS), to investigate whether these symptoms reveal an associated spondyloarthritis (SpA), and to assess their therapeutic management. METHODS Among 148 consecutive patients with pSS fulfilling European League Against Rheumatism (EULAR)/American College of Rheumatology 2019 classification criteria followed between 2010 and 2018, we selected those who presented with AAMs. The association with SpA was retained when patients fulfilled Assessment of SpA international Society criteria. RESULTS A total of 29 patients (20%, 28 women) with a median age of 43 years (range 15-65 yrs), were identified. The main extraglandular features were peripheral arthralgia and arthritis in 93% and 90% of patients, respectively. Positive anti-Ro/SSA (anti-SSA) antibody was reported in 62%. AAMs were inaugural in 7%, delayed from the diagnostic of pSS in 7%, and occurred concomitantly in 86% of patients. AAMs were not associated to multisystemic involvement of pSS. Radiographic sacroiliitis was mentioned in 65%, and HLA-B27 was positive in 13%. The diagnosis of SpA was retained in 23/29 patients (79%), among which 74% and 26% fulfilled psoriatic arthritis and ankylosing spondylitis criteria, respectively. There was no phenotypic difference according to the anti-SSA antibody status. With a median follow-up of 60 months (range: 5-96), 61% of patients with associated SpA required biotherapies, mainly of anti-tumor necrosis factor-α or anti-interleukin 17A molecules with a good clinical outcome in 64% and no effect on pSS. CONCLUSION AAMs are not uncommon in patients with pSS and may reveal an associated SpA. Treatment of AAMs, especially when clearly associated with SpA, may necessitate biologics, following SpA-management therapeutic guidelines.
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Affiliation(s)
- Pierre-André Jarrot
- P.A. Jarrot, MD, PhD, R. Cauchois, MD, G. Kaplanski, MD, PhD, Department of Internal Medicine and Clinical Immunology CHU Conception, AP-HM, and Center for Cardiovascular and Nutrition Research, INRA 1260, INSERM UMR_S1263, Aix-Marseille University;
| | - Robin Arcani
- R. Arcani, MD, O. Darmon, MD, K. Mazodier, MD, R. Jean, MD, Department of Internal Medicine and Clinical Immunology CHU Conception, AP-HM
| | - Olivier Darmon
- R. Arcani, MD, O. Darmon, MD, K. Mazodier, MD, R. Jean, MD, Department of Internal Medicine and Clinical Immunology CHU Conception, AP-HM
| | - Jean Roudier
- J. Roudier, MD, PhD, N. Balandraud, MD, PhD, Department of Rheumatology, Institut du Mouvement et de l'appareil Locomoteur, CHU Sainte-Marguerite, AP-HM, and INSERM UMRs1097, Aix-Marseille University, Marseille, France
| | - Raphael Cauchois
- P.A. Jarrot, MD, PhD, R. Cauchois, MD, G. Kaplanski, MD, PhD, Department of Internal Medicine and Clinical Immunology CHU Conception, AP-HM, and Center for Cardiovascular and Nutrition Research, INRA 1260, INSERM UMR_S1263, Aix-Marseille University
| | - Karin Mazodier
- R. Arcani, MD, O. Darmon, MD, K. Mazodier, MD, R. Jean, MD, Department of Internal Medicine and Clinical Immunology CHU Conception, AP-HM
| | - Rodolphe Jean
- R. Arcani, MD, O. Darmon, MD, K. Mazodier, MD, R. Jean, MD, Department of Internal Medicine and Clinical Immunology CHU Conception, AP-HM
| | - Nathalie Balandraud
- J. Roudier, MD, PhD, N. Balandraud, MD, PhD, Department of Rheumatology, Institut du Mouvement et de l'appareil Locomoteur, CHU Sainte-Marguerite, AP-HM, and INSERM UMRs1097, Aix-Marseille University, Marseille, France
| | - Gilles Kaplanski
- P.A. Jarrot, MD, PhD, R. Cauchois, MD, G. Kaplanski, MD, PhD, Department of Internal Medicine and Clinical Immunology CHU Conception, AP-HM, and Center for Cardiovascular and Nutrition Research, INRA 1260, INSERM UMR_S1263, Aix-Marseille University
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Im JH, Chung MH, Park YK, Kwon HY, Baek JH, Lee SY, Lee JS. Antinuclear antibodies in infectious diseases. Infect Dis (Lond) 2019; 52:177-185. [PMID: 31718355 DOI: 10.1080/23744235.2019.1690676] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Introduction: Antinuclear antibody (ANA) tests are widely used for the diagnosis of autoimmune diseases, but ANAs are also commonly found in patients with various infections. This retrospective study aimed to investigate the relationship between infections and ANA status.Methods: Patients that visited the Department of Infectious Diseases at Inha University Hospital between January 2007 and July 2018 were investigated. We analysed their ANA test results and reviewed rheumatic and infectious diagnoses of patients with positive ANA findings.Results: Of the 9,320 patients during the study period, 1,111 underwent ANA testing and 110 tested positive. Seven of the 110 patients were previously diagnosed with ANA-positive disease, and 21 were diagnosed with autoimmune disease during the present study. Of the remaining 82 patients, 43 were confirmed with infectious disease. The most common pathogen was Mycobacterium tuberculosis (n = 10), followed by Treponema pallidum (n = 5), Orientia tsutsugamushi (n = 5), Escherichia coli (n = 5), Bartonella henselae (n = 3), and human immunodeficiency virus (n = 3). Of the 39 patients without a confirmed pathogen, 7 were seropositive for O. tsutsugamushi, B. henselae, or Rickettsia spp. Patients were observed at an average of 24 weeks in our hospital. One patient developed systemic lupus erythematosus after being diagnosed with Epstein-Barr virus-induced infectious mononucleosis, and another patient developed adult-onset Still's disease after being diagnosed with scrub typhus.Conclusion: This study showed that various relationships exist between infections and rheumatic diseases. In particular, several patients with a positive ANA test result were found to have intracellular infections such as mycobacterial infections, syphilis, or scrub typhus.
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Affiliation(s)
- Jae Hyoung Im
- Division of Infectious Diseases, Department of Internal Medicine, Inha University School of Medicine, Incheon, Republic of Korea
| | - Moon-Hyun Chung
- Department of Internal Medicine, Seigui-po Medical Center, Jeju-Do, Republic of Korea
| | - Young Kyoung Park
- Translation Research Center, Inha University School of Medicine, Incheon, Republic of Korea
| | - Hea Yoon Kwon
- Division of Infectious Diseases, Department of Internal Medicine, Inha University School of Medicine, Incheon, Republic of Korea
| | - Ji Hyeon Baek
- Division of Infectious Diseases, Department of Internal Medicine, Inha University School of Medicine, Incheon, Republic of Korea
| | - Seung Yun Lee
- Department of Rheumatology, Inha University Hospital, Incheon, Republic of Korea
| | - Jin-Soo Lee
- Division of Infectious Diseases, Department of Internal Medicine, Inha University School of Medicine, Incheon, Republic of Korea
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Eren R, Can M, Alibaz-Öner F, Yilmaz-Oner S, Yilmazer B, Cefle A, Direskeneli H, Atagündüz P. Prevalence of inflammatory back pain and radiologic sacroiliitis is increased in patients with primary Sjögren's syndrome. Pan Afr Med J 2018; 30:98. [PMID: 30344882 PMCID: PMC6191247 DOI: 10.11604/pamj.2018.30.98.15588] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 05/23/2018] [Indexed: 01/21/2023] Open
Abstract
Introduction The prevalence of Sjögren's syndrome (SS) in patients with the diagnosis of SpA has been reported to be higher than normal population. Yet, the vice-versa is unclear. In this study, we aimed to investigate the prevalence of IBP, radiologic sacroiliitis and SpA in patients with primary SS. Methods 85 patients followed at the rheumatology clinics of the Marmara and Kocaeli Universities with the diagnosis of primary SS between November 2011 and August 2012 were included in this study. The control group consisted of 100 age-and gender-matched patients. Inflammatory back pain and axial SpA were diagnosed according to the assessment of spondylo arthritis International Society (ASAS) criteria. Results 83 patients were (97%) female and 2 (3%) were male. Mean age of the patients was 49.1 (±11) years. Mean disease duration was 7.3 (±4) years. The patient and control groups were comparable in terms of age and gender (p > 0.05). Inflammatory back pain was observed in 21 (24.7%) of 85 primary SS patients and in 4 (4%) of 100 control subjects (p < 0.001), radiographic sacroiliitis was demonstrated in 9 (10.5%) of primary SS patients and 2 (2%) of the control subjects (p = 0.025). Remaining SpA findings were not encountered in either group. Conclusion inflammatory back pain and radiologic sacroiliitis is increased in patients with primary SS. Whether IBP, SI joint inflammation and radiologic sacroiliitis is due to the co-existence of SpA and primary SS or IBP is an underdiagnosed clinical feature of SS deserves further studies of large patient numbers.
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Affiliation(s)
- Rafet Eren
- Department of Hematology, University of Health Sciences, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Meryem Can
- Department of Rheumatology, Medipol University, Faculty of Medicine, Istanbul, Turkey
| | - Fatma Alibaz-Öner
- Department of Rheumatology, Marmara University, Faculty of Medicine, Istanbul, Turkey
| | - Sibel Yilmaz-Oner
- Department of Rheumatology, Bakirköy Sadi Konuk Training and Research Hospital, Istanbul,Turkey
| | - Baris Yilmazer
- Department of Rheumatology, Kocaeli University, Faculty of Medicine, Kocaeli, Turkey
| | - Ayse Cefle
- Department of Rheumatology, Kocaeli University, Faculty of Medicine, Kocaeli, Turkey
| | - Haner Direskeneli
- Department of Rheumatology, Marmara University, Faculty of Medicine, Istanbul, Turkey
| | - Pamir Atagündüz
- Department of Rheumatology, Marmara University, Faculty of Medicine, Istanbul, Turkey
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