Atteintes articulaires dans le syndrome de Sjögren primitif

Joint involvement is one of the most common extra-glandular manifestations in primary Sjögren's syndrome (pSS), affecting almost half of the patients with clinical arthritis in 16 %. Most commonly, these are symmetrical arthritis, affecting fewer than 5 joints. Ultrasound shows grade 1 or 2 synovitis, with a positive doppler signal in less than a fourth of cases, and tenosynovitis, mostly of the finger flexors. Radiographs should not show erosion. In presence of erosions on ultrasound or MRI, which may be found on MCP and wrists, RA with secondary SS should be excluded. Five to 10 % of patients with SSp have anti-CCP antibodies. The presence of anti-CCP antibodies does not necessarily exclude the diagnosis of SSp, but it should alert to the risk of further development of RA, therefore requiring radiographic follow-up even if the pSS has been evolving for many years. Joint involvement has a good prognosis and appears to be a predictor of a favourable clinical course. Treatment should be guided by the level of clinical activity and should be based on NSAIDs or corticosteroids ± hydroxychloroquine. Synthetic disease-modifying anti-rheumatic drugs should be offered for corticosteroid sparing.