Axial articular manifestations in primary Sjögren's syndrome: Association with spondyloarthritis.

Objective To assess the prevalence of axial articular manifestations (AAMs) in primary Sjogren’s syndrome (pSS) patients; to investigate whether these symptoms do reveal an associated spondyloarthritis (SpA); and to assess their therapeutic management. Methods Among 148 consecutive pSS patients fulfilling ACR/EULAR classification criteria followed between 2010 and 2018, we selected those who presented with AAMs. The association with SpA was retained when patients fulfilled ASAS criteria. Results A total of 29 patients (20%, 28 women), median age of 43 years (range: 15–65), were identified. The main extra-glandular features were peripheral arthralgia and arthritis in 93% and 90%, respectively. Positive 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 pluri-systemic involvement of pSS. Radiological 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-TNF-⍺ or anti-IL17A molecules with a good clinical outcome in 64% and no effect on pSS. Conclusion AAMs are not uncommon in pSS patients and may reveal an associated SpA. Treatment of AAMs, especially when clearly associated with SpA, may necessitate biologicals following SpA-management therapeutic guidelines.