Joint involvement in primary Sjögren's syndrome: an ultrasound "target area approach to arthritis".
OBJECTIVE
To characterize the ultrasound (US) pattern of joint involvement in primary Sjögren's syndrome (pSS).


METHODS
Seventeen patients with pSS, 18 with secondary Sjögren's syndrome (sSS), and 17 healthy controls underwent US examinations of various articular regions. Synovitis (synovial hypertrophy/joint effusion), power Doppler (PD) signals, and erosions were assessed.


RESULTS
In patients with pSS, synovitis was found in the metacarpophalangeal joints (MCP, 76%), wrists (76%), and knees (76%), while the proximal interphalangeal joints, elbows, and ankles were mostly unscathed. Intra-articular PD signals were occasionally detected in wrists (12%), elbows (6%), and knees (6%). Erosions were evident in the wrists of three (18%) patients with pSS, one of these also having anti-cyclic citrullinated peptide (anti-CCP) antibodies. While US synovitis does not discriminate between sSS and pSS, demonstration of bone erosions in the 2nd MCP joints showed 28.8% sensitivity and 100% specificity for diagnosing sSS; in comparison, these figures were 72.2 and 94.1% for circulating anti-CCP antibodies.


CONCLUSIONS
In pSS, the pattern of joint involvement by US is polyarticular, bilateral, and symmetrical. Synovitis is the US sign most commonly found in patients with pSS, especially in MCP joints, wrists, and knees, and bone erosions also may occur.
Department of Immunology, Instituto Nacional de Cardiología Ignacio Chávez, Tlalpan, 14080 Mexico City, Mexico.
Luis M
LM
Amezcua-Guerra
Fritz
F
Hofmann
Angelica
A
Vargas
Pedro
P
Rodriguez-Henriquez
Carla
C
Solano
Cristina
C
Hernández-Díaz
Diana
D
Castillo-Martinez
Lucio
L
Ventura-Ríos
Marwin
M
Gutiérrez
Carlos
C
Pineda
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D006801:Humans; D007717:Knee / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008662:Metacarpophalangeal Joint / Q000000981:diagnostic imaging* / Q000473:pathology; D008875:Middle Aged; D012859:Sjogren's Syndrome / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D013585:Synovitis / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D014463:Ultrasonography; D014953:Wrist / Q000000981:diagnostic imaging / Q000473:pathology