title: Clinical characteristics of RA patients with secondary SS and association with joint damage.
abstract: OBJECTIVE
  Secondary SS (sSS) is a common extra-articular manifestation of RA. There are conflicting data regarding the association of sSS with worse joint damage. This study aims to characterize sSS patients in an RA cohort and study the association between sSS and joint damage.
  
  
  METHODS
  We conducted a cross-sectional study of RA patients with ≥1 year of follow-up at a large academic centre. Subjects with co-morbid diseases that can also result in sicca symptoms were excluded from the analysis. Subjects were considered to have sSS if they were reported as having sSS by their rheumatologist at recruitment into the cohort and had the diagnosis confirmed by chart review. The primary outcome was Sharp score using bilateral hand radiographs at recruitment. We constructed a linear regression model to determine the association of sSS status and Sharp score adjusted by age, gender, disease duration and ACPA and RF status.
  
  
  RESULTS
  We studied 829 RA subjects, mean age 57 years, 83% female, mean RA duration 13 years, 74% seropositive; 85 subjects (10.3%) had sSS. We observed a female predominance (95.3%), longer mean disease duration (16.9 years) and higher frequency of RF or ACPA positive among patients with sSS and RA. Having sSS at baseline was associated with higher Sharp scores (P = 0.03), independent of age, gender, RA disease duration and seropositive disease.
  
  
  CONCLUSIONS
  In our RA cohort, RA subjects with sSS had worse joint damage, suggesting that sSS is a marker of more aggressive disease.
authors.affiliation: Department of Medicine, Massachusetts General Hospital and Division of Rheumatology, Department of Medicine, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Lindsay E
authors.initials: LE
authors.lastname: Brown
authors.affiliation: Department of Medicine, Massachusetts General Hospital and Division of Rheumatology, Department of Medicine, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Frits
authors.affiliation: Department of Medicine, Massachusetts General Hospital and Division of Rheumatology, Department of Medicine, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Christine K
authors.initials: CK
authors.lastname: Iannaccone
authors.affiliation: Department of Medicine, Massachusetts General Hospital and Division of Rheumatology, Department of Medicine, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Weinblatt
authors.affiliation: Department of Medicine, Massachusetts General Hospital and Division of Rheumatology, Department of Medicine, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Shadick
authors.affiliation: Department of Medicine, Massachusetts General Hospital and Division of Rheumatology, Department of Medicine, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA kliao@partners.org.
authors.forename: Katherine P
authors.initials: KP
authors.lastname: Liao
mesh_terms: D000328:Adult; D000368:Aged; D000906:Antibodies / Q000097:blood; D001172:Arthritis, Rheumatoid / Q000150:complications*; D001175:Arthrography; D015897:Comorbidity; D003430:Cross-Sectional Studies; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007596:Joints / Q000473:pathology*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D012217:Rheumatoid Factor / Q000097:blood; D012720:Severity of Illness Index; D012859:Sjogren's Syndrome / Q000150:complications*
chemical_list: D000906:Antibodies; D012217:Rheumatoid Factor
keywords: Sjögren’s syndrome; hand; radiology; rheumatoid arthritis; synovium