Characteristics of Sjögren's Syndrome in Rheumatoid Arthritis

Jing He; Yan Ding; Min Feng; Jianping Guo; Xiaolin Sun; Jing Zhao; Di Yu; Zhanguo Li


Rheumatology. 2013;52(6):1084-1089. 

In This Article

Abstract and Introduction


Objective. To compare features of SS in RA with primary SS and RA without SS.

Methods. Patients hospitalized between January 2007 and December 2010 were retrospectively studied. Seventy-four cases of overlap RA and SS (RA/SS) among 509 cases of RA were identified. Cases of SS (n = 187) detected during the same period acted as controls.

Results. Among those with RA/SS, there were 46 cases of RA-onset SS and 12 cases of SS-onset RA. Sixteen patients had simultaneous-onset RA and SS. Compared with RA without SS, RA/SS patients had more severe arthritis; a higher incidence of haematological abnormality, fever and rash; and a higher frequency of RF, ANAs and anti-SSA and anti-SSB antibodies (P < 0.05). Compared with primary SS, RA/SS patients were older, had more severe arthritis, anaemia and lung involvement; a lower incidence of fever, rash, leucopenia, thrombocytopenia and hyperthyroidism; and a higher frequency of RF, anti-keratin antibody, anti-perinuclear factor and anti-cyclic citrullinated antibodies (P < 0.05). Compared with RA and primary SS, RA/SS patients had higher disease activity scores of both RA and SS.

Conclusion. RA/SS patients have distinctive features, with more complications and systemic involvement. In addition, disease activity is higher in RA/SS.


RA is a systemic autoimmune disease that causes joint damage as well as extra-articular complications. Sicca symptoms are common in patients with RA. SS is a chronic autoimmune disease characterized by lymphocytic infiltration of the exocrine glands. The features of SS are xerostomia and xerophthalmia, which are caused by impaired function of the salivary and lacrimal glands.[1] Earlier studies classified SS as primary or secondary according to whether or not it coexisted with other CTDs. Secondary SS can be associated with diseases such as SLE and RA.[1,2]

Previous studies[3] have revealed profiles of the clinical manifestations of sicca symptoms that are distinct from those of primary SS (pSS). However, the percentage of RA patients who fulfil the SS classification criteria, and the prevalence of sicca symptoms in patients with RA, varies considerably among published studies.[1,4,5] There is controversy about whether secondary SS is related to disease activity and disease duration in RA.[6] In addition, the characteristics and pathogenesis of the SS in RA is unclear. Therefore research that focuses on the features of overlap RA and SS (RA/SS) is needed. In this study we systematically compared the clinical and serological characteristics of RA/SS with pSS and RA to establish features of RA in patients who are prone to developing the sicca syndrome. We also compared complications in different groups, such as the incidence of coronary heart disease, hypertension and diabetes mellitus, in an attempt to explore the clinical spectrum of RA/SS and to help physicians in the recognition of disease severity in patients with RA/SS.