Ab0671 longitudinal assessment of hand and wrist bone destruction by ultrasound, and its association with disease activity in primary sjögren’s syndrome

Background Primary Sjögren’s syndrome (pSS) is a chronic systemic inflammatory autoimmune disease primarily affecting the exocrine glands (1). Joint damage is the main extra-glandular manifestation, usually described in 11% of patients as non-erosive polyarthritis of small joints, mainly of the upper limbs (2). Although articular bone erosion is a rare finding on hands’ radiography, hand and wrist ultrasound (US) is an emerging technology in the rheumatology field used for diagnosis and follow-up disease activity through the assessment of bone articular erosions, synovitis and tissue power doppler (3). Objectives To evaluate joint damage by hand and wrist ultrasound, and its association with disease activity in primary Sjögren’s syndrome patients in a longitudinal setting. Methods Ninety-seven consecutive pSS patients according to the American College of Rheumatology (ACR) and European Alliance of Associations for Rheumatology (EULAR) criteria without meeting the ACR criteria (1987) for rheumatoid arthritis were evaluated by hand and wrist ultrasound and clinical activity disease index previously by our group (3). Twelve patients of this initial evaluation were followed with hand and wrist ultrasound and clinical activity disease index. Disease activity was assessed by EULAR Sjögren’s Syndrome Disease Activity Index (ESSDAI). The US was performed by one expert blinded. Data were analyzed by Wilcoxon signed-rank test. Significance level was set at P<0.05. Results All patients were female and 8 (66.6%) were white. The time between the first and the second evaluation was 9.5 ± 1.6 years. At the first evaluation, only 1 (8.3%) patient had wrist erosion, 5 (41.6%) patients had synovitis and 4 (33.3%) patients had tissue power doppler in the US. The mean ESSDAI was 6.83 ± 5.70. At the second evaluation, 5 (41.6%) patients had wrist erosion (P=0.059), 10 (83.3%) patients had synovitis (P=0.010) and 7 (58.3%) patients had tissue power doppler in the US (P = 0.014). The mean ESSDAI was 2.33 ± 4.05 (P = 0.022). After the follow-up period, despite the improvement in the disease activity score, there was an increase in the number of erosions, mainly of the wrists, presence of tissue power doppler and synovitis. Conclusion This study describes a longitudinal evaluation of a small sample size of pSS. The findings show a worsening of joint assessments despite low-activity disease, indicating possible local inflammation in addition to systemic involvement. References [1]Mariette X, Criswell LA. Primary Sjögren’s Syndrome. N Engl J Med. 2018. [2]Negrini S, Emmi G, Greco M, Borro M, Sardanelli F, Murdaca G, et al. Sjögren’s syndrome: a systemic autoimmune disease. Clin Exp Med [Internet]. 2022;22(1):9–25. [3]Guedes LKN, Leon EP, Bocate TS, Bonfigliolli KR, Lourenço SV, Bonfa E, Pasoto SG. Characterizing hand and wrist ultrasound pattern in primary Sjögren’s syndrome: a case-control study. Clin Rheumatol. 2020 Jun;39(6):1907-1918. doi: 10.1007/s10067-020-04983-y. Epub 2020 Feb 19. Acknowledgements Our acknowledgement to Prof. Dr Rosa MR Pereira (in memorian) who was responsible for the project starting. Disclosure of Interests None declared