Abstract
Objectives: Rheumatoid arthritis (RA) and Sjögren’s Syndrome (SjS) frequently co-exist but the consequence for RA disease activity of having concomitant SjS (RA/SjS) is not well established. We conducted a systematic review and meta-analysis to investigate the impact of SjS on disease outcomes in individuals with RA.
Methods: We searched Web of Science (Core Collection, FSTA, Medline), PubMed and Cochrane databases, without language restriction. Studies reporting RA disease activity scores, joint counts, visual analogue scales (VAS), disability and joint damage, and comparing RA and RA/SjS were selected. Outcomes reported in at least 3 studies in which the diagnosis of SjS fulfilled classification criteria underwent meta-analysis, using a random effects model where heterogeneity was detected.
Results: The literature search identified 2991 articles and abstracts; 23 underwent full-text review and 16 were included. The studies included a total of 29722 patients (8614 with RA/SjS and 21108 with RA). Using studies eligible for meta-analysis (744 patients with RA/SjS and 4450 with RA), we found higher DAS-28 ESR scores (mean difference 0.50, 95% CI -0.008-1.006; p = 0.05), higher swollen joint count scores (mean difference 1.05, 95% CI 0.42-1.67; p = 0.001), and greater functional disability as measured by HAQ (mean difference 0.19, 95% CI 0.05-0.34; p=0.009) in RA/SjS compared to RA alone. Other outcome measures (tender joint count, fatigue VAS) showed a numerical trend towards higher scores in RA/SjS but were not statistically significant.
Conclusion: RA/SjS patients appear to have higher disease activity and more functional disability than patients with RA alone. The aetiology and clinical implications of this are unclear and warrant further investigation.
Methods: We searched Web of Science (Core Collection, FSTA, Medline), PubMed and Cochrane databases, without language restriction. Studies reporting RA disease activity scores, joint counts, visual analogue scales (VAS), disability and joint damage, and comparing RA and RA/SjS were selected. Outcomes reported in at least 3 studies in which the diagnosis of SjS fulfilled classification criteria underwent meta-analysis, using a random effects model where heterogeneity was detected.
Results: The literature search identified 2991 articles and abstracts; 23 underwent full-text review and 16 were included. The studies included a total of 29722 patients (8614 with RA/SjS and 21108 with RA). Using studies eligible for meta-analysis (744 patients with RA/SjS and 4450 with RA), we found higher DAS-28 ESR scores (mean difference 0.50, 95% CI -0.008-1.006; p = 0.05), higher swollen joint count scores (mean difference 1.05, 95% CI 0.42-1.67; p = 0.001), and greater functional disability as measured by HAQ (mean difference 0.19, 95% CI 0.05-0.34; p=0.009) in RA/SjS compared to RA alone. Other outcome measures (tender joint count, fatigue VAS) showed a numerical trend towards higher scores in RA/SjS but were not statistically significant.
Conclusion: RA/SjS patients appear to have higher disease activity and more functional disability than patients with RA alone. The aetiology and clinical implications of this are unclear and warrant further investigation.
| Original language | English |
|---|---|
| Pages (from-to) | 2484-2492 |
| Number of pages | 9 |
| Journal | Clinical and Experimental Rheumatology |
| Volume | 41 |
| Issue number | 12 |
| DOIs | |
| Publication status | Published - 23 Dec 2023 |
Bibliographical note
Funding:T. Tomizawa received a grant from Japanese College of Rheumatology (JCR) as JCR-EULAR young rheumatologist training program. B.A. Fisher and S.J. Bowman have received support from the National Institute of Health Research (NIHR) Birmingham Biomedical Research Centre. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.
Keywords
- Sjögren’s syndrome
- rheumatoid arthritis
- outcome assessment
- health care
- patient-reported outcome measures
- disability evaluation
- fatigue
- erosive arthropathy
ASJC Scopus subject areas
- Rheumatology
- Immunology and Allergy
- Immunology