Does Sjögren's Syndrome Cause Polyarthralgias?
Yes, polyarthralgias (joint pain affecting multiple joints) are a common systemic manifestation of Sjögren's syndrome, occurring in a substantial proportion of patients either at diagnosis or during the disease course.
Prevalence and Clinical Patterns
- Joint pain (arthralgias) and muscle pain (myalgias) are recognized as common musculoskeletal symptoms in Sjögren's syndrome 1
- In a cohort study, 86% of primary Sjögren's syndrome patients demonstrated articular involvement, with 68% displaying articular manifestations at the time of diagnosis and 32% developing them during the disease course 2
- The hands and wrists are the most frequently involved sites, followed by knees, shoulders, and ankles 2
Spectrum of Articular Disease
The articular manifestations in Sjögren's syndrome encompass a wide disease spectrum ranging from simple arthralgia to erosive arthritis resembling rheumatoid arthritis 2:
- Most cases present as mild, self-limiting joint pain 2
- Some patients may experience chronic polyarthritis requiring treatment with disease-modifying antirheumatic drugs (DMARDs) 2
- Ultrasonography and MRI can detect subclinical abnormalities even before joint swelling becomes clinically apparent 2, 3
Associated Musculoskeletal Findings
- Enthesopathy (inflammation at tendon/ligament insertion sites) is significantly more common in Sjögren's patients than healthy controls, with plantar fascia, Achilles tendon, and distal patellar tendons being significantly thicker 3
- This entheseal involvement may contribute to the musculoskeletal pain experienced by patients 3
- Other musculoskeletal manifestations include myalgia, myositis, fibromyalgia, and chronic fatigue 3
Clinical Presentation Patterns
- Polyarthralgia can precede other Sjögren's symptoms, as documented in case reports where patients presented with fever and polyarthralgia before sicca symptoms became prominent 4
- Patients who develop articular manifestations during the disease course tend to be diagnosed with Sjögren's at a younger age and report higher dryness scores compared to those with articular symptoms at onset 2
Management Approach
- For mild systemic manifestations including joint pain, the European League Against Rheumatism suggests considering antimalarials such as hydroxychloroquine and NSAIDs 1
- In one case report, prednisolone 15 mg daily resulted in immediate resolution of arthralgia 5
- Imaging techniques (ultrasound and MRI) are useful for quantifying the extent of articular involvement and guiding treatment decisions 2
Important Clinical Caveat
Articular manifestations represent an important determinant of quality of life in Sjögren's patients and warrant systematic evaluation and monitoring 2. Co-management with a rheumatologist is essential due to the potential for progression to chronic polyarthritis and other systemic complications 1, 6.