ANCA-associated vasculitis in patients with primary Sjögren's syndrome: Detailed analysis of 7 new cases and systematic literature review

ObjectivesTo describe the clinical presentation, management and prognosis of patients diagnosed with both primary Sjögren's syndrome (pSS) and anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV).MethodsFrench nation-wide survey completed by a systematic literature review.ResultsThis work identified 7 new cases of coexisting pSS and AAV: 2 microscopic polyangiitis (MPA), 2 granulomatosis with polyangiitis (GPA), 2 anti-myeloperoxidase (MPO)–ANCA renal-limited AAV, and 1 eosinophilic granulomatosis with polyangiitis (EGPA). The systematic literature search identified 15 previously published cases. Among the 22 patients, 19 were females. Mean age at diagnosis of AAV was 63.9 ± 9.8 years. All individuals with available information experienced at least one extra-glandular manifestation attributable to pSS. p-ANCA with anti-MPO specificity were found in 76.2% (16/21), c-ANCA with anti-PR3 specificity in 14.3% (3/21) and isolated c-ANCA in 13.6% (3/22). Vasculitis involved kidneys (n = 13), lungs (n = 8), skin (n = 6), peripheral nerves (n = 5), central nervous system (n = 2), small bowel (n = 1), muscle (n = 1), ear chondritis (n = 1) and sinuses (n = 1). The mean AAV follow-up was 73.5 (± 120.0) months. While on treatment, disease remission occurred in 77.3% of cases, and one death was reported in the first 6 months after diagnosis.ConclusionThis work shows that AAV may occur in patients with pSS. These are most commonly p-ANCA associated vasculitis with anti-MPO specificity. AAV may reveal an underlying pSS or arise during its evolution, but did not precede pSS in any of these cases. AAV occurrence appears to be correlated with extra-glandular manifestations of pSS.