Chronic hives, joint pain lead to Sjögren’s diagnosis

It's important to find, treat underlying rheumatological disease, researchers advise

Marisa Wexler, MS avatar

by Marisa Wexler, MS |

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Two doctors use a giant magnifying glass to examine a patient in this case study illustration.

The case of a woman who was diagnosed with Sjögren’s syndrome after experiencing unusual symptoms, including hives and joint pain, was described in a recent report.

“Our case highlights that rheumatological diseases do not always present with the typical clinical features and require a more detailed physical examination and history taking to form a diagnosis,” the researchers wrote.

The study, “Atypical Presentation of Sjogren’s Syndrome With Chronic Urticaria: A Case Report and Literature Review,” was published in the journal Cureus.

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This illustration shows a person who has joint pain reclining on a red couch.

Clinical features may distinguish causes in primary Sjögren’s joint pain

Sjögren’s syndrome is an autoimmune disease that mainly affects saliva- and tear-producing glands, resulting in symptoms of dryness in the eyes and mouth. Sjögren’s also can affect other bodily systems, giving rise to a range of other symptoms.

Hives, referred to as urticaria in scientific literature, is a common symptom of allergic reactions, and chronic urticaria — when a person has hives that persist for several weeks — is often a sign of an autoimmune disease.

In this report, a team of scientists in the U.S. and Pakistan described the case of a 26-year-old woman. In the previous months before she was seen in the clinic, she had experienced repeated attacks of what appeared to be severe allergic reactions. Treatment with antihistamines and corticosteroids had not been effective for controlling her allergy-like symptoms.

When she was evaluated at the researchers’ clinic, she was found to have patchy hives on her abdomen, as well as notable inflammation and pain in the joints of her right hand, knees, and shoulders. She also reported notable fatigue, dry eyes, and difficulty swallowing due to mouth dryness.

Laboratory tests came back positive for self-reactive antibodies that are characteristic of Sjögren’s syndrome, and also revealed elevated levels of several inflammatory markers. Based on these results combined with her symptoms, she was diagnosed with Sjögren’s syndrome.

After the Sjögren’s diagnosis, the patient was started on a course of immune-suppressing therapies, including methotrexate and a corticosteroid (prednisone). This moderately eased her symptoms, according to  researchers.

Later, she was tapered off the corticosteroid and started on treatment with another immune-suppressing agent called hydroxychloroquine, which the researchers said was effective for easing her allergy-like symptoms and joint pain.

She also was given topical agents to help manage eye and mouth dryness, which the researchers said were effective.

“The case highlights the association of chronic urticaria and allergic reactions with Sjogren’s syndrome and emphasizes the importance of treating the underlying rheumatological disease in patients not improving with the conventional treatment for chronic urticaria,” the researchers wrote.