Occurrence of Rheumatoid Arthritis Requiring Oral and/or Biological Disease-Modifying Antirheumatic Drug Therapy Following a Diagnosis of Primary Sjögren SyndromeKhan, Omar DO; Carsons, Steven MDJCR: Journal of Clinical Rheumatology: October 2012 - Volume 18 - Issue 7 - p 356–358 doi: 10.1097/RHU.0b013e31826d2abb Case Reports Abstract Author Information We report 6 patients with an established diagnosis of primary Sjögren syndrome who developed severe rheumatoid arthritis (RA) requiring oral disease-modifying antirheumatic drug with or without biologic therapy. Rheumatoid arthritis was diagnosed between 14 months and 17 years following initial sicca symptoms. Five patients were female. Two thirds were seropositive for Sjögren antibody, and 5 of 6 were either rheumatoid factor or anti-cyclic citrullinated peptide positive at the time of RA diagnosis. All had either hand or wrist involvement; one third had nodules. Although none demonstrated erosion on x-ray, all required methotrexate or leflunomide, and 4 required a biologic agent for the treatment of their arthritis. Primary Sjögren patients may develop RA after a long course of stable Sjögren. From the Division of Rheumatology, Allergy and Immunology Winthrop-University Hospital, Stony Brook University School of Medicine, Mineola, NY. The authors declare no conflict of interest. Correspondence: Steven Carsons, MD, Winthrop University Hospital, 120 Mineola Blvd, Mineola, NY 11501. E-mail: firstname.lastname@example.org. © 2012 Lippincott Williams & Wilkins, Inc.