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Retamozo S, Brito-Zerón P, Ramos-Casals M. Prognostic markers of lymphoma development in primary Sjögren syndrome. Lupus 2019; 28:923-936. [PMID: 31215845 DOI: 10.1177/0961203319857132] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Sjögren syndrome is a systemic autoimmune disease that principally affects women between the fourth and sixth decades of life who present with sicca symptomatology caused by dryness of the main mucosal surfaces. The clinical spectrum of Sjögren syndrome extends from dryness to systemic involvement. Since 1978, Sjögren syndrome has been closely associated with an enhanced risk of lymphoma, one of the most severe complications a patient may develop. Primary Sjögren syndrome patients have a 10-44-fold greater risk of lymphoma than healthy individuals, higher than that reported for systemic lupus erythematosus and rheumatoid arthritis. The close link between lymphoma and Sjögren syndrome is clearly exemplified by the very specific type of lymphoma arising in Sjögren syndrome patients, mainly low-grade B-cell lymphomas (predominantly a marginal zone histological type) with primary extranodal involvement of the major salivary glands (overwhelmingly parotid), with a primordial role of cryoglobulinemic-related markers (both clinical and immunological). The most recent studies support a higher number of risk factors detected in an individual leads to a higher lymphoma risk. A close follow-up of high-risk groups with longitudinal assessments of all known risk factors, including cryoglobulin-related markers and EULAR Sjögren's syndrome disease activity index measurement in particular, is mandatory.
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Affiliation(s)
- S Retamozo
- 1 Instituto de Investigaciones en Ciencias de la Salud (INICSA), Universidad Nacional de Córdoba (UNC), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Córdoba, Argentina.,2 Instituto Universitario de Ciencias Biomédicas de Córdoba (IUCBC), Córdoba, Argentina.,3 Laboratory of Autoimmune Diseases Josep Font, IDIBAPS-CELLEX, Barcelona, Spain
| | - P Brito-Zerón
- 3 Laboratory of Autoimmune Diseases Josep Font, IDIBAPS-CELLEX, Barcelona, Spain.,4 Department of Medicine, Hospital CIMA-Sanitas, Barcelona, Spain
| | - M Ramos-Casals
- 3 Laboratory of Autoimmune Diseases Josep Font, IDIBAPS-CELLEX, Barcelona, Spain.,5 Department of Autoimmune Diseases, ICMiD, Barcelona, Spain.,6 Department of Medicine, University of Barcelona, Barcelona, Spain
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Sanosyan A, Daien C, Nutz A, Bollore K, Bedin AS, Morel J, Zimmermann V, Nocturne G, Peries M, Guigue N, Gottenberg JE, Van de Perre P, Mariette X, Tuaillon E. Discrepancy of Serological and Molecular Patterns of Circulating Epstein-Barr Virus Reactivation in Primary Sjögren's Syndrome. Front Immunol 2019; 10:1153. [PMID: 31191532 PMCID: PMC6549440 DOI: 10.3389/fimmu.2019.01153] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 05/07/2019] [Indexed: 11/21/2022] Open
Abstract
Primary Sjögren's syndrome (pSS) is characterized by B cell hyperactivation, production of autoantibodies and increased risk of B cell lymphomas. Serological profile of Epstein-Barr virus (EBV) reactivation and increase EBV DNA levels in exocrine glands are observed in pSS, but whether these abnormalities are accompanied with disturbed systemic EBV control or have any association with pSS activity remains to be investigated. In this observational study, we initially explored anti-EBV antibodies and cell-free DNA in 395 samples from a cross-sectional plasma collection of pSS patients included in ASSESS French national cohort. Results were assessed in relation with disease activity. Further, to assess cell-associated EBV DNA we organized a case-control study including 20 blood samples from pSS patients followed in University Hospital Center of Montpellier. Results were compared with matched controls. Robust response against EBV early antigen (EA) was observed in pSS patients with anti-SSA/B (Sjögren's syndrome A and B) and anti-SSA autoantibodies compared to anti-SSA/B negatives (P < 0.01 and P = 0.01, respectively). Increased beta-2 microglobulin, kappa and lambda light chains, and immunoglobulin G levels were more frequently observed in anti-EA seropositive pSS subjects compared to anti-EA negative subjects (P < 0.001; P = 0.001; P = 0.003, respectively). Beta-2 microglobulin was independently associated with anti-EA positivity in multivariate analysis (P < 0.001). Plasma cell-free EBV DNA and EBV cellular reservoir was not different between pSS patients and controls. We conclude that serological evidence of EBV reactivation was more frequently observed and more strongly associated with anti-SSA/B status and B cell activation markers in pSS. However, serological profile of EBV reactivation was not accompanied by molecular evidence of systemic EBV reactivation. Our data indicated that EBV infection remains efficiently controlled in the blood of pSS patients.
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Affiliation(s)
- Armen Sanosyan
- Pathogenesis and Control of Chronic Infections, University of Montpellier, INSERM, EFS, CHU Montpellier, Montpellier, France
| | - Claire Daien
- CHU Montpellier, Department of Rheumatology, Montpellier, France
- Institut de Génétique Moléculaire de Montpellier, Centre National de la Recherche Scientifique UMR 5535, Université de Montpellier, Montpellier, France
| | | | - Karine Bollore
- Pathogenesis and Control of Chronic Infections, University of Montpellier, INSERM, EFS, CHU Montpellier, Montpellier, France
| | - Anne-Sophie Bedin
- Pathogenesis and Control of Chronic Infections, University of Montpellier, INSERM, EFS, CHU Montpellier, Montpellier, France
| | - Jacques Morel
- CHU Montpellier, Department of Rheumatology, Montpellier, France
- Institut de Génétique Moléculaire de Montpellier, Centre National de la Recherche Scientifique UMR 5535, Université de Montpellier, Montpellier, France
| | - Valérie Zimmermann
- Institut de Génétique Moléculaire de Montpellier, Centre National de la Recherche Scientifique UMR 5535, Université de Montpellier, Montpellier, France
| | - Gaetane Nocturne
- Faculté de Médecine, Université Paris Sud, INSERM, U1184, Center for Immunology of Viral Infections and Autoimmune Diseases, Le Kremlin-Bicêtre, France
| | - Marianne Peries
- Pathogenesis and Control of Chronic Infections, University of Montpellier, INSERM, EFS, CHU Montpellier, Montpellier, France
| | - Nicolas Guigue
- Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal, Laboratory of Parasitology and Mycology, AP-HP, Paris, France
| | | | - Philippe Van de Perre
- Pathogenesis and Control of Chronic Infections, University of Montpellier, INSERM, EFS, CHU Montpellier, Montpellier, France
| | - Xavier Mariette
- Faculté de Médecine, Université Paris Sud, INSERM, U1184, Center for Immunology of Viral Infections and Autoimmune Diseases, Le Kremlin-Bicêtre, France
- Service de Rhumatologie AP-HP, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Edouard Tuaillon
- Pathogenesis and Control of Chronic Infections, University of Montpellier, INSERM, EFS, CHU Montpellier, Montpellier, France
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153
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Associations of cigarette smoking with disease phenotype and type I interferon expression in primary Sjögren’s syndrome. Rheumatol Int 2019; 39:1575-1584. [DOI: 10.1007/s00296-019-04335-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 05/23/2019] [Indexed: 12/31/2022]
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154
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Abstract
PURPOSE Sjögren's syndrome (SS) is a common autoimmune disease affecting about four million Americans. Although approximately 1 in 10 patients with clinically-significant aqueous deficient dry eye has underlying SS, widespread underappreciation of SS leads to significant underdiagnosis, delays in diagnosis, and consequent morbidity and mortality. The purpose of this article is to illustrate that in addition to dry eye, SS can cause serious, vision-threatening extraglandular ocular manifestations. METHODS We conducted a narrative review of studies that have examined the dry eye and extraglandular ocular complications of SS. RESULTS SS-related dry eye is a progressive condition with major negative impact on the quality-of-life of afflicted patients, not only due to symptoms of ocular discomfort but also visual dysfunction. In addition, SS can lead to corneal melt/perforation, uveitis, scleritis, retinal vasculitis, and optic neuritis. A major problem with currently-available SS disease activity measurement instruments is the lack of domains evaluating dry eye-related visual dysfunction. For example, one of the most commonly-used instruments for assessing patient symptoms in SS (the EULAR Sjögren's Syndrome Patient Reported Index [ESSPRI]) only includes one item (out of three) that addresses the severity of overall dryness, without mention of dry eye symptoms or vision-related quality-of-life. Similarly, no extraglandular ocular complications are included in currently-available SS disease activity instruments (e.g., the EULAR Sjögren's Syndrome Disease Activity Index [ESSDAI]). CONCLUSIONS There needs to be a paradigm shift in which eye care providers and rheumatologists become more familiar with various SS-related extraglandular ocular manifestations. Existing disease activity measurement instruments must incorporate dry eye symptoms, particularly those related to visual dysfunction. An evidence-based screening algorithm for determining which patients with dry eye should be tested for underlying SS may be particularly helpful in preventing delays in diagnosis.
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155
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Cognitive Function in Primary Sjögren's Syndrome: A Systematic Review. Brain Sci 2019; 9:brainsci9040085. [PMID: 30991679 PMCID: PMC6523842 DOI: 10.3390/brainsci9040085] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 04/03/2019] [Accepted: 04/09/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Cognitive disorders are reported to be common in patients with primary Sjogren's syndrome (pSS). In some cases, they are the first clinical manifestation, preceding the diagnosis of pSS by two years on average. AIM A systematic review was conducted to explore cognitive impairment in pSS, with reference to diagnostic methods and their relationship with laboratory data and clinical manifestations. MATERIALS AND METHODS According to the PRISMA 2009 checklist, we carried out a comprehensive literature search in the three main bibliographic databases: MEDLINE, EMBASE, and PsycINFO (NICE HDAS interface). The following main search terms were used: primary Sjogren syndrome, neurological manifestations, fatigue, cognitive functions, psychiatric manifestations, mild cognitive impairment, dementia, and neurocognitive disorder. The search was made on 14 September, 2018. References from all selected studies were also examined. Inclusion criteria were: all studies and case-reports published in any language from 2002 that assessed the association of pSS (according to classification criteria proposed by the 2002 American/European collaborative group (AECG)) with all types of cognitive impairment (including dementia). Exclusion criteria were: reviews, abstracts, secondary Sjögren's syndrome (SS), and all articles in which other classification criteria were used. RESULTS The initial search yielded 352 articles, of which 253 were excluded based on the title and abstract review. A total of 54 articles underwent a full-length review, and 32 articles were excluded. Data were extracted from 18 studies and three case-reports involving a total of 6196 participants. In most cases, cognitive dysfunction was a brain fog or a mild cognitive impairment (MCI). Occasionally, an autoimmune dementia was present. The relationship between pSS and degenerative dementias, such as Alzheimer's disease (AD), was a controversial issue, even if some investigators hypothesized that pSS could be a risk factor. Several unmet needs were highlighted. First, some of the included studies had not reported the severity of pSS; hence, few correlations between disease severity and cognitive function were possible. Secondly, the evaluation of the pathogenetic role of comorbid diseases was often absent. The lack of information on the type of dementia represented a third critical point in the majority of the included studies. CONCLUSIONS This systematic review confirmed that adequate studies on cognitive function in pSS are scarce, mostly performed on small-sized samples, and often conflicting. The routine assessment of cognitive function in patients with pSS seems advisable and it will help to elucidate some of the unmet needs highlighted by this review in future appropriately designed studies.
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156
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Rosas J, Sánchez-Piedra C, Fernández-Castro M, Andreu JL, Martínez-Taboada V, Olivé A. ESSDAI activity index of the SJÖGRENSER cohort: analysis and comparison with other European cohorts. Rheumatol Int 2019; 39:991-999. [DOI: 10.1007/s00296-019-04285-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 03/13/2019] [Indexed: 02/06/2023]
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157
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Pezoulas VC, Kourou KD, Kalatzis F, Exarchos TP, Venetsanopoulou A, Zampeli E, Gandolfo S, Skopouli F, De Vita S, Tzioufas AG, Fotiadis DI. Medical data quality assessment: On the development of an automated framework for medical data curation. Comput Biol Med 2019; 107:270-283. [PMID: 30878889 DOI: 10.1016/j.compbiomed.2019.03.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 03/01/2019] [Accepted: 03/02/2019] [Indexed: 01/25/2023]
Abstract
Data quality assessment has gained attention in the recent years since more and more companies and medical centers are highlighting the importance of an automated framework to effectively manage the quality of their big data. Data cleaning, also known as data curation, lies in the heart of the data quality assessment and is a key aspect prior to the development of any data analytics services. In this work, we present the objectives, functionalities and methodological advances of an automated framework for data curation from a medical perspective. The steps towards the development of a system for data quality assessment are first described along with multidisciplinary data quality measures. A three-layer architecture which realizes these steps is then presented. Emphasis is given on the detection and tracking of inconsistencies, missing values, outliers, and similarities, as well as, on data standardization to finally enable data harmonization. A case study is conducted in order to demonstrate the applicability and reliability of the proposed framework on two well-established cohorts with clinical data related to the primary Sjögren's Syndrome (pSS). Our results confirm the validity of the proposed framework towards the automated and fast identification of outliers, inconsistencies, and highly-correlated and duplicated terms, as well as, the successful matching of more than 85% of the pSS-related medical terms in both cohorts, yielding more accurate, relevant, and consistent clinical data.
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Affiliation(s)
- Vasileios C Pezoulas
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, Ioannina, GR45110, Greece
| | - Konstantina D Kourou
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, Ioannina, GR45110, Greece; Department of Biological Applications and Technology, University of Ioannina, Ioannina, GR45110, Greece
| | - Fanis Kalatzis
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, Ioannina, GR45110, Greece
| | - Themis P Exarchos
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, Ioannina, GR45110, Greece; Department of Informatics, Ionian University, Corfu, GR49100, Greece
| | - Aliki Venetsanopoulou
- Department of Pathophysiology, School of Medicine, University of Athens, Athens, GR15772, Greece
| | - Evi Zampeli
- Institute for Systemic Autoimmune and Neurological Diseases, Athens, GR11743, Greece
| | - Saviana Gandolfo
- Clinic of Rheumatology, Department of Medical and Biological Sciences, Udine University, Udine, IT33100, Italy
| | - Fotini Skopouli
- Department of Internal Medicine and Clinical Immunology, Euroclinic Hospital, Athens, GR11521, Greece
| | - Salvatore De Vita
- Clinic of Rheumatology, Department of Medical and Biological Sciences, Udine University, Udine, IT33100, Italy
| | - Athanasios G Tzioufas
- Department of Pathophysiology, School of Medicine, University of Athens, Athens, GR15772, Greece
| | - Dimitrios I Fotiadis
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, Ioannina, GR45110, Greece; Department of Biomedical Research, FORTH-IMBB, Ioannina, GR45110, Greece.
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158
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Lei L, Morgan S, Ntatsaki E, Ciurtin C. Comparative Assessment of Hand Joint Ultrasound Findings in Symptomatic Patients with Systemic Lupus Erythematosus and Sjögren's Syndrome: A Pilot Study. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:452-460. [PMID: 30401509 DOI: 10.1016/j.ultrasmedbio.2018.09.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 09/24/2018] [Accepted: 09/27/2018] [Indexed: 06/08/2023]
Abstract
Systemic lupus erythematosus (SLE) and primary Sjögren's syndrome (SS) can be associated with inflammatory arthritis, which is underdiagnosed by clinical examination. The aim of this cross-sectional, observational study was to compare, for the first time, the ultrasound (US)-detected joint abnormalities in these two diseases and to define the role of US in patient management. Participants had SLE (n = 18) and SS (n = 23), symptoms of hand joint pain and no previous diagnosis of arthritis. Data on disease activity, duration, damage scores, inflammatory and serologic markers, treatment and clinical and ultrasound parameters (derived from the assessment of 902 joints) were analysed and correlated using descriptive statistics, correlation tests and regression models. Subclinical synovitis/tenosynovitis was detected in 44.4% of SLE patients and 21.7% of SS patients (p = 0.23). There was no significant correlation between either the total Power Doppler score or the total grey-scale score and disease activity scores (British Isles Lupus Assessment Group index and European League Against Rheumatism Sjögren's syndrome disease activity index). Both damage scores (Systemic Lupus International Collaborating Clinics index and Sjögren's syndrome disease damage index) correlated with the total grey-scale synovitis score. Significant proportions of the participants with SLE and SS had erosions (55.6% and 34.8%, respectively, p = 0.184) and osteophytes (61.1% vs. 60.9%, p = 0.98) in at least one joint. The lack of correlation between disease activity scores and US outcome measures indicated their limitations in diagnosing subclinical synovitis in SLE and SS patients. Future research is needed to determine if the development of erosions could be prevented by early diagnosis and prompt treatment of inflammatory arthritis associated with SLE and SS.
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Affiliation(s)
- Linda Lei
- University College London Medical School, London, United Kingdom
| | - Stephen Morgan
- University College London Medical School, London, United Kingdom
| | - Eleana Ntatsaki
- Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Coziana Ciurtin
- Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Division of Medicine, University College London, London, United Kingdom.
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159
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Servioli L, Maciel G, Nannini C, Crowson CS, Matteson EL, Cornec D, Berti A. Association of Smoking and Obesity on the Risk of Developing Primary Sjögren Syndrome: A Population-based Cohort Study. J Rheumatol 2019; 46:727-730. [PMID: 30647188 DOI: 10.3899/jrheum.180481] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2018] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To explore the role of smoking and obesity in primary Sjögren syndrome (pSS). METHODS Olmsted County (Minnesota, USA) residents (n = 106) diagnosed with pSS from 2000 to 2015 were compared to 3 controls without pSS and matched for age and sex who were randomly selected from Olmsted County residents. RESULTS Current smokers were less likely to be pSS cases (OR 0.34, 95% CI 0.14-0.85), while there was no association between former smoking and case/control status (OR 1.27, 95% CI 0.80-2.03) compared to never smokers. Smoking status was not associated with antinuclear antibody, anti-SSA, anti-SSB, or rheumatoid factor positivity (p > 0.05). OR for obesity was 0.79 (95% CI 0.48-1.30). CONCLUSION In this population-based study, current smoking was inversely associated with case/control status, while body mass index lacked any association.
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Affiliation(s)
- Luisa Servioli
- From the Division of Rheumatology, and Division of Biomedical Statistics and Informatics, and Division of Epidemiology, and Division of Pulmonary and Critical Care Medicine, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Autoimmune Diseases Department, Medical Clinic 1, Hospital Maciel, Montevideo, Uruguay; Department of Rheumatology, Hospital of Prato, Prato, Italy; Rheumatology Department, Brest Teaching Hospital, Brest, France; Immunology, Rheumatology, Allergy and Rare Diseases Department, San Raffaele Scientific Institute, Milan, Italy; Rheumatology Department, Santa Chiara Hospital, Trento, Italy.,L. Servioli, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science, and Autoimmune diseases Department, Medical Clinic 1, Hospital Maciel; G. Maciel, MD, Autoimmune Diseases Department, Medical Clinic 1, Hospital Maciel; C. Nannini, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science, and Department of Rheumatology, Hospital of Prato; C.S. Crowson, PhD, Division of Rheumatology, and Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science; E.L. Matteson, MD, MPH, Division of Rheumatology, and Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science; D. Cornec, MD, PhD, Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, and Rheumatology Department, Brest Teaching Hospital; A. Berti, MD, Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, and the Immunology, Rheumatology, Allergy and Rare Diseases Department, San Raffaele Scientific Institute, and the Rheumatology Department, Santa Chiara Hospital
| | - Gabriel Maciel
- From the Division of Rheumatology, and Division of Biomedical Statistics and Informatics, and Division of Epidemiology, and Division of Pulmonary and Critical Care Medicine, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Autoimmune Diseases Department, Medical Clinic 1, Hospital Maciel, Montevideo, Uruguay; Department of Rheumatology, Hospital of Prato, Prato, Italy; Rheumatology Department, Brest Teaching Hospital, Brest, France; Immunology, Rheumatology, Allergy and Rare Diseases Department, San Raffaele Scientific Institute, Milan, Italy; Rheumatology Department, Santa Chiara Hospital, Trento, Italy.,L. Servioli, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science, and Autoimmune diseases Department, Medical Clinic 1, Hospital Maciel; G. Maciel, MD, Autoimmune Diseases Department, Medical Clinic 1, Hospital Maciel; C. Nannini, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science, and Department of Rheumatology, Hospital of Prato; C.S. Crowson, PhD, Division of Rheumatology, and Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science; E.L. Matteson, MD, MPH, Division of Rheumatology, and Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science; D. Cornec, MD, PhD, Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, and Rheumatology Department, Brest Teaching Hospital; A. Berti, MD, Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, and the Immunology, Rheumatology, Allergy and Rare Diseases Department, San Raffaele Scientific Institute, and the Rheumatology Department, Santa Chiara Hospital
| | - Carlotta Nannini
- From the Division of Rheumatology, and Division of Biomedical Statistics and Informatics, and Division of Epidemiology, and Division of Pulmonary and Critical Care Medicine, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Autoimmune Diseases Department, Medical Clinic 1, Hospital Maciel, Montevideo, Uruguay; Department of Rheumatology, Hospital of Prato, Prato, Italy; Rheumatology Department, Brest Teaching Hospital, Brest, France; Immunology, Rheumatology, Allergy and Rare Diseases Department, San Raffaele Scientific Institute, Milan, Italy; Rheumatology Department, Santa Chiara Hospital, Trento, Italy.,L. Servioli, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science, and Autoimmune diseases Department, Medical Clinic 1, Hospital Maciel; G. Maciel, MD, Autoimmune Diseases Department, Medical Clinic 1, Hospital Maciel; C. Nannini, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science, and Department of Rheumatology, Hospital of Prato; C.S. Crowson, PhD, Division of Rheumatology, and Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science; E.L. Matteson, MD, MPH, Division of Rheumatology, and Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science; D. Cornec, MD, PhD, Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, and Rheumatology Department, Brest Teaching Hospital; A. Berti, MD, Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, and the Immunology, Rheumatology, Allergy and Rare Diseases Department, San Raffaele Scientific Institute, and the Rheumatology Department, Santa Chiara Hospital
| | - Cynthia S Crowson
- From the Division of Rheumatology, and Division of Biomedical Statistics and Informatics, and Division of Epidemiology, and Division of Pulmonary and Critical Care Medicine, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Autoimmune Diseases Department, Medical Clinic 1, Hospital Maciel, Montevideo, Uruguay; Department of Rheumatology, Hospital of Prato, Prato, Italy; Rheumatology Department, Brest Teaching Hospital, Brest, France; Immunology, Rheumatology, Allergy and Rare Diseases Department, San Raffaele Scientific Institute, Milan, Italy; Rheumatology Department, Santa Chiara Hospital, Trento, Italy.,L. Servioli, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science, and Autoimmune diseases Department, Medical Clinic 1, Hospital Maciel; G. Maciel, MD, Autoimmune Diseases Department, Medical Clinic 1, Hospital Maciel; C. Nannini, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science, and Department of Rheumatology, Hospital of Prato; C.S. Crowson, PhD, Division of Rheumatology, and Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science; E.L. Matteson, MD, MPH, Division of Rheumatology, and Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science; D. Cornec, MD, PhD, Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, and Rheumatology Department, Brest Teaching Hospital; A. Berti, MD, Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, and the Immunology, Rheumatology, Allergy and Rare Diseases Department, San Raffaele Scientific Institute, and the Rheumatology Department, Santa Chiara Hospital
| | - Eric L Matteson
- From the Division of Rheumatology, and Division of Biomedical Statistics and Informatics, and Division of Epidemiology, and Division of Pulmonary and Critical Care Medicine, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Autoimmune Diseases Department, Medical Clinic 1, Hospital Maciel, Montevideo, Uruguay; Department of Rheumatology, Hospital of Prato, Prato, Italy; Rheumatology Department, Brest Teaching Hospital, Brest, France; Immunology, Rheumatology, Allergy and Rare Diseases Department, San Raffaele Scientific Institute, Milan, Italy; Rheumatology Department, Santa Chiara Hospital, Trento, Italy. .,L. Servioli, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science, and Autoimmune diseases Department, Medical Clinic 1, Hospital Maciel; G. Maciel, MD, Autoimmune Diseases Department, Medical Clinic 1, Hospital Maciel; C. Nannini, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science, and Department of Rheumatology, Hospital of Prato; C.S. Crowson, PhD, Division of Rheumatology, and Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science; E.L. Matteson, MD, MPH, Division of Rheumatology, and Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science; D. Cornec, MD, PhD, Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, and Rheumatology Department, Brest Teaching Hospital; A. Berti, MD, Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, and the Immunology, Rheumatology, Allergy and Rare Diseases Department, San Raffaele Scientific Institute, and the Rheumatology Department, Santa Chiara Hospital.
| | - Divi Cornec
- From the Division of Rheumatology, and Division of Biomedical Statistics and Informatics, and Division of Epidemiology, and Division of Pulmonary and Critical Care Medicine, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Autoimmune Diseases Department, Medical Clinic 1, Hospital Maciel, Montevideo, Uruguay; Department of Rheumatology, Hospital of Prato, Prato, Italy; Rheumatology Department, Brest Teaching Hospital, Brest, France; Immunology, Rheumatology, Allergy and Rare Diseases Department, San Raffaele Scientific Institute, Milan, Italy; Rheumatology Department, Santa Chiara Hospital, Trento, Italy.,L. Servioli, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science, and Autoimmune diseases Department, Medical Clinic 1, Hospital Maciel; G. Maciel, MD, Autoimmune Diseases Department, Medical Clinic 1, Hospital Maciel; C. Nannini, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science, and Department of Rheumatology, Hospital of Prato; C.S. Crowson, PhD, Division of Rheumatology, and Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science; E.L. Matteson, MD, MPH, Division of Rheumatology, and Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science; D. Cornec, MD, PhD, Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, and Rheumatology Department, Brest Teaching Hospital; A. Berti, MD, Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, and the Immunology, Rheumatology, Allergy and Rare Diseases Department, San Raffaele Scientific Institute, and the Rheumatology Department, Santa Chiara Hospital
| | - Alvise Berti
- From the Division of Rheumatology, and Division of Biomedical Statistics and Informatics, and Division of Epidemiology, and Division of Pulmonary and Critical Care Medicine, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Autoimmune Diseases Department, Medical Clinic 1, Hospital Maciel, Montevideo, Uruguay; Department of Rheumatology, Hospital of Prato, Prato, Italy; Rheumatology Department, Brest Teaching Hospital, Brest, France; Immunology, Rheumatology, Allergy and Rare Diseases Department, San Raffaele Scientific Institute, Milan, Italy; Rheumatology Department, Santa Chiara Hospital, Trento, Italy.,L. Servioli, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science, and Autoimmune diseases Department, Medical Clinic 1, Hospital Maciel; G. Maciel, MD, Autoimmune Diseases Department, Medical Clinic 1, Hospital Maciel; C. Nannini, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science, and Department of Rheumatology, Hospital of Prato; C.S. Crowson, PhD, Division of Rheumatology, and Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science; E.L. Matteson, MD, MPH, Division of Rheumatology, and Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science; D. Cornec, MD, PhD, Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, and Rheumatology Department, Brest Teaching Hospital; A. Berti, MD, Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, and the Immunology, Rheumatology, Allergy and Rare Diseases Department, San Raffaele Scientific Institute, and the Rheumatology Department, Santa Chiara Hospital
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Kim JH, Ha YJ, Kang EH, Song YW, Lee YJ. Longitudinal Changes in the European League Against Rheumatism Sjögren's Syndrome Patient Reported Index in Real-Life Practice. JOURNAL OF RHEUMATIC DISEASES 2019. [DOI: 10.4078/jrd.2019.26.3.191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Ji Hyoun Kim
- Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - You-Jung Ha
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eun Ha Kang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yeong Wook Song
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- WCU Department of Molecular Medicine and Biopharmaceutical Sciences, Medical Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Yun Jong Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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161
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Baer AN, Walitt B. Update on Sjögren Syndrome and Other Causes of Sicca in Older Adults. Rheum Dis Clin North Am 2018; 44:419-436. [PMID: 30001784 DOI: 10.1016/j.rdc.2018.03.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Dry eye and dry mouth symptoms are each reported by up to 30% of persons more than 65 years of age, particularly in women. Medication side effects are the most common contributing factors. The evaluation of these symptoms requires measures of ocular and oral dryness. Sjögren syndrome is the prototypical disease associated with dryness of the eyes and mouth and predominantly affects women in their perimenopausal and postmenopausal years. In addition to topical treatment of the mucosal dryness, patients with Sjögren syndrome may require treatment with systemic immunomodulatory and immunosuppressive agents to manage a variety of extraglandular manifestations.
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Affiliation(s)
- Alan N Baer
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Suite 4000, Mason Lord Center Tower, Baltimore, MD 21224, USA; National Institute of Dental and Craniofacial Research, National Institutes of Health, 10 Center Drive, Bethesda, MD 20892, USA.
| | - Brian Walitt
- National Institute of Dental and Craniofacial Research, National Institutes of Health, 10 Center Drive, Bethesda, MD 20892, USA
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Pezoulas VC, Exarchos TP, Andronikou V, Varvarigou T, Tzioufas AG, De Vita S, Fotiadis DI. Towards the Establishment of a Biomedical Ontology for the Primary Sjögren's Syndrome. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2018; 2018:4089-4092. [PMID: 30441255 DOI: 10.1109/embc.2018.8513349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Primary Sjögren's Syndrome (pSS) has been characterized as a hypersensitivity reaction type II systemic autoimmune chronic disease causing exocrine gland dysfunction mainly affecting women near the menopausal age. pSS patients exhibit dryness of the main mucosal surfaces and are highly prone to lymphoma development. This paper presents a first biomedical ontology for pSS based on a reference model which was determined by pSS clinical experts. The ensuing ontology constitutes the fundamental basis for mapping pSS-related ontologies from international cohorts to a common ontology. The ontology mapping (i.e., schematic interlinking) procedure is, in fact, a preliminary step to harmonize heterogeneous medical data obtained from various cohorts.
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163
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Stefanski AL, Tomiak C, Pleyer U, Dietrich T, Burmester GR, Dörner T. The Diagnosis and Treatment of Sjögren's Syndrome. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 114:354-361. [PMID: 28610655 DOI: 10.3238/arztebl.2017.0354] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 12/13/2016] [Accepted: 03/14/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Sjögren's syndrome is one of the more common inflammatory rheumatological diseases, with a prevalence of at least 0.4% in Germany. METHODS This review is based on pertinent articles retrieved by a selective search in PubMed. Special attention is drawn to updated classification criteria and current treatment recommendations. RESULTS Sjögren's syndrome has a wide variety of presentations, ranging from the local involvement of exocrine glands with keratoconjunctivitis sicca and xerostomia (the leading signs of the disease) to the systemic, extraglandular involvement of multiple organs. Fatigue also markedly worsens the patients' quality of life. Serologic testing reveals antinuclear auto-antibodies (anti-Ro/ SSA and anti-La/SSB) as well as rheumatoid factors. The histological hallmark of the disease is focal lymphocytic infiltration in otherwise normal-appearing glandular acini. The disease also markedly elevates the risk of non-Hodgkin lymphoma of the B-cell series, which arises in about 5% of patients. Primary Sjögren's syndrome (pSS) differs from the secondary form (sSS), which appears in the setting of another autoimmune disease, particularly systemic lupus erythematosus (15-36%), rheumatoid arthritis (20-32%), and limited or progressive systemic sclerosis (11-24%). Disease-modifying therapy is reserved for patients with systemic involvement; there is limited evidence for its efficacy. Because of the complexity of this disease, some of its clinical manifestations may require interdisciplinary treatment. CONCLUSION The main considerations in the interdisciplinary care of patients with Sjögren's disease are measures to improve quality of life, pharmacological and non-pharmacological treatments to keep disease activity in check, and management of the risk of lymphoma. Future therapeutic approaches must take the heterogeneity of the disease into account.
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Affiliation(s)
- Ana-Luisa Stefanski
- Charité Center for Internal Medicine, Medical Department-Division of Rheumatology and Clinical Immunology, Berlin, Germany; University Clinic of Rheumatology, Immunology and Allergology, Inselspital Bern, Bern, Switzerland; BfA Wendelstein Rehabilitation Clinic, Rheumatology Center, AHB Clinic, Bad Aibling, Germany; Department of Ophthalmology, Charité Campus Virchow, Berlin, Germany; Oral Surgery, The School of Dentistry, University of Birmingham, United Kingdom
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164
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Romão VC, Talarico R, Scirè CA, Vieira A, Alexander T, Baldini C, Gottenberg JE, Gruner H, Hachulla E, Mouthon L, Orlandi M, Pamfil C, Pineton de Chambrun M, Taglietti M, Toplak N, van Daele P, van Laar JM, Bombardieri S, Schneider M, Smith V, Cutolo M, Mosca M, Mariette X. Sjögren's syndrome: state of the art on clinical practice guidelines. RMD Open 2018; 4:e000789. [PMID: 30402274 PMCID: PMC6203093 DOI: 10.1136/rmdopen-2018-000789] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 09/12/2018] [Accepted: 09/13/2018] [Indexed: 02/06/2023] Open
Abstract
Sjögren's syndrome (SS) is a complex autoimmune rheumatic disease that specifically targets salivary and lachrymal glands. As such, patients typically had ocular and oral dryness and salivary gland swelling. Moreover, skin, nasal and vaginal dryness are frequently present. In addition to dryness, musculoskeletal pain and fatigue are the hallmarks of this disease and constitute the classic symptom triad presented by the vast majority of patients. Up to 30% to 50 % of patients with SS may present systemic disease; moreover, there is an increased risk for the development of non-Hodgkin's lymphoma that occurs in a minority of patients. The present work was developed in the framework of the European Reference Network (ERN) dedicated to Rare and Complex Connective Tissue and Musculoskeletal Diseases (ReCONNET). In line with its goals of aiming to improve early diagnosis, treatment and care of rare connective and musculoskeletal diseases, ERN-ReCONNET set to review the current state of clinical practice guidelines (CPGs) in the rare and complex connective tissue diseases of interest of the network. Therefore, the present work was aimed at providing a state of the art of CPGs for SS.
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Affiliation(s)
- Vasco C Romão
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | | | - Carlo Alberto Scirè
- Section of Rheumatology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Ana Vieira
- Núcleo Síndrome de Sjögren, Liga Portuguesa Contra as Doenças Reumáticas, Lisbon, Portugal
| | - Tobias Alexander
- Department of Rheumatology and Clinical Immunology, Charité University Hospital Berlin, Berlin, Germany
| | - Chiara Baldini
- Rheumatology Unit, AOU Pisana, Pisa, Italy
- Rheumatology Unit, University of Pisa, Pisa, Italy
| | - Jacques-Eric Gottenberg
- Service de rhumatologie, Hôpitaux Universitaires de Strasbourg, Centre National de Référence des Maladies Systémiques et Auto-immunes Rares Grand-Est Sud-Ouest (RESO), INSERM-UMRS 1109, F-67000, Strasbourg, France
| | - Heidi Gruner
- Unidade de Doenças Auto-imunes, Medicina 7.2, Hospital Curry Cabral, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Eric Hachulla
- Département de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Systémiques et Auto-Immunes Rares du Nord-Ouest (CERAINO), LIRIC, INSERM, Univ. Lille, CHU Lille, Lille, France
| | - Luc Mouthon
- Service de Médecine Interne, Hôpital Cochin, Centre de Référence Maladies systémiques Autoimmunes Rares d’Ile de France, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Descartes, Paris, France
| | - Martina Orlandi
- Department of Clinical and Experimental Medicine, Division of Rheumatology and Scleroderma Unit, AOU Careggi, University of Florence, Florence, Italy
| | - Cristina Pamfil
- Department of Rheumatology, Emergency County Teaching Hospital, Cluj-Napoca, Romania
| | - Marc Pineton de Chambrun
- Service de Médecine Interne 2, Hôpital La Pitié-Salpêtrière, Institut E3M, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marco Taglietti
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Natasa Toplak
- Department of Allergology, Rheumatology and Clinical Immunology, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Paul van Daele
- Department of Internal Medicine and Immunology, Erasmus MC, Rotterdam, The Netherlands
| | - Jacob M van Laar
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | - Matthias Schneider
- Department of Rheumatology, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Vanessa Smith
- Department of Rheumatology and Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium
| | - Maurizio Cutolo
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, IRCCS Polyclinic Hospital San Martino, University of Genoa, Genoa, Italy
| | - Marta Mosca
- Rheumatology Unit, AOU Pisana, Pisa, Italy
- Rheumatology Unit, University of Pisa, Pisa, Italy
| | - Xavier Mariette
- Université Paris-Sud: AP-HP, Hôpitaux Universitaires Paris-Sud; INSERM UMR 1184, Le Kremlin Bicêtre, France
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165
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St Clair EW, Baer AN, Wei C, Noaiseh G, Parke A, Coca A, Utset TO, Genovese MC, Wallace DJ, McNamara J, Boyle K, Keyes-Elstein L, Browning JL, Franchimont N, Smith K, Guthridge JM, Sanz I, James JA. Clinical Efficacy and Safety of Baminercept, a Lymphotoxin β Receptor Fusion Protein, in Primary Sjögren's Syndrome: Results From a Phase II Randomized, Double-Blind, Placebo-Controlled Trial. Arthritis Rheumatol 2018; 70:1470-1480. [PMID: 29604186 PMCID: PMC6115299 DOI: 10.1002/art.40513] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 03/22/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To evaluate the clinical efficacy and safety of baminercept, a lymphotoxin β receptor IgG fusion protein (LTβR-Ig), for the treatment of primary Sjögren's syndrome (SS), and to explore the possible mechanisms of action of this treatment. METHODS In this multicenter trial, 52 patients with primary SS were randomized in a 2:1 ratio to receive subcutaneous injections of 100 mg of baminercept every week for 24 weeks or matching placebo. The primary end point was the change between screening and week 24 in the stimulated whole salivary flow (SWSF) rate. Secondary end points included the European League Against Rheumatism Sjögren's Syndrome Disease Activity Index (ESSDAI), as well as measurements of select chemokines and cytokines and enumeration of peripheral blood B and T cell subsets. RESULTS The change from baseline to week 24 in the SWSF rate was not significantly different between the baminercept and placebo treatment groups (baseline-adjusted mean change -0.01 versus 0.07 ml/minute; P = 0.332). The change in the ESSDAI during treatment was also not significantly different between the treatment groups (baseline-adjusted mean change -1.23 versus -0.15; P = 0.104). Although the incidence of adverse events was similar between the treatment groups, baminercept therapy was associated with a higher incidence of liver toxicity, including 2 serious adverse events. Baminercept also produced a significant decrease in plasma levels of CXCL13 and significant changes in the number of circulating B and T cells, consistent with its known inhibitory effects on LTβR signaling. CONCLUSION In this trial, treatment with baminercept failed to significantly improve glandular and extraglandular disease in patients with primary SS, despite evidence from mechanistic studies showing that it blocks LTβR signaling.
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Affiliation(s)
| | - Alan N Baer
- Johns Hopkins University, Baltimore, Maryland
| | - Chungwen Wei
- Ignacio Sanz, Emory University, Atlanta, Georgia
| | | | - Anne Parke
- Saint Francis Medical Group, Hartford, Connecticut
| | | | | | | | | | - James McNamara
- National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland
| | | | | | | | | | | | | | - Ignacio Sanz
- Ignacio Sanz, Emory University, Atlanta, Georgia
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166
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Cui Y, Li L, Xia L, Zhao Q, Chen S, Fu T, Ji J, Gu Z. The impact of disease activity and psychological status on quality of life for Chinese patients with primary Sjögren's syndrome. Patient Prefer Adherence 2018; 12:1513-1519. [PMID: 30174416 PMCID: PMC6110269 DOI: 10.2147/ppa.s163417] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE The primary purpose of the present study was to survey the quality of life (QoL) in primary Sjögren's syndrome (pSS) and to analyze the relationships between disease activity, anxiety/depression, fatigue, pain, age, oral disorders, impaired swallowing, sicca symptoms, and QoL. PATIENTS AND METHODS A survey was conducted on 185 pSS patients and 168 healthy individuals using the Short Form 36 health survey for QoL. Disease activity was assessed using the European League Against Rheumatism Sjögren's Syndrome Disease Activity Index. We examined these data using independent samples t-tests, Mann-Whitney U test, chi squared analysis, and linear regression. RESULTS The result for each domain in Short Form 36 health survey was lower in pSS patients than in healthy controls, especially the score in the dimension of role physical function. In the bivariate analysis, age, pain, fatigue, disease activity, disease complication, anxiety/depression, oral disorders, and impaired swallowing correlated with QoL. Also, in the linear regression model, pain, fatigue, disease activity, impaired swallowing, and anxiety/depression remained the main predictors of QoL. CONCLUSION pSS patients had a considerably impaired QoL compared to the controls, and pSS could negatively affect the QoL of patients. Measuring QoL should be considered as a vital part of the comprehensive evaluation of the health status of pSS patients, which could contribute some valuable clues in improving the management of disease and treatment decisions.
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Affiliation(s)
- Yafei Cui
- Department of Rheumatology, Affiliated Hospital of Nantong University, Nantong, China,
- School of Nursing, Nantong University, Nantong, China
- Department of Nursing, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lin Li
- School of Nursing, Nantong University, Nantong, China
- Department of Nursing, Changzhou 2nd People's Affiliated Hospital of Nanjing Medical University, Changzhou, China
| | - Ling Xia
- Department of Rheumatology, Affiliated Hospital of Nantong University, Nantong, China,
| | - Qian Zhao
- School of Nursing, Nantong University, Nantong, China
| | - Shengnan Chen
- School of Nursing, Nantong University, Nantong, China
| | - Ting Fu
- Department of Rheumatology, Affiliated Hospital of Nantong University, Nantong, China,
| | - Juan Ji
- Department of Rheumatology, Affiliated Hospital of Nantong University, Nantong, China,
| | - Zhifeng Gu
- Department of Rheumatology, Affiliated Hospital of Nantong University, Nantong, China,
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167
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Li Z, Fu T, Li L, Cui Y, Dong C, Li J, Gu Z. Prevalence, severity, and predictors of dry eye and dry mouth in Chinese patients with primary Sjögren syndrome. Clin Rheumatol 2018; 37:2971-2979. [PMID: 30094749 DOI: 10.1007/s10067-018-4233-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 06/23/2018] [Accepted: 07/23/2018] [Indexed: 02/08/2023]
Abstract
Dry eye and dry mouth are typical clinical symptoms of primary Sjögren's syndrome (pSS), yet not considered in the assessment of severity and predictors in China. This study aimed to investigate the prevalence, severity, and potential predictors of dry eye/dry mouth among Chinese pSS patients. A cross-sectional study was conducted from the Affiliated Hospital of Nantong University. A series of questionnaires were applied: Ocular Surface Disease Index (OSDI), EULAR Sjogren's Syndrome Patient Reported Index (ESSPRI)-dry mouth items, fatigue severity scale (FSS), the 10 cm visual analog scale (VAS). Laboratory examinations were taken to obtain some biochemical indicators (i.e., C-reactive protein, erythrocyte sedimentation rate, anti-SSA/SSB antibody). Stepwise logistic/linear regression model was used to investigate the potential predictors of dry eye/dry mouth, respectively. Statistical analysis was performed using SPSS version 20.0. Two hundred twenty-four pSS patients were included in this study. Among them, 215 (95.98%) patients reported ESSPRI-dry mouth items score > 0, and the mean score was 4.92 ± 2.43. In addition, according to the score of OSDI, 84 (37.5%) subjects reported non-dry eye, whereas 140 (62.5%) subjects reported dry eye (44 mild, 31 moderate, 65 severe), and the mean of the total OSDI score was 25.01 ± 23.58. Then, using logistic regression and linear regression respectively, we found that age and fatigue were the potential predictors of dry eye, whereas dry mouth was predicted by age, fatigue, total pain, and ESR. The results of this study suggested that rheumatologists should pay attention to pSS patients' dry eye and dry mouth, especially those with older age, higher level of ESR, more severe fatigue, and pain.
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Affiliation(s)
- Zhenyu Li
- Research Center of Clinical Medicine, Affiliated Hospital of Nantong University, 20th Xisi Road, Nantong, 226001, China.,School of Nursing, Nantong University, 19th Qixiu Road, Nantong, 226001, China
| | - Ting Fu
- Research Center of Clinical Medicine, Affiliated Hospital of Nantong University, 20th Xisi Road, Nantong, 226001, China
| | - Lin Li
- School of Nursing, Nantong University, 19th Qixiu Road, Nantong, 226001, China
| | - Yafei Cui
- School of Nursing, Nantong University, 19th Qixiu Road, Nantong, 226001, China
| | - Chen Dong
- School of Nursing, Nantong University, 19th Qixiu Road, Nantong, 226001, China
| | - Jing Li
- Department of Rheumatology, Affiliated Hospital of Nantong University, 20th Xisi Road, Nantong, 226001, China.
| | - Zhifeng Gu
- Research Center of Clinical Medicine, Affiliated Hospital of Nantong University, 20th Xisi Road, Nantong, 226001, China. .,Department of Rheumatology, Affiliated Hospital of Nantong University, 20th Xisi Road, Nantong, 226001, China.
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168
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Wang JJ, Reed JH, Colella AD, Russell AJ, Murray-Brown W, Chataway TK, Jackson KJL, Goodnow CC, Gordon TP. Molecular Profiling and Clonal Tracking of Secreted Rheumatoid Factors in Primary Sjögren's Syndrome. Arthritis Rheumatol 2018; 70:1617-1625. [PMID: 29697211 DOI: 10.1002/art.40539] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 04/19/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Rheumatoid factors (RFs) are associated with systemic disease in primary Sjögren's syndrome (SS) and may be pathogenic as mixed cryoglobulins. Current detection methods cannot resolve RFs at a molecular level. This study was undertaken to perform the first proteomic and transcriptomic analysis of secreted and membrane-bound IgM-RF in primary SS and identify unique heavy-chain peptide signatures for RF clonotype tracking. METHODS Purified heavy chains of serum RFs from 15 patients with primary SS were subjected to de novo mass spectrometric sequencing. The circulating B cell Ig repertoire was determined by massively parallel sequencing of IGH RNA from matched peripheral blood mononuclear cells (n = 7). RF-specific heavy-chain third complementarity-determining region (CDR3) peptides were identified by searching RF heavy-chain peptide sequences against the corresponding IGH RNA sequence libraries. Heavy-chain CDR3 peptides were used as biomarkers to track serum RF clonotypes using quantitative multiple reaction monitoring. RESULTS Serum RFs were clonally restricted and composed of shared sets of IgM heavy-chain variable region (Ig VH ) 1-69, 3-15, 3-7, and 3-74 subfamilies. Cryoprecipitable RFs from patients with mixed cryoglobulinemia (MC) were distinguishable from nonprecipitating RFs by a higher frequency of amino acid substitutions and identification of stereotypic heavy-chain CDR3 transcripts. Potentially pathogenic RF clonotypes were detected in serum by multiple reaction monitoring years before patients presented with MC. Levels of Ig VH 4-34 IgM-RF decreased following immunosuppression and remission of MC. CONCLUSION Cryoprecipitable RF clonotypes linked to vasculitis in primary SS have different molecular profiles than nonprecipitating RFs, suggesting different underlying mechanisms of production. The combined omics workflow presented herein provides molecular biomarkers for tracking and removal of pathogenic RF clones.
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Affiliation(s)
- Jing J Wang
- Flinders University and SA Pathology, Bedford Park, South Australia, Australia
| | - Joanne H Reed
- Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia
| | - Alex D Colella
- Flinders University and SA Pathology, Bedford Park, South Australia, Australia
| | - Amanda J Russell
- Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia
| | | | - Tim K Chataway
- Flinders University, Bedford Park, South Australia, Australia
| | | | | | - Tom P Gordon
- Flinders University and SA Pathology, Bedford Park, South Australia, Australia
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169
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Liu Z, Wang J, Lai J, Wang Q, Zhao J, Huang C, Yang X, Qian J, Wang H, Guo X, Liu Y, Tian Z, Li M, Zhao Y, Zeng X. Is it possible to apply the treat-to-target strategy in primary Sjögren’s syndrome-associated pulmonary arterial hypertension? Clin Rheumatol 2018; 37:2989-2998. [DOI: 10.1007/s10067-018-4184-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 05/12/2018] [Accepted: 06/19/2018] [Indexed: 02/07/2023]
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Lee KA, Kim KW, Kim BM, Won JY, Kim HA, Moon HW, Kim HR, Lee SH. Clinical and diagnostic significance of serum immunoglobulin A rheumatoid factor in primary Sjogren's syndrome. Clin Oral Investig 2018; 23:1415-1423. [PMID: 30032469 DOI: 10.1007/s00784-018-2545-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 06/21/2018] [Indexed: 01/10/2023]
Abstract
OBJECTIVES The aim of this study was to investigate the diagnostic accuracy of rheumatoid factor (RF) isotype for the detection of primary Sjogren's syndrome (pSS) and evaluate the clinical and serological associations of immunoglobulin (Ig) A RF in patients with pSS. MATERIALS AND METHODS RF levels were measured in 77 and 37 patients with pSS and idiopathic sicca symptoms, respectively, using ELISA and analysed with respect to clinical and laboratory disease characteristics. Receiver operating characteristic curves were used to determine and compare the diagnostic accuracy of IgA RF with other diagnostic tests. RESULTS Serum levels of IgA RF were significantly higher in patients with pSS than in those with idiopathic sicca symptoms. IgA RF showed sensitivity, specificity, positive, and negative predictive values of 83.1, 78.4, 88.9, and 69.0%, respectively, for pSS diagnosis. IgA RF was associated with xerostomia, severe sialoscintigraphic grade, low unstimulated salivary flow rate (USFR), antinuclear antibody, high IgG and IgM/G RF levels, and low C3 levels in patients with pSS. IgA RF titres had positive correlations with sialoscintigraphic grade and IgG and IgG/M RF levels and had negative correlations with USFR and C3 levels. CONCLUSION Our findings confirmed the potential of IgA RF to distinguish pSS from idiopathic sicca symptoms. The presence of IgA RF in patients with pSS was associated with significantly worse exocrine function and active serologic profile. No association between IgA RF and extra-glandular manifestations was noted. CLINICAL RELEVANCE IgA RF should be the predictive and diagnostic marker in patients with pSS.
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Affiliation(s)
- Kyung-Ann Lee
- Division of Rheumatology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Neungdong-ro 120-1, Seoul, 05030, South Korea
| | - Kyoung-Woon Kim
- Convergent Research Consortium for Immunologic Disease, The Catholic University, Banpodae-ro 222, Seoul, 06591, South Korea
| | - Bo-Mi Kim
- Convergent Research Consortium for Immunologic Disease, The Catholic University, Banpodae-ro 222, Seoul, 06591, South Korea
| | - Ji-Yeon Won
- Convergent Research Consortium for Immunologic Disease, The Catholic University, Banpodae-ro 222, Seoul, 06591, South Korea
| | - Han-Ah Kim
- Department of Laboratory Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Neungdong-ro 120-1, Seoul, 05030, South Korea
| | - Hee-Won Moon
- Department of Laboratory Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Neungdong-ro 120-1, Seoul, 05030, South Korea
| | - Hae-Rim Kim
- Division of Rheumatology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Neungdong-ro 120-1, Seoul, 05030, South Korea
| | - Sang-Heon Lee
- Division of Rheumatology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Neungdong-ro 120-1, Seoul, 05030, South Korea.
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López-Villalobos EF, Carrillo-Ballesteros FJ, Muñoz-Valle JF, Palafox-Sánchez CA, Valle Y, Orozco-Barocio G, Oregon-Romero E. Association of CD28 and CTLA4 haplotypes with susceptibility to primary Sjögren's syndrome in Mexican population. J Clin Lab Anal 2018; 33:e22620. [PMID: 29992636 DOI: 10.1002/jcla.22620] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 06/20/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Primary Sjögren's syndrome (pSS) is an autoimmune disease characterized by destruction of exocrine glands as a result of T and B cells infiltrated in glandular tissue. CD28 and CTLA-4 play a crucial role in T cell activation and inhibition. The aim of this study was to associate CD28 and CTLA4 haplotypes with susceptibility to pSS in patients from western Mexico. METHODS Polymerase chain reaction and restriction fragment length polymorphism were performed to identify CD28 and CTLA4 genotypes in 111 patients with pSS and 138 control subjects (CS). Haplotype analysis was carried out by SHEsis program. Soluble serum levels of CD28 (sCD28) and CTLA-4 (sCTLA-4) were quantified by ELISA kit. RESULTS The CD28 GC haplotype was associated with low risk to pSS (2.5-folds, P < 0.001). CTLA4 CAG and CGA were identified as genetic risk factor (P < 0.001;OR = 3.82[CI95%:2.022-7.296] and P < 0.001; OR = 11.38[CI95%:3.282-37.69] respectively). No difference in sCD28 and sCTLA-4 were found between patients and CS. However, pSS patients carriers of CD28 IVS3 + 17TC genotype showed high sCD28 (P = 0.039 vs TT carriers in CS). In regard to sCTLA-4, patient who carry CTLA4-319C>T, +49 A>G, and +6230 G>A, or their haplotypes did not show any difference. CONCLUSION Our findings suggest that CD28 GC, CTLA4 CAG, and CGA haplotypes are associated with susceptibility to pSS in patients from western Mexico. It seems that genetic control of CD28 and CTLA4 as well as local immune response in glandular tissue may regulate the impact of the gene expression in pSS. It is necessary to confirm this hypothesis in an integrative study.
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Affiliation(s)
- Erika Fabiola López-Villalobos
- Instituto de Investigación en Ciencias Biomédicas (IICB), Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, México
| | - Francisco Josué Carrillo-Ballesteros
- Instituto de Investigación en Ciencias Biomédicas (IICB), Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, México
| | - José Francisco Muñoz-Valle
- Instituto de Investigación en Ciencias Biomédicas (IICB), Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, México
| | - Claudia Azucena Palafox-Sánchez
- Instituto de Investigación en Ciencias Biomédicas (IICB), Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, México
| | - Yeminia Valle
- Instituto de Investigación en Ciencias Biomédicas (IICB), Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, México
| | | | - Edith Oregon-Romero
- Instituto de Investigación en Ciencias Biomédicas (IICB), Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, México
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Jones A, Cotton A, Guinto J, Wilton J, Ciurtin C. Outcome measures of disease activity for rare autoimmune rheumatic diseases. Br J Hosp Med (Lond) 2018; 79:396-401. [PMID: 29995544 DOI: 10.12968/hmed.2018.79.7.396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Systemic lupus erythematosus, scleroderma, myositis and Sjögren's syndrome are rare, complex, multi-systemic rheumatic diseases associated with significant morbidity and mortality. Thorough assessments of disease activity are required to guide clinical management and assess response to new therapies in clinical trials. This article reviews the commonly used outcome measures to assess this group of diseases and discusses the limitations of their use.
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Affiliation(s)
- Alexis Jones
- Senior Clinical Research Fellow, Department of Rheumatology, University College London Hospital NHS Trust, London NW1 2PQ
| | - Alice Cotton
- Clinical Research Nurse, Department of Rheumatology, University College London Hospital NHS Trust, London
| | - Jesusa Guinto
- Clinical Research Nurse, Department of Rheumatology, University College London Hospital NHS Trust, London
| | - James Wilton
- Clinical Trial Coordinator, Department of Rheumatology, University College London Hospital NHS Trust, London
| | - Coziana Ciurtin
- Consultant, Department of Rheumatology, University College London Hospital NHS Trust, London
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How to Distinguish Patients with pSS among Individuals with Dryness without Invasive Diagnostic Studies. J Immunol Res 2018; 2018:1060421. [PMID: 29854827 PMCID: PMC5954915 DOI: 10.1155/2018/1060421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 03/27/2018] [Accepted: 04/11/2018] [Indexed: 11/18/2022] Open
Abstract
In the course of pSS, inflammatory cell infiltration consists mainly of lymphocytes infiltrating exocrine glands, which leads to their impaired function. The characteristic feature is generalized dryness. The aim of this study was to attempt to answer the question whether it is possible to distinguish between patients with pSS and individuals with dryness caused by other pathologies without applying invasive studies. The study included 68 patients with pSS and 43 healthy controls with dryness. FS ≥ 1 was observed in 90% of patients with pSS (with or without dryness), and only in 23% of the control group (only with xerostomia). In the pSS group, anaemia (p = 0.0085), lymphocytopenia (p = 0.0006), elevated ERS (p = 0.001), higher RF titer, and ANA antibodies were noted. Configuration of anti-SSA + SSB + Ro52 antibodies was characteristic for the pSS group. Considering the clinical symptoms, statistically significant differences were noted between pSS patients and the control group in frequency (p = 0.02) and severity (p = 0.042) of fatigue, lymphadenopathy, major salivary gland involvement, and photosensitivity to UV light. In conclusion, invasive methods are pivotal in pSS diagnosis in this salivary gland biopsy. Chronic fatigue syndrome is more common in pSS patients and can be subjective distinguishing factor in the group of people with dryness.
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Cui Y, Xia L, li L, Zhao Q, Chen S, Gu Z. Anxiety and depression in primary Sjögren's syndrome: a cross-sectional study. BMC Psychiatry 2018; 18:131. [PMID: 29769121 PMCID: PMC5956972 DOI: 10.1186/s12888-018-1715-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Accepted: 05/02/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Prevalence of anxiety and depression is high in people with Primary Sjögren's syndrome (pSS). However, there are currently no known reported studies about anxiety/depression in pSS patients from China. Our aim was to compare anxiety/depression in pSS patients and healthy controls; to investigate the prevalence of anxiety and/or depression among pSS patients in China; to evaluate its relationship with the disease activity, fatigue, pain, education, ocular surface disease, oral health, swallowing disorders, employment status, European League Against Rheumatism Sjögren's Syndrome Patient Reported Index(ESSPRI) as well as to analyze potential determinants of anxiety and depression. METHODS In this study, 160 pSS patients and 170 age- and sex- matched healthy controls were included. Participants completed self-administered questionnaires, Hospital Anxiety and Depression Scale (HADS) and so on. Independent samples t-tests, χ2 analyses and multivariable stepwise logistic regression modeling were used to analyze the data. RESULTS We found 33.8% pSS patients were anxiety, and 36.9% had depression, which were significantly higher than controls. And there were significant correlations among education, employment status, disease activity, fatigue, ocular surface disease, ESSPRI, oral health, swallowing disorders and anxiety/depression. Meanwhile, logistic regression analysis revealed that oral health and swallowing disorders were significantly associated with anxiety in pSS patients; as well as fatigue was significantly associated with depression. CONCLUSIONS The prevalence of depression and anxiety was high in adult pSS patients. Interestingly, oral health and swallowing disorders were the most important predictors of anxiety in pSS patients. Therefore, rheumatologists should pay attention to the potential mental comorbidities while managing patients with pSS and provide the basis for mental health providers in order to identify effective strategies for preventing and treating depression and anxiety among adult pSS patients. Simultaneously, rheumatologists should also focus on the oral health and swallowing disorders in pSS patients.
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Affiliation(s)
- Yafei Cui
- 0000 0000 9530 8833grid.260483.bDepartment of Rheumatology, Affliated Hospital of Nantong University, 20th Xisi road, 226001 Nantong, People’s Republic of China ,0000 0000 9530 8833grid.260483.bSchool of Nursing, Nantong University, 19th Qixiu Road, 226001 Nantong, People’s Republic of China
| | - Ling Xia
- 0000 0000 9530 8833grid.260483.bDepartment of Nursing, Affliated Hospital of Nantong University, 20th Xisi road, Nantong, 226001 China
| | - Lin li
- 0000 0000 9530 8833grid.260483.bSchool of Nursing, Nantong University, 19th Qixiu Road, 226001 Nantong, People’s Republic of China
| | - Qian Zhao
- 0000 0000 9530 8833grid.260483.bSchool of Nursing, Nantong University, 19th Qixiu Road, 226001 Nantong, People’s Republic of China
| | - Shengnan Chen
- 0000 0000 9530 8833grid.260483.bSchool of Nursing, Nantong University, 19th Qixiu Road, 226001 Nantong, People’s Republic of China
| | - Zhifeng Gu
- Department of Rheumatology, Affliated Hospital of Nantong University, 20th Xisi road, 226001, Nantong, People's Republic of China.
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175
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Parameters of Somatosensory Evoked Potentials in Patients with Primary Sjӧgren's Syndrome: Preliminary Results. J Immunol Res 2018; 2018:8174340. [PMID: 29850640 PMCID: PMC5907518 DOI: 10.1155/2018/8174340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 02/25/2018] [Indexed: 12/14/2022] Open
Abstract
Primary Sjogren's syndrome (pSS) is a chronic autoimmune disease. The aim of the study was to establish whether in patients with pSS without central nervous system (CNS) involvement, the function of the central portion of the sensory pathway can be challenged. In 33 patients with pSS without clinical features of CNS damage and normal head computed tomography scan, somatosensory evoked potentials (SEP) were studied. The results were compared to other clinical parameters of the disease, particularly to immunological status. The control group consisted of 20 healthy volunteers. Mean latency of all components of SEP was considerably prolonged in patients compared to the control group. Mean interpeak latency N20-N13 (duration of central conduction TT) did not differ significantly between the groups. However, in the study group, mean amplitude of N20P22 and N13P16 was significantly higher compared to healthy individuals. In patients with pSS, significant differences in SEP parameters depending on the duration of the disease and presence of SSA and SSB antibodies were noted. The authors confirmed CNS involvement often observed in patients with pSS. They also showed dysfunction of the central sensory neuron as a difference in the amplitude of cortical response, which indicates subclinical damage to the CNS.
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176
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James K, Chipeta C, Parker A, Harding S, Cockell SJ, Gillespie CS, Hallinan J, Barone F, Bowman SJ, Ng WF, Fisher BA. B-cell activity markers are associated with different disease activity domains in primary Sjögren's syndrome. Rheumatology (Oxford) 2018; 57:1222-1227. [PMID: 29608774 PMCID: PMC6014143 DOI: 10.1093/rheumatology/key063] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 02/12/2018] [Indexed: 11/24/2022] Open
Abstract
Objectives B-cell activating factor (BAFF), β-2 microglobulin (β2M) and serum free light chains (FLCs) are elevated in primary SS (pSS) and associated with disease activity. We aimed to investigate their association with the individual disease activity domains of the EULAR Sjögren’s Syndrome Disease Activity Index (ESSDAI) in a large well-characterized pSS cohort. Methods Sera from pSS patients enrolled in the UK Primary Sjögren’s Syndrome Registry (UKPSSR) (n = 553) and healthy controls (n = 286) were analysed for FLC (κ and λ), BAFF and β2 M. Pearson correlation coefficients were calculated for patient clinical characteristics, including salivary flow, Schirmer’s test, EULAR Sjögren’s Syndrome Patient Reported Index and serum IgG levels. Poisson regression was performed to identify independent predictors of total ESSDAI and ClinESSDAI (validated ESSDAI minus the biological domain) scores and their domains. Results Levels of BAFF, β2M and FLCs were higher in pSS patients compared to controls. All three biomarkers associated significantly with the ESSDAI and the ClinESSDAI. BAFF associated with the peripheral nervous system domain of the ESSDAI, whereas β2M and FLCs associated with the cutaneous, biological and renal domains. Multivariate analysis showed BAFF, β2M and their interaction to be independent predictors of ESSDAI/ClinESSDAI. FLCs were also shown to associate with the ESSDAI/ClinESSDAI but not independent of serum IgG. Conclusion All biomarkers were associated with total ESSDAI scores but with differing domain associations. These findings should encourage further investigation of these biomarkers in longitudinal studies and against other disease activity measures.
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Affiliation(s)
- Katherine James
- Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University, Newcastle, UK
- Interdisciplinary Computing and Complex BioSystems (ICOS) Research Group, Newcastle University, Newcastle, UK
| | - Chimwemwe Chipeta
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Antony Parker
- Department of Clinical R&D, The Binding Site Group Ltd, Edgbaston, UK
| | - Stephen Harding
- Department of Clinical R&D, The Binding Site Group Ltd, Edgbaston, UK
| | - Simon J Cockell
- Bioinformatics Support Unit, Newcastle University, Newcastle, UK
| | - Colin S Gillespie
- School of Mathematics & Statistics, Newcastle University, Newcastle, UK
| | - Jennifer Hallinan
- Interdisciplinary Computing and Complex BioSystems (ICOS) Research Group, Newcastle University, Newcastle, UK
- Department of Biological Sciences, Macquarie University, Sydney, Australia
| | - Francesca Barone
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Simon J Bowman
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- Rheumatology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Wan-Fai Ng
- Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University, Newcastle, UK
| | - Benjamin A Fisher
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- Rheumatology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Correspondence to: Benjamin Fisher, Centre for Translational Inflammation Research, Institute of Inflammation and Ageing, Queen Elizabeth Hospital Birmingham, Birmingham, B15 2WB, UK. E-mail:
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Abstract
Sjögren's syndrome (pSS) is a complex and heterogeneous disorder characterized by different clinical subsets. Recently, great efforts have been made searching for reliable biomarkers able to ameliorate the diagnostic algorithm and the prognostic stratification of pSS patients and ultimately allowing the scientific community to address some of the unmet needs for the disease. In this review, we have summarized the state of the art of 'traditional' widely acknowledged clinical, serological and histologic biomarkers for pSS with the aim of highlighting their relevance and limitations in clinical practice. We have also explored some of the novel potential biomarkers that have been proposed more recently, potentially able to open new ways in the assessment of the disease.
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Affiliation(s)
- Chiara Baldini
- Rheumatology Unit, Department of Clinical & Experimental Medicine, University of Pisa, 56126, Italy
| | - Francesco Ferro
- Rheumatology Unit, Department of Clinical & Experimental Medicine, University of Pisa, 56126, Italy
| | - Elena Elefante
- Rheumatology Unit, Department of Clinical & Experimental Medicine, University of Pisa, 56126, Italy
| | - Stefano Bombardieri
- Rheumatology Unit, Department of Clinical & Experimental Medicine, University of Pisa, 56126, Italy
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Suzuki Y, Fujii H, Nomura H, Mizushima I, Yamada K, Yamagishi M, Kawano M. Impact of double positive for anti-centromere and anti-SS-a/Ro antibodies on clinicopathological characteristics of primary Sjögren's syndrome: a retrospective cohort study. Mod Rheumatol 2017; 28:872-878. [PMID: 29251022 DOI: 10.1080/14397595.2017.1418164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The purpose of our study was to define the clinical characteristics of anti-centromere antibody and anti-SS-A/Ro antibody (ACA/SS-A) double positive Sjögren's syndrome (SS) and to clarify the clinical impact of these antibodies. METHODS We examined 108 patients (6 males, mean age 57.9 years) with SS who underwent labial salivary gland biopsy. The patients were divided into four groups by ACA and anti-SS-A/Ro antibody positivity. Symptoms, laboratory and pathological data, and scleroderma-related data were compared among the groups. RESULTS The cohort consisted of 16 ACA/SS-A double positive, 20 ACA single positive, 67 SS-A single positive, and 5 ACA/SS-A double negative SS. ACA/SS-A double positive SS were significantly older than SS-A single positive SS (mean age 71.1 vs. 53.1 years). They had higher EULAR Sjögren's syndrome disease activity index (ESSDAI) at diagnosis (mean 3.81 vs. 0.50) and higher serum IgG (mean 2009 vs. 1389 mg/dL) than ACA single positive SS. No patients developed skin sclerosis during a mean follow-up period of 45.6 months (range: 1-178). CONCLUSION These results demonstrate that ACA/SS-A double positive SS is distinct from ACA single positive and SSA single positive SS. The combination of ACA and anti-SS-A/Ro antibody in SS should deserve greater attention in clinical practice.
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Affiliation(s)
- Yasunori Suzuki
- a Division of Rheumatology, Department of Cardiovascular and Internal Medicine , Kanazawa University Graduate School of Medicine , Kanazawa , Japan
| | - Hiroshi Fujii
- a Division of Rheumatology, Department of Cardiovascular and Internal Medicine , Kanazawa University Graduate School of Medicine , Kanazawa , Japan
| | - Hideki Nomura
- b Department of General Medicine , Kanazawa University Hospital , Kanazawa , Japan
| | - Ichiro Mizushima
- a Division of Rheumatology, Department of Cardiovascular and Internal Medicine , Kanazawa University Graduate School of Medicine , Kanazawa , Japan
| | - Kazunori Yamada
- a Division of Rheumatology, Department of Cardiovascular and Internal Medicine , Kanazawa University Graduate School of Medicine , Kanazawa , Japan
| | - Masakazu Yamagishi
- c Division of Cardiology, Department of Cardiovascular and Internal Medicine , Kanazawa University Graduate School of Medicine , Kanazawa , Japan
| | - Mitsuhiro Kawano
- a Division of Rheumatology, Department of Cardiovascular and Internal Medicine , Kanazawa University Graduate School of Medicine , Kanazawa , Japan
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Ishioka-Takei E, Yoshimoto K, Suzuki K, Nishikawa A, Yasuoka H, Yamaoka K, Takeuchi T. Increased proportion of a CD38 highIgD + B cell subset in peripheral blood is associated with clinical and immunological features in patients with primary Sjögren's syndrome. Clin Immunol 2017; 187:85-91. [PMID: 29061446 DOI: 10.1016/j.clim.2017.10.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 10/13/2017] [Accepted: 10/19/2017] [Indexed: 12/16/2022]
Abstract
We investigated the correlation between the increased proportion of peripheral B cell subsets and clinical and immunological features in primary Sjögren's syndrome (pSS). We found that the proportion of CD19+ B cells was significantly increased in pSS as compared with HC and was correlated with serum IgG levels. Moreover, in vitro IgG production by CD19+ B cells was significantly increased in pSS and was positively and significantly correlated with serum IgG levels. FACS analysis revealed that the proportions of peripherally CD38highIgD+ B cells and CD38highIgD- B cells were significantly increased in pSS. In addition, the proportion of CD38highIgD+ B cells positively correlated with ESSDAI scores and serum levels of IgG, anti-Ro/SSA and anti-La/SSB antibodies while that of CD38highIgD- B cells showed no correlation with these parameters. Our data suggest that increased proportion of CD38highIgD+ B cells in pSS is involved in IgG overproduction including autoantibodies, and correlates with disease progression.
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Affiliation(s)
- Eriko Ishioka-Takei
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Keiko Yoshimoto
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan; Clinical and Translational Research Center, Keio University Hospital, Tokyo, Japan.
| | - Katsuya Suzuki
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Ayumi Nishikawa
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Hidekata Yasuoka
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Kunihiro Yamaoka
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Tsutomu Takeuchi
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
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Is primary Sjögren's syndrome a risk factor for malignancies different from lymphomas? What does the literature highlight about it? Reumatologia 2017; 55:136-139. [PMID: 28769137 PMCID: PMC5534508 DOI: 10.5114/reum.2017.68913] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 06/12/2017] [Indexed: 12/29/2022] Open
Abstract
Background Primary Sjögren’s syndrome (pSS) is a chronic systemic autoimmune disease with an elevated risk of developing lymphoproliferative malignancies (LM). Whether pSS is a risk factor or not for non-lymphoma malignancies (NLM) has been scarcely evaluated in the literature. Age is per se a risk factor for malignancies: patients over 70 years old have 4 times higher risk for cancers than adults. Even if the mean age of pSS onset usually is in the 4th and 5th decade, its onset in patients aged over 65 years (Elderly Onset pSS – EOpSS) is not uncommon. Material and methods To evaluate pSS as a risk factor for NLM we performed a systematic electronic search on PubMed in the period 2006–2016 to identify all the publications on this topic. The studies were eligible for inclusion if they reported specific Standardized Incidence Ratio (SIR) with 95% CI. Studies that did not report sufficient published and/or original data were excluded. Results Only 7 articles of 494 that we found in PubMed fulfilled the inclusion criterion. In the vast majority of these, SIR values were not statistically significant for NLM. The occurrence of NLM after LM was statistically significant in some studies and a NLM represented the most frequent cause of death. The possibility that NLM may represent a paraneoplastic syndrome seems much more frequent than LM, the risk of which increases with time after the diagnosis. Data regarding the neoplastic weight of EOpSS are mainly pointed out by case reports. Conclusions Primary Sjögren’s syndrome is not associated with an increased risk for NLM. However the possibility that NLM may appear after recovery from lymphoma should be carefully considered because it could be cause of the patient’s death. Similarly the possibility that NLM may represent a paraneoplastic syndrome must be highlighted. The relationship between EOpSS and SIRs for NLM should be deepened with studies on ad hoc cohorts.
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Baldini C, Ferro F, Bombardieri S. Classification criteria in Sjögren's syndrome. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:313. [PMID: 28856153 DOI: 10.21037/atm.2017.05.07] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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182
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Capaccio P, Canzi P, Torretta S, Rossi V, Benazzo M, Bossi A, Vitali C, Cavagna L, Pignataro L. Combined interventional sialendoscopy and intraductal steroid therapy for recurrent sialadenitis in Sjögren's syndrome: Results of a pilot monocentric trial. Clin Otolaryngol 2017; 43:96-102. [DOI: 10.1111/coa.12911] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2017] [Indexed: 12/11/2022]
Affiliation(s)
- P. Capaccio
- ENT Clinic; Department of Biomedical, Surgical and Dental Sciences; University of Milan; Fondazione IRCCS Ca’ Granda Policlinico; Milan Italy
| | - P. Canzi
- Department of Otorhinolaryngology; University of Pavia; IRCCS Policlinico S. Matteo Foundation; Pavia Italy
| | - S. Torretta
- Otolaryngology Unit; Department of Clinical Sciences and Community Health; University of Milan; Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico; Milan Italy
| | - V. Rossi
- Department of Otorhinolaryngology; University of Pavia; IRCCS Policlinico S. Matteo Foundation; Pavia Italy
| | - M. Benazzo
- Department of Otorhinolaryngology; University of Pavia; IRCCS Policlinico S. Matteo Foundation; Pavia Italy
| | - A. Bossi
- Branch of Medical Statistics, Biometry and Epidemiology “G. A. Maccacaro”; Department of Clinical Sciences and Community Health; University of Milan; Milan Italy
| | - C. Vitali
- Istituto Villa San Giuseppe; Como Italy
- Casa di Cura di Lecco; Lecco Italy
| | - L. Cavagna
- Division of Rheumatology; University of Pavia; IRCCS Policlinico S. Matteo Foundation; Pavia Italy
| | - L. Pignataro
- Otolaryngology Unit; Department of Clinical Sciences and Community Health; University of Milan; Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico; Milan Italy
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183
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Oftedal BE, Marthinussen MC, Erichsen MM, Tveitarås MK, Kjellesvik-Kristiansen A, Hammenfors D, Jonsson MV, Kisand K, Jonsson R, Wolff ASB. Impaired salivary gland activity in patients with autoimmune polyendocrine syndrome type I. Autoimmunity 2017; 50:211-222. [PMID: 28686485 DOI: 10.1080/08916934.2017.1344972] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 06/18/2017] [Indexed: 10/19/2022]
Abstract
Autoimmune polyendocrine syndrome type I (APS-I) is a severe disease caused by mutations in the autoimmune regulator (AIRE) gene. We hypothesized that salivary gland dysfunction could be a possible unexplored component of these patients and here aimed to investigate salivary and lachrymal symptoms in the Norwegian cohort of APS-I patients (N = 41) and the aetiology behind it. Sicca symptoms and possible corresponding underlying factors were assessed by subjective reports combined with objective measures of saliva and tear flow, serological testing, immune fluorescence microscopy, ultrasonography and searching for putative autoantibodies in the salivary glands. In addition, defensin and anti-defensin levels were analysed in patients and compared with healthy controls. Our results indicate mild salivary and/or lachrymal gland dysfunction manifesting in low saliva or tear flow in a total of 62% of APS-I patients. Serum IgG from 9 of 12 patients bound to targets in salivary gland biopsy slides, although the specificity and pattern of binding varied. There was no reactivity against known Sjögren-associated autoantigens in sera from APS-I patients using quantitative methods, but 11% were ANA positive by immunofluorescence microscopy. We identified several putative autoantigens in one patient, although none of these were verified as APS-I specific. We conclude that impaired salivary gland activity is part of the clinical picture of APS-I and our findings could indicate an autoimmune aetiology. We further show that APS-I patients have an altered antimicrobial signature in both sera and saliva, which requires further investigations.
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Affiliation(s)
- Bergithe E Oftedal
- a Department of Clinical Science , University of Bergen , Bergen , Norway
| | | | - Martina M Erichsen
- c Department of Medicine , Haukeland University Hospital , Bergen , Norway
| | - Maria K Tveitarås
- a Department of Clinical Science , University of Bergen , Bergen , Norway
| | | | - Daniel Hammenfors
- a Department of Clinical Science , University of Bergen , Bergen , Norway
- d Department of Rheumatology , Haukeland University Hospital , Bergen , Norway
| | - Malin V Jonsson
- e Department of Clinical Dentistry , University of Bergen , Bergen , Norway
| | - Kai Kisand
- f Molecular Pathology, Institute of Biomedical and Translational Medicine, University of Tartu , Tartu , Estonia
| | - Roland Jonsson
- d Department of Rheumatology , Haukeland University Hospital , Bergen , Norway
- g Broegelmann Research Laboratory, Department of Clinical Science , University of Bergen , Bergen , Norway
| | - Anette S B Wolff
- a Department of Clinical Science , University of Bergen , Bergen , Norway
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184
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Quartuccio L, Baldini C, Priori R, Bartoloni E, Carubbi F, Alunno A, Gandolfo S, Colafrancesco S, Giacomelli R, Gerli R, Valesini G, Bombardieri S, De Vita S. Cryoglobulinemia in Sjögren Syndrome: A Disease Subset that Links Higher Systemic Disease Activity, Autoimmunity, and Local B Cell Proliferation in Mucosa-associated Lymphoid Tissue. J Rheumatol 2017; 44:1179-1183. [PMID: 28507188 DOI: 10.3899/jrheum.161465] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To compare systemic disease activity by validated tools, i.e., the European League Against Rheumatism Sjögren Syndrome Disease Activity Index (ESSDAI) and the Clinical ESSDAI (ClinESSDAI) scores, between primary Sjögren syndrome (pSS) with positive serum cryoglobulins and pSS without serum cryoglobulins. METHODS There were 825 consecutive patients with pSS who were retrospectively evaluated. RESULTS The ESSDAI and the ClinESSDAI scores were significantly higher in cryoglobulin-positive patients (p < 0.0001, for both scores). Cryoglobulinemia was significantly associated with these domains: constitutional (p = 0.003), lymphadenopathy (p = 0.007), glandular (p = 0.0002), cutaneous (p < 0.0001), peripheral nervous system (p < 0.0001), hematological (p = 0.004), and biological (p < 0.0001). CONCLUSION Cryoglobulin-positive patients show the highest systemic activity in pSS.
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Affiliation(s)
- Luca Quartuccio
- From the Rheumatology Clinic, Department of Medical and Biological Sciences, Azienda Ospedaliero-Universitaria S. Maria della Misericordia, Udine; Rheumatology Unit, Department of Internal Medicine, University of Pisa, Pisa; Rheumatology Unit, Sapienza University of Rome, Rome; Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Perugia, Perugia; Rheumatology Unit, University of L'Aquila, L'Aquila, Italy. .,L. Quartuccio, MD, PhD, Rheumatology Clinic, Department of Medical and Biological Sciences, Azienda Ospedaliero-Universitaria S. Maria della Misericordia; C. Baldini, MD, Rheumatology Unit, Department of Internal Medicine, University of Pisa; R. Priori, MD, Rheumatology Unit, Sapienza University of Rome; E. Bartoloni, MD, Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Perugia; F. Carubbi, MD, Rheumatology Unit, University of L'Aquila; A. Alunno, MD, Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Perugia; S. Gandolfo, MD, Rheumatology Clinic, Department of Medical and Biological Sciences, Azienda Ospedaliero-Universitaria S. Maria della Misericordia; S. Colafrancesco, MD, Rheumatology Unit, Sapienza University of Rome; R. Giacomelli, MD, Professor, Rheumatology Unit, University of L'Aquila; R. Gerli, MD, Professor, Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Perugia; G. Valesini, MD, Professor, Rheumatology Unit, Sapienza University of Rome; S. Bombardieri, MD, Professor, Rheumatology Unit, Department of Internal Medicine, University of Pisa; S. De Vita, MD, Professor, Rheumatology Clinic, Department of Medical and Biological Sciences, Azienda Ospedaliero-Universitaria S. Maria della Misericordia.
| | - Chiara Baldini
- From the Rheumatology Clinic, Department of Medical and Biological Sciences, Azienda Ospedaliero-Universitaria S. Maria della Misericordia, Udine; Rheumatology Unit, Department of Internal Medicine, University of Pisa, Pisa; Rheumatology Unit, Sapienza University of Rome, Rome; Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Perugia, Perugia; Rheumatology Unit, University of L'Aquila, L'Aquila, Italy.,L. Quartuccio, MD, PhD, Rheumatology Clinic, Department of Medical and Biological Sciences, Azienda Ospedaliero-Universitaria S. Maria della Misericordia; C. Baldini, MD, Rheumatology Unit, Department of Internal Medicine, University of Pisa; R. Priori, MD, Rheumatology Unit, Sapienza University of Rome; E. Bartoloni, MD, Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Perugia; F. Carubbi, MD, Rheumatology Unit, University of L'Aquila; A. Alunno, MD, Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Perugia; S. Gandolfo, MD, Rheumatology Clinic, Department of Medical and Biological Sciences, Azienda Ospedaliero-Universitaria S. Maria della Misericordia; S. Colafrancesco, MD, Rheumatology Unit, Sapienza University of Rome; R. Giacomelli, MD, Professor, Rheumatology Unit, University of L'Aquila; R. Gerli, MD, Professor, Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Perugia; G. Valesini, MD, Professor, Rheumatology Unit, Sapienza University of Rome; S. Bombardieri, MD, Professor, Rheumatology Unit, Department of Internal Medicine, University of Pisa; S. De Vita, MD, Professor, Rheumatology Clinic, Department of Medical and Biological Sciences, Azienda Ospedaliero-Universitaria S. Maria della Misericordia
| | - Roberta Priori
- From the Rheumatology Clinic, Department of Medical and Biological Sciences, Azienda Ospedaliero-Universitaria S. Maria della Misericordia, Udine; Rheumatology Unit, Department of Internal Medicine, University of Pisa, Pisa; Rheumatology Unit, Sapienza University of Rome, Rome; Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Perugia, Perugia; Rheumatology Unit, University of L'Aquila, L'Aquila, Italy.,L. Quartuccio, MD, PhD, Rheumatology Clinic, Department of Medical and Biological Sciences, Azienda Ospedaliero-Universitaria S. Maria della Misericordia; C. Baldini, MD, Rheumatology Unit, Department of Internal Medicine, University of Pisa; R. Priori, MD, Rheumatology Unit, Sapienza University of Rome; E. Bartoloni, MD, Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Perugia; F. Carubbi, MD, Rheumatology Unit, University of L'Aquila; A. Alunno, MD, Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Perugia; S. Gandolfo, MD, Rheumatology Clinic, Department of Medical and Biological Sciences, Azienda Ospedaliero-Universitaria S. Maria della Misericordia; S. Colafrancesco, MD, Rheumatology Unit, Sapienza University of Rome; R. Giacomelli, MD, Professor, Rheumatology Unit, University of L'Aquila; R. Gerli, MD, Professor, Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Perugia; G. Valesini, MD, Professor, Rheumatology Unit, Sapienza University of Rome; S. Bombardieri, MD, Professor, Rheumatology Unit, Department of Internal Medicine, University of Pisa; S. De Vita, MD, Professor, Rheumatology Clinic, Department of Medical and Biological Sciences, Azienda Ospedaliero-Universitaria S. Maria della Misericordia
| | - Elena Bartoloni
- From the Rheumatology Clinic, Department of Medical and Biological Sciences, Azienda Ospedaliero-Universitaria S. Maria della Misericordia, Udine; Rheumatology Unit, Department of Internal Medicine, University of Pisa, Pisa; Rheumatology Unit, Sapienza University of Rome, Rome; Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Perugia, Perugia; Rheumatology Unit, University of L'Aquila, L'Aquila, Italy.,L. Quartuccio, MD, PhD, Rheumatology Clinic, Department of Medical and Biological Sciences, Azienda Ospedaliero-Universitaria S. Maria della Misericordia; C. Baldini, MD, Rheumatology Unit, Department of Internal Medicine, University of Pisa; R. Priori, MD, Rheumatology Unit, Sapienza University of Rome; E. Bartoloni, MD, Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Perugia; F. Carubbi, MD, Rheumatology Unit, University of L'Aquila; A. Alunno, MD, Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Perugia; S. Gandolfo, MD, Rheumatology Clinic, Department of Medical and Biological Sciences, Azienda Ospedaliero-Universitaria S. Maria della Misericordia; S. Colafrancesco, MD, Rheumatology Unit, Sapienza University of Rome; R. Giacomelli, MD, Professor, Rheumatology Unit, University of L'Aquila; R. Gerli, MD, Professor, Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Perugia; G. Valesini, MD, Professor, Rheumatology Unit, Sapienza University of Rome; S. Bombardieri, MD, Professor, Rheumatology Unit, Department of Internal Medicine, University of Pisa; S. De Vita, MD, Professor, Rheumatology Clinic, Department of Medical and Biological Sciences, Azienda Ospedaliero-Universitaria S. Maria della Misericordia
| | - Francesco Carubbi
- From the Rheumatology Clinic, Department of Medical and Biological Sciences, Azienda Ospedaliero-Universitaria S. Maria della Misericordia, Udine; Rheumatology Unit, Department of Internal Medicine, University of Pisa, Pisa; Rheumatology Unit, Sapienza University of Rome, Rome; Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Perugia, Perugia; Rheumatology Unit, University of L'Aquila, L'Aquila, Italy.,L. Quartuccio, MD, PhD, Rheumatology Clinic, Department of Medical and Biological Sciences, Azienda Ospedaliero-Universitaria S. Maria della Misericordia; C. Baldini, MD, Rheumatology Unit, Department of Internal Medicine, University of Pisa; R. Priori, MD, Rheumatology Unit, Sapienza University of Rome; E. Bartoloni, MD, Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Perugia; F. Carubbi, MD, Rheumatology Unit, University of L'Aquila; A. Alunno, MD, Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Perugia; S. Gandolfo, MD, Rheumatology Clinic, Department of Medical and Biological Sciences, Azienda Ospedaliero-Universitaria S. Maria della Misericordia; S. Colafrancesco, MD, Rheumatology Unit, Sapienza University of Rome; R. Giacomelli, MD, Professor, Rheumatology Unit, University of L'Aquila; R. Gerli, MD, Professor, Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Perugia; G. Valesini, MD, Professor, Rheumatology Unit, Sapienza University of Rome; S. Bombardieri, MD, Professor, Rheumatology Unit, Department of Internal Medicine, University of Pisa; S. De Vita, MD, Professor, Rheumatology Clinic, Department of Medical and Biological Sciences, Azienda Ospedaliero-Universitaria S. Maria della Misericordia
| | - Alessia Alunno
- From the Rheumatology Clinic, Department of Medical and Biological Sciences, Azienda Ospedaliero-Universitaria S. Maria della Misericordia, Udine; Rheumatology Unit, Department of Internal Medicine, University of Pisa, Pisa; Rheumatology Unit, Sapienza University of Rome, Rome; Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Perugia, Perugia; Rheumatology Unit, University of L'Aquila, L'Aquila, Italy.,L. Quartuccio, MD, PhD, Rheumatology Clinic, Department of Medical and Biological Sciences, Azienda Ospedaliero-Universitaria S. Maria della Misericordia; C. Baldini, MD, Rheumatology Unit, Department of Internal Medicine, University of Pisa; R. Priori, MD, Rheumatology Unit, Sapienza University of Rome; E. Bartoloni, MD, Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Perugia; F. Carubbi, MD, Rheumatology Unit, University of L'Aquila; A. Alunno, MD, Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Perugia; S. Gandolfo, MD, Rheumatology Clinic, Department of Medical and Biological Sciences, Azienda Ospedaliero-Universitaria S. Maria della Misericordia; S. Colafrancesco, MD, Rheumatology Unit, Sapienza University of Rome; R. Giacomelli, MD, Professor, Rheumatology Unit, University of L'Aquila; R. Gerli, MD, Professor, Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Perugia; G. Valesini, MD, Professor, Rheumatology Unit, Sapienza University of Rome; S. Bombardieri, MD, Professor, Rheumatology Unit, Department of Internal Medicine, University of Pisa; S. De Vita, MD, Professor, Rheumatology Clinic, Department of Medical and Biological Sciences, Azienda Ospedaliero-Universitaria S. Maria della Misericordia
| | - Saviana Gandolfo
- From the Rheumatology Clinic, Department of Medical and Biological Sciences, Azienda Ospedaliero-Universitaria S. Maria della Misericordia, Udine; Rheumatology Unit, Department of Internal Medicine, University of Pisa, Pisa; Rheumatology Unit, Sapienza University of Rome, Rome; Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Perugia, Perugia; Rheumatology Unit, University of L'Aquila, L'Aquila, Italy.,L. Quartuccio, MD, PhD, Rheumatology Clinic, Department of Medical and Biological Sciences, Azienda Ospedaliero-Universitaria S. Maria della Misericordia; C. Baldini, MD, Rheumatology Unit, Department of Internal Medicine, University of Pisa; R. Priori, MD, Rheumatology Unit, Sapienza University of Rome; E. Bartoloni, MD, Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Perugia; F. Carubbi, MD, Rheumatology Unit, University of L'Aquila; A. Alunno, MD, Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Perugia; S. Gandolfo, MD, Rheumatology Clinic, Department of Medical and Biological Sciences, Azienda Ospedaliero-Universitaria S. Maria della Misericordia; S. Colafrancesco, MD, Rheumatology Unit, Sapienza University of Rome; R. Giacomelli, MD, Professor, Rheumatology Unit, University of L'Aquila; R. Gerli, MD, Professor, Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Perugia; G. Valesini, MD, Professor, Rheumatology Unit, Sapienza University of Rome; S. Bombardieri, MD, Professor, Rheumatology Unit, Department of Internal Medicine, University of Pisa; S. De Vita, MD, Professor, Rheumatology Clinic, Department of Medical and Biological Sciences, Azienda Ospedaliero-Universitaria S. Maria della Misericordia
| | - Serena Colafrancesco
- From the Rheumatology Clinic, Department of Medical and Biological Sciences, Azienda Ospedaliero-Universitaria S. Maria della Misericordia, Udine; Rheumatology Unit, Department of Internal Medicine, University of Pisa, Pisa; Rheumatology Unit, Sapienza University of Rome, Rome; Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Perugia, Perugia; Rheumatology Unit, University of L'Aquila, L'Aquila, Italy.,L. Quartuccio, MD, PhD, Rheumatology Clinic, Department of Medical and Biological Sciences, Azienda Ospedaliero-Universitaria S. Maria della Misericordia; C. Baldini, MD, Rheumatology Unit, Department of Internal Medicine, University of Pisa; R. Priori, MD, Rheumatology Unit, Sapienza University of Rome; E. Bartoloni, MD, Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Perugia; F. Carubbi, MD, Rheumatology Unit, University of L'Aquila; A. Alunno, MD, Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Perugia; S. Gandolfo, MD, Rheumatology Clinic, Department of Medical and Biological Sciences, Azienda Ospedaliero-Universitaria S. Maria della Misericordia; S. Colafrancesco, MD, Rheumatology Unit, Sapienza University of Rome; R. Giacomelli, MD, Professor, Rheumatology Unit, University of L'Aquila; R. Gerli, MD, Professor, Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Perugia; G. Valesini, MD, Professor, Rheumatology Unit, Sapienza University of Rome; S. Bombardieri, MD, Professor, Rheumatology Unit, Department of Internal Medicine, University of Pisa; S. De Vita, MD, Professor, Rheumatology Clinic, Department of Medical and Biological Sciences, Azienda Ospedaliero-Universitaria S. Maria della Misericordia
| | - Roberto Giacomelli
- From the Rheumatology Clinic, Department of Medical and Biological Sciences, Azienda Ospedaliero-Universitaria S. Maria della Misericordia, Udine; Rheumatology Unit, Department of Internal Medicine, University of Pisa, Pisa; Rheumatology Unit, Sapienza University of Rome, Rome; Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Perugia, Perugia; Rheumatology Unit, University of L'Aquila, L'Aquila, Italy.,L. Quartuccio, MD, PhD, Rheumatology Clinic, Department of Medical and Biological Sciences, Azienda Ospedaliero-Universitaria S. Maria della Misericordia; C. Baldini, MD, Rheumatology Unit, Department of Internal Medicine, University of Pisa; R. Priori, MD, Rheumatology Unit, Sapienza University of Rome; E. Bartoloni, MD, Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Perugia; F. Carubbi, MD, Rheumatology Unit, University of L'Aquila; A. Alunno, MD, Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Perugia; S. Gandolfo, MD, Rheumatology Clinic, Department of Medical and Biological Sciences, Azienda Ospedaliero-Universitaria S. Maria della Misericordia; S. Colafrancesco, MD, Rheumatology Unit, Sapienza University of Rome; R. Giacomelli, MD, Professor, Rheumatology Unit, University of L'Aquila; R. Gerli, MD, Professor, Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Perugia; G. Valesini, MD, Professor, Rheumatology Unit, Sapienza University of Rome; S. Bombardieri, MD, Professor, Rheumatology Unit, Department of Internal Medicine, University of Pisa; S. De Vita, MD, Professor, Rheumatology Clinic, Department of Medical and Biological Sciences, Azienda Ospedaliero-Universitaria S. Maria della Misericordia
| | - Roberto Gerli
- From the Rheumatology Clinic, Department of Medical and Biological Sciences, Azienda Ospedaliero-Universitaria S. Maria della Misericordia, Udine; Rheumatology Unit, Department of Internal Medicine, University of Pisa, Pisa; Rheumatology Unit, Sapienza University of Rome, Rome; Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Perugia, Perugia; Rheumatology Unit, University of L'Aquila, L'Aquila, Italy.,L. Quartuccio, MD, PhD, Rheumatology Clinic, Department of Medical and Biological Sciences, Azienda Ospedaliero-Universitaria S. Maria della Misericordia; C. Baldini, MD, Rheumatology Unit, Department of Internal Medicine, University of Pisa; R. Priori, MD, Rheumatology Unit, Sapienza University of Rome; E. Bartoloni, MD, Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Perugia; F. Carubbi, MD, Rheumatology Unit, University of L'Aquila; A. Alunno, MD, Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Perugia; S. Gandolfo, MD, Rheumatology Clinic, Department of Medical and Biological Sciences, Azienda Ospedaliero-Universitaria S. Maria della Misericordia; S. Colafrancesco, MD, Rheumatology Unit, Sapienza University of Rome; R. Giacomelli, MD, Professor, Rheumatology Unit, University of L'Aquila; R. Gerli, MD, Professor, Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Perugia; G. Valesini, MD, Professor, Rheumatology Unit, Sapienza University of Rome; S. Bombardieri, MD, Professor, Rheumatology Unit, Department of Internal Medicine, University of Pisa; S. De Vita, MD, Professor, Rheumatology Clinic, Department of Medical and Biological Sciences, Azienda Ospedaliero-Universitaria S. Maria della Misericordia
| | - Guido Valesini
- From the Rheumatology Clinic, Department of Medical and Biological Sciences, Azienda Ospedaliero-Universitaria S. Maria della Misericordia, Udine; Rheumatology Unit, Department of Internal Medicine, University of Pisa, Pisa; Rheumatology Unit, Sapienza University of Rome, Rome; Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Perugia, Perugia; Rheumatology Unit, University of L'Aquila, L'Aquila, Italy.,L. Quartuccio, MD, PhD, Rheumatology Clinic, Department of Medical and Biological Sciences, Azienda Ospedaliero-Universitaria S. Maria della Misericordia; C. Baldini, MD, Rheumatology Unit, Department of Internal Medicine, University of Pisa; R. Priori, MD, Rheumatology Unit, Sapienza University of Rome; E. Bartoloni, MD, Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Perugia; F. Carubbi, MD, Rheumatology Unit, University of L'Aquila; A. Alunno, MD, Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Perugia; S. Gandolfo, MD, Rheumatology Clinic, Department of Medical and Biological Sciences, Azienda Ospedaliero-Universitaria S. Maria della Misericordia; S. Colafrancesco, MD, Rheumatology Unit, Sapienza University of Rome; R. Giacomelli, MD, Professor, Rheumatology Unit, University of L'Aquila; R. Gerli, MD, Professor, Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Perugia; G. Valesini, MD, Professor, Rheumatology Unit, Sapienza University of Rome; S. Bombardieri, MD, Professor, Rheumatology Unit, Department of Internal Medicine, University of Pisa; S. De Vita, MD, Professor, Rheumatology Clinic, Department of Medical and Biological Sciences, Azienda Ospedaliero-Universitaria S. Maria della Misericordia
| | - Stefano Bombardieri
- From the Rheumatology Clinic, Department of Medical and Biological Sciences, Azienda Ospedaliero-Universitaria S. Maria della Misericordia, Udine; Rheumatology Unit, Department of Internal Medicine, University of Pisa, Pisa; Rheumatology Unit, Sapienza University of Rome, Rome; Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Perugia, Perugia; Rheumatology Unit, University of L'Aquila, L'Aquila, Italy.,L. Quartuccio, MD, PhD, Rheumatology Clinic, Department of Medical and Biological Sciences, Azienda Ospedaliero-Universitaria S. Maria della Misericordia; C. Baldini, MD, Rheumatology Unit, Department of Internal Medicine, University of Pisa; R. Priori, MD, Rheumatology Unit, Sapienza University of Rome; E. Bartoloni, MD, Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Perugia; F. Carubbi, MD, Rheumatology Unit, University of L'Aquila; A. Alunno, MD, Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Perugia; S. Gandolfo, MD, Rheumatology Clinic, Department of Medical and Biological Sciences, Azienda Ospedaliero-Universitaria S. Maria della Misericordia; S. Colafrancesco, MD, Rheumatology Unit, Sapienza University of Rome; R. Giacomelli, MD, Professor, Rheumatology Unit, University of L'Aquila; R. Gerli, MD, Professor, Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Perugia; G. Valesini, MD, Professor, Rheumatology Unit, Sapienza University of Rome; S. Bombardieri, MD, Professor, Rheumatology Unit, Department of Internal Medicine, University of Pisa; S. De Vita, MD, Professor, Rheumatology Clinic, Department of Medical and Biological Sciences, Azienda Ospedaliero-Universitaria S. Maria della Misericordia
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The value of rituximab treatment in primary Sjögren's syndrome. Clin Immunol 2017; 182:62-71. [PMID: 28478105 DOI: 10.1016/j.clim.2017.05.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 05/02/2017] [Indexed: 12/12/2022]
Abstract
The rationale for B cell depletion therapy with rituximab in primary Sjögren's syndrome relies upon the well-established role of B cell hyperactivity in immunopathogenesis. In line with this notion, several biomarkers of B cell activity are significantly affected by treatment, both in the target organs and periphery. In contrast to most biological outcomes, clinical outcomes are not consistent between studies. Although two large RCTs did not meet their primary endpoint, several beneficial clinical effects of treatment have been shown. As discussed in this review, differences in study design and patient characteristics could explain the variation in results. Interestingly, a newly developed composite endpoint of subjective and objective outcomes did show a significant effect of rituximab in one of the large RCTs. Response predictors need to be identified to define more targeted inclusion criteria and achieve precision medicine. The positive effects seen on biological and clinical parameters warrant future studies to investigate this promising treatment modality.
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186
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Maciel G, Crowson CS, Matteson EL, Cornec D. Incidence and Mortality of Physician-Diagnosed Primary Sjögren Syndrome: Time Trends Over a 40-Year Period in a Population-Based US Cohort. Mayo Clin Proc 2017; 92:734-743. [PMID: 28389066 PMCID: PMC5470777 DOI: 10.1016/j.mayocp.2017.01.020] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 01/11/2017] [Accepted: 01/16/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To estimate the incidence and mortality rates, and their evolution over time, of physician-diagnosed primary Sjögren syndrome (pSS) in residents of Olmsted County, Minnesota. PATIENTS AND METHODS Medical records of patients with a diagnosis or suspicion of SS in Olmsted County from January 1, 2006, through December 31, 2015, were reviewed to identify incident cases of pSS (defined by physician diagnosis). These cases were combined with those from a 1976 through 2005 incident cohort (n=111) from the same population. Incidence rates were age and sex adjusted to the 2010 US white population. Survival rates were compared with the expected rates in the population of Minnesota. RESULTS With 61 incident cases of pSS diagnosed in Olmsted County from 2006 through 2015, the total cohort included 172 patients with incident pSS from 1976 through 2015. Of the 172 patients, 151 (88%) were women and 161 (94%) were white, with a mean ± SD age at diagnosis of 58.3±16.7 years. The average age- and sex-adjusted annual incidence for 2006 through 2015 was 5.9 per 100,000 population (95% CI, 4.4-7.4 per 100,000 population), and the overall incidence for the entire period was 5.8 per 100,000 (95% CI, 4.9-6.6 per 100,000). The incidence increased with calendar time over the 40-year period (P=.005). There was no difference in mortality in the pSS cohort compared with expected (standardized mortality ratio, 1.15; 95% CI, 0.86-1.50). CONCLUSION The average annual incidence of pSS in this population-based cohort was 5.8 per 100,000, with a progressive increase over the 40 years of the study. Overall survival of patients with pSS was not different from that of the general population.
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Affiliation(s)
- Gabriel Maciel
- Division of Rheumatology, Mayo Clinic College of Medicine and Science, Rochester, MN; Hospital Maciel, Montevideo, Uruguay
| | - Cynthia S Crowson
- Division of Rheumatology, Mayo Clinic College of Medicine and Science, Rochester, MN; Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Eric L Matteson
- Division of Rheumatology, Mayo Clinic College of Medicine and Science, Rochester, MN; Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science, Rochester, MN.
| | - Divi Cornec
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN; Rheumatology Department, Brest Teaching Hospital, Brest, France
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Cornec D, Devauchelle‐Pensec V, Mariette X, Jousse‐Joulin S, Berthelot J, Perdriger A, Puéchal X, Le Guern V, Sibilia J, Gottenberg J, Chiche L, Hachulla E, Yves Hatron P, Goeb V, Hayem G, Morel J, Zarnitsky C, Dubost JJ, Saliou P, Pers JO, Seror R, Saraux A. Severe Health‐Related Quality of Life Impairment in Active Primary Sjögren's Syndrome and Patient‐Reported Outcomes: Data From a Large Therapeutic Trial. Arthritis Care Res (Hoboken) 2017; 69:528-535. [DOI: 10.1002/acr.22974] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 05/14/2016] [Accepted: 06/21/2016] [Indexed: 12/22/2022]
Affiliation(s)
- Divi Cornec
- Centre Hospitalier Universitaire de la Cavale Blanche, and EA 2216, INSERM ESPRI, ERI29, Université de Brest, LabEx IGOBrest France
| | - Valérie Devauchelle‐Pensec
- Centre Hospitalier Universitaire de la Cavale Blanche, and EA 2216, INSERM ESPRI, ERI29, Université de Brest, LabEx IGOBrest France
| | - Xavier Mariette
- Assistance Publique‐Hôpitaux de Paris, Hôpitaux Universitaires Paris‐Sud, INSERM U1184, Université Paris‐SudLe Kremlin Bicêtre France
| | - Sandrine Jousse‐Joulin
- Centre Hospitalier Universitaire de la Cavale Blanche, and EA 2216, INSERM ESPRI, ERI29, Université de Brest, LabEx IGOBrest France
| | | | | | | | | | - Jean Sibilia
- Hôpitaux Universitaires de Strasbourg and Université de StrasbourgStrasbourg France
| | | | | | - Eric Hachulla
- Hôpital Claude Huriez and Université Lille Nord‐de‐FranceLille France
| | | | - Vincent Goeb
- Centres Hospitaliers Régionaux Universitaires de AmiensAmiens France
| | - Gilles Hayem
- Centre Hospitalier Universitaire Ambroise ParéBoulogne France
| | - Jacques Morel
- Centre Hospitalier Universitaire LapeyronieMontpellier France
| | | | | | - Philippe Saliou
- Centres Hospitaliers Régionaux Universitaires MorvanBrest France
| | - Jacques Olivier Pers
- EA 2216, INSERM ESPRI, ERI29, Université de Brest, LabEx IGO, and Centre Hospitalier Universitaire Morvan, and EA 2216, Université Bretagne OccidentaleBrest France
| | - Raphaèle Seror
- Assistance Publique‐Hôpitaux de Paris, Hôpitaux Universitaires Paris‐Sud, INSERM U1184, Université Paris‐SudLe Kremlin Bicêtre France
| | - Alain Saraux
- Centre Hospitalier Universitaire de la Cavale Blanche, and EA 2216, INSERM ESPRI, ERI29, Université de Brest, LabEx IGOBrest France
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188
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Prevalence and characterization of non-sicca onset primary Sjögren syndrome with interstitial lung involvement. Clin Rheumatol 2017; 36:1261-1268. [DOI: 10.1007/s10067-017-3601-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 03/06/2017] [Accepted: 03/09/2017] [Indexed: 01/17/2023]
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189
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Moerman RV, Arends S, Meiners PM, Vissink A, Spijkervet FK, Kroese FG, Brouwer E, Bootsma H. Detailed Analysis of the Articular Domain in Patients with Primary Sjögren Syndrome. J Rheumatol 2017; 44:292-296. [DOI: 10.3899/jrheum.160459] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2016] [Indexed: 11/22/2022]
Abstract
Objective.We used the 28-joint Disease Activity Score (DAS28) and the European League Against Rheumatism Sjögren’s Syndrome Disease Activity Index (ESSDAI) articular domain to assess the effect of rituximab (RTX) and abatacept (ABA) on articular involvement in primary Sjögren syndrome (pSS).Methods.Patients with pSS treated with RTX (n = 18) or ABA (n = 13) and having a DAS28 erythrocyte sedimentation rate (ESR)/C-reactive protein (CRP) level ≥ 3.2 at baseline were selected. Generalized estimating equations were used to analyze the DAS28 and ESSDAI articular domain over time.Results.In the RTX group, DAS28-ESR/CRP decreased significantly up to 48 weeks. In the ABA group, DAS28-ESR/CRP decreased significantly up to 24 weeks. DAS28 correlated significantly with ESSDAI articular domain.Conclusion.DAS28 is useful to evaluate the effect of biologicals on articular involvement in patients with pSS.
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190
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PADRÕES HISTOLÓGICOS DE GLÂNDULA SALIVAR E CARACTERÍSTICAS CLINICAS E IMUNOLÓGICAS NA SÍNDROME DE SJÖGREN. REVISTA BRASILEIRA DE REUMATOLOGIA 2017. [DOI: 10.1016/j.rbr.2017.07.368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] Open
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191
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Rose T, Szelinski F, Lisney A, Reiter K, Fleischer SJ, Burmester GR, Radbruch A, Hiepe F, Grützkau A, Biesen R, Dörner T. SIGLEC1 is a biomarker of disease activity and indicates extraglandular manifestation in primary Sjögren's syndrome. RMD Open 2016; 2:e000292. [PMID: 28123773 PMCID: PMC5237743 DOI: 10.1136/rmdopen-2016-000292] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 10/22/2016] [Accepted: 11/01/2016] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES To evaluate the interferon (IFN) biomarkers sialic acid binding Ig like lectin 1 (SIGLEC1, CD169) and IFN-γ-inducible protein-10 (IP-10) in patients with primary Sjögren's syndrome (pSS). METHODS 31 patients fulfilling the American-European criteria for pSS were included. Disease activity was obtained by EULAR Sjögren's syndrome disease activity index (ESSDAI). SIGLEC1 expression on monocytes was analysed using flow cytometry. IP-10 concentrations were determined using Bioplex human Cytokine 27-plex kit. Spearman rank test (SRT) was used for correlation analysis and Mann-Whitney U (MWU) to test for differences between glandular and extraglandular manifestations. RESULTS An activated IFN system was detected by an upregulation of SIGLEC1 expression in 64.5% and by elevated serum level of IP-10 in 78.9% of our patients with pSS. In a subsequent analysis SIGLEC1 expression was found to be upregulated more frequently in patients with extraglandular manifestations (16/16, 100%) compared to patients with exclusively glandular involvement (4/15, 27%). SIGLEC1 expression could significantly discriminate between these two disease subgroups (p=0.0001, MWU) with a positive predictive value (PPV) of 80% for extraglandular disease. Moreover, the expression correlated with disease activity (p=0.005, r=0.54, SRT). Serum IP-10 levels neither differed significantly between glandular and extraglandular disease nor correlated with ESSDAI. CONCLUSIONS Our results indicate that increased SIGLEC1 expression characterises patients with systemic involvement and high disease activity. Therefore, SIGLEC1 determination might be of value for subset definition, risk stratification and differential therapeutic considerations in pSS.
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Affiliation(s)
- Thomas Rose
- Department of Rheumatology and Clinical Immunology , Charité Universitätsmedizin Berlin , Berlin , Germany
| | - Franziska Szelinski
- Department of Rheumatology and Clinical Immunology , Charité Universitätsmedizin Berlin , Berlin , Germany
| | - Anna Lisney
- Department of Rheumatology and Clinical Immunology , Charité Universitätsmedizin Berlin , Berlin , Germany
| | - Karin Reiter
- Department of Rheumatology and Clinical Immunology , Charité Universitätsmedizin Berlin , Berlin , Germany
| | - Sarah J Fleischer
- Department of Rheumatology and Clinical Immunology , Charité Universitätsmedizin Berlin , Berlin , Germany
| | - Gerd R Burmester
- Department of Rheumatology and Clinical Immunology , Charité Universitätsmedizin Berlin , Berlin , Germany
| | - Andreas Radbruch
- German Rheumatism Research Center (DRFZ) Berlin, a Leibniz Institute , Berlin , Germany
| | - Falk Hiepe
- Department of Rheumatology and Clinical Immunology , Charité Universitätsmedizin Berlin , Berlin , Germany
| | - Andreas Grützkau
- German Rheumatism Research Center (DRFZ) Berlin, a Leibniz Institute , Berlin , Germany
| | - Robert Biesen
- Department of Rheumatology and Clinical Immunology , Charité Universitätsmedizin Berlin , Berlin , Germany
| | - Thomas Dörner
- Department of Rheumatology and Clinical Immunology , Charité Universitätsmedizin Berlin , Berlin , Germany
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192
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Legány N, Berta L, Kovács L, Balog A, Toldi G. The role of B7 family costimulatory molecules and indoleamine 2,3-dioxygenase in primary Sjögren’s syndrome and systemic sclerosis. Immunol Res 2016; 65:622-629. [DOI: 10.1007/s12026-016-8880-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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193
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Legány N, Toldi G, Orbán C, Megyes N, Bajnok A, Balog A. Calcium influx kinetics, and the features of potassium channels of peripheral lymphocytes in primary Sjögren’s syndrome. Immunobiology 2016; 221:1266-72. [DOI: 10.1016/j.imbio.2016.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 06/01/2016] [Accepted: 06/09/2016] [Indexed: 11/24/2022]
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194
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Martínez-Balzano CD, Touray S, Kopec S. Cystic Lung Disease Among Patients With Sjögren Syndrome: Frequency, Natural History, and Associated Risk Factors. Chest 2016; 150:631-9. [PMID: 27231156 DOI: 10.1016/j.chest.2016.05.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 05/04/2016] [Accepted: 05/11/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Cystic lung disease (CLD) in Sjögren syndrome (SS) is a condition with unclear prognostic implications. Our objectives in this study are to determine its frequency, progression over time, and associated risk factors and complications. METHODS Eighty-four patients with primary or secondary SS and chest imaging, chest radiograph, or CT scan were retrospectively evaluated for CLD. Thirteen patients with cysts were found. Baseline characteristics of all patients were collected. A multivariate logistic regression model was used to look for predictors of CLD in patients with CT scan. Additional imaging, SS activity, and complications from CLD and SS were collected for the patients with cysts. RESULTS CLD had a frequency of 15.4% for all patients with chest imaging. Not all cysts were evident on radiography, and CLD frequency was 30.9% for the patients with chest CT scan. Six patients had cysts without other radiographic findings. CLD was associated with older age (OR, 1.1; 95% CI, 1.0-1.16), a diagnosis of secondary SS (OR, 12.1; 95% CI, 1.12-130.4), and seropositivity for anti-SS-related antigen A/Ro autoantibodies (OR, 26.9; 95% CI, 1.44-93.61). There was no radiologic progression of CLD for 12 patients after a 4-year median follow-up. Lung function did not exhibit temporal worsening. CLD did not correlate with a specific pattern in pulmonary function testing. Two patients had secondary infectious complications of the cysts. CONCLUSIONS CLD is a relatively common condition in SS that does not progress on serial radiologic and lung function follow-up. CLD, without other radiographic findings, may represent a direct manifestation of SS.
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Affiliation(s)
- Carlos D Martínez-Balzano
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Massachusetts Medical School, Worcester, MA.
| | - Sunkaru Touray
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Massachusetts Medical School, Worcester, MA
| | - Scott Kopec
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Massachusetts Medical School, Worcester, MA
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195
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Carvajal Alegria G, Guellec D, Mariette X, Gottenberg JE, Dernis E, Dubost JJ, Trouvin AP, Hachulla E, Larroche C, Le Guern V, Cornec D, Devauchelle-Pensec V, Saraux A. Epidemiology of neurological manifestations in Sjögren's syndrome: data from the French ASSESS Cohort. RMD Open 2016; 2:e000179. [PMID: 27110384 PMCID: PMC4838763 DOI: 10.1136/rmdopen-2015-000179] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 01/08/2016] [Accepted: 01/17/2016] [Indexed: 12/23/2022] Open
Abstract
Objectives Neurological manifestations seem common in primary Sjögren's syndrome (pSS) but their reported prevalences vary. We investigated the prevalence and epidemiology of neurological manifestations in a French nationwide multicentre prospective cohort of patients with pSS, the Assessment of Systemic Signs and Evolution in Sjögren's syndrome (ASSESS) cohort. Methods The ASSESS cohort, established in 2006, includes 395 patients fulfilling American–European Consensus Group criteria for pSS. Demographic and clinical data were compared between patient groups with and without neurological manifestations, and across patient groups with peripheral nervous system (PNS) manifestations, central nervous system (CNS) manifestations and no neurological manifestations. Results Data at inclusion were available for 392 patients, whose mean age was 58±12 years. Mean follow-up was 33.9 months. Neurological manifestations were present in 74/392 (18.9%) patients, including 63 (16%) with PNS manifestations and 14 (3.6%) with CNS manifestations. Prevalences were 9.2% for pure sensory neuropathy, 5.3% for sensorimotor neuropathy, 1.3% for cerebral vasculitis and 1.0% for myelitis. Neurological manifestations were associated with greater pSS activity as assessed using the ESSDAI (9.4±6.8 vs 4.3±4.8; p<0.001) and proportion of patients taking immunomodulatory/immunosuppressive drugs (32.4% (24/74) versus 13.8% (44/318), p=0003). New neurological symptoms were more common in patients with than without prior neurological manifestations (RR=3.918 (95% CI 1.91 to 8.05); p<0.001). Conclusions Prevalences of peripheral and central neurological manifestations in pSS are about 15% and 5%, respectively. Neurological manifestations are associated with greater pSS activity. New neurological manifestations are more common in patients with prior neurological involvement.
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Affiliation(s)
- Guillermo Carvajal Alegria
- Service de rhumatologie , CHRU Cavale Blanche, EA 2216, INSERM ERI 29, Université de Bretagne occidentale , Brest Cedex , France
| | - Dewi Guellec
- Service de rhumatologie , CHRU Cavale Blanche, EA 2216, INSERM ERI 29, Université de Bretagne occidentale , Brest Cedex , France
| | - Xavier Mariette
- Service de rhumatologie , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Sud, INSERM U1184 , Le Kremlin-Bicêtre , France
| | | | - Emmanuelle Dernis
- Service de rhumatologie , Centre hospitalier Le Mans , Le Mans Cedex , France
| | - Jean-Jacques Dubost
- Service de rhumatologie , CHU Gabriel Montpied , Clermont-Ferrand Cedex , France
| | | | - Eric Hachulla
- Service de médecine interne , CHU Claude Huriez , Lille Cedex , France
| | - Claire Larroche
- Service de médecine interne , Hôpital Avicenne APHP , Bobigny Cedex , France
| | - Veronique Le Guern
- Centre de référence des maladies auto-immunes rares, CHU Cochin APHP , Paris , France
| | - Divi Cornec
- Service de rhumatologie , CHRU Cavale Blanche, EA 2216, INSERM ERI 29, Université de Bretagne occidentale , Brest Cedex , France
| | - Valérie Devauchelle-Pensec
- Service de rhumatologie , CHRU Cavale Blanche, EA 2216, INSERM ERI 29, Université de Bretagne occidentale , Brest Cedex , France
| | - Alain Saraux
- Service de rhumatologie , CHRU Cavale Blanche, EA 2216, INSERM ERI 29, Université de Bretagne occidentale , Brest Cedex , France
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Abstract
Dry mouth is a common condition presenting to a GP or general dental practitioner. The most common cause of a dry mouth is related to medication use, however patients with Sjögren's syndrome, a multisystem autoimmune condition, may present to their dentist rather than their GP complaining of dry mouth and dry eyes. This article explores the causes of dry mouth and how a patient can be investigated to find the cause of their dry mouth. An overview of Sjögren's syndrome, the relevant diagnostic criteria, presenting signs and symptoms, investigations and management principles are outlined.
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197
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Brito-Zerón P, Theander E, Baldini C, Seror R, Retamozo S, Quartuccio L, Bootsma H, Bowman SJ, Dörner T, Gottenberg JE, Mariette X, Bombardieri S, de Vita S, Mandl T, Ng WF, Kruize AA, Tzioufas A, Vitali C, Buyon J, Izmirly P, Fox R, Ramos-Casals M, on behalf of the EULAR Sjögren Synd. Early diagnosis of primary Sjögren’s syndrome: EULAR-SS task force clinical recommendations. Expert Rev Clin Immunol 2015; 12:137-56. [DOI: 10.1586/1744666x.2016.1109449] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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198
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[Clinical usefulness of salivary gland ultrasonography in Sjögren's syndrome: Where are we now?]. Rev Med Interne 2015; 37:186-94. [PMID: 26608250 DOI: 10.1016/j.revmed.2015.10.341] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 10/19/2015] [Indexed: 12/18/2022]
Abstract
Salivary gland ultrasonography is a simple, noninvasive and inexpensive procedure, which provides valuable information for the diagnosis of primary Sjögren's syndrome (pSS). The main sonographic characteristic of the major salivary glands (parotid and submandibular) in pSS patients is the heterogeneity of the parenchyma, with the appearance of hypoechoic areas. Numerous studies published over the past 20 years report a sensitivity of 70% and a specificity of more than 90% for the diagnosis of pSS. Before the widespread use of this procedure in daily practice and its integration into classification criteria of the disease, it has yet to be validated in terms of reproducibility and a consensus score should be established. This work is being conducted by an international group of experts. Other ultrasound techniques such as elastography could also be of interest to objectively quantify changes in the glandular tissue that occur during the disease.
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