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Lan J, Deng C, Huang H, Rao P, Chen Y, Shi Y, Chen J, Shi G, Liu Y, Chen S. Seronegative primary Sjögren's syndrome, a distinct subtype of primary Sjögren's syndrome in Chinese patients. BMC Rheumatol 2024; 8:15. [PMID: 38627838 PMCID: PMC11020423 DOI: 10.1186/s41927-024-00384-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 03/21/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND To investigate the clinical and immune characteristics of patients with primary Sjögren's syndrome (pSS) who were negative for anti-Sjögren's-syndrome-related antigen A antibodies (anti-SSA) and anti-Sjögren's-syndrome-related antigen B antibodies (anti-SSB) in Chinese population. METHODS A retrospective study were performed and 232 patients with pSS were analyzed. Patients positive for anti-SSA or/and anti-SSB were termed as seropositive pSS, and these negative for both anti-SSA and anti-SSB (non-antinuclear antibodies) as seronegative pSS. Clinical manifestations and laboratory findings were compared between the two groups. RESULTS Among the 232 patients with pSS, 192 (82.8%) were seropositive pSS and 40 (17.2%) were seronegative pSS. Compared to seropositive pSS, seronegative pSS were older and with higher percentage of low disease activity (ESSDAI < 5), xerostomia and xerophthalmia, with higher platelet count and level of creatine kinase. This subgroup was with lower levels of gamma globulin, immunoglobulin G, immunoglobulin A and autoantibodies including rheumatoid factor and antinuclear antibody in serum, and less immunoglobulin G deposition in labial gland. CONCLUSION Seronegative pSS was a distinct subtype of pSS different from seropositive pSS. Clinical manifestations in seronegative pSS subgroup were restricted to exocrine gland and less B lymphocyte activation, while seropositive pSS were prone to present with systemic involvement and high disease activity. Specific underlying pathogenesis mechanisms and therapeutic strategies in this subgroup needed to be further studied.
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Affiliation(s)
- Jingying Lan
- Department of Rheumatology and Clinical Immunology, School of Medicine, The First Affiliated Hospital of Xiamen University, Xiamen University, Zhenhai Rd. 55#, 361000, Xiamen, Fujian, China
- Xiamen Municipal Clinical Research Center for Immune Diseases, 361000, Xiamen, Fujian, China
- Xiamen Key Laboratory of Rheumatology and Clinical Immunology, 361000, Xiamen, Fujian, China
- Department of Rheumatology and Immunology, The First People's Hospital of Yibin, 644000, Yibin, Sichuan, China
| | - Chaoqiong Deng
- Department of Rheumatology and Clinical Immunology, School of Medicine, The First Affiliated Hospital of Xiamen University, Xiamen University, Zhenhai Rd. 55#, 361000, Xiamen, Fujian, China
- Xiamen Municipal Clinical Research Center for Immune Diseases, 361000, Xiamen, Fujian, China
- Xiamen Key Laboratory of Rheumatology and Clinical Immunology, 361000, Xiamen, Fujian, China
| | - Heqing Huang
- Department of Rheumatology and Clinical Immunology, School of Medicine, The First Affiliated Hospital of Xiamen University, Xiamen University, Zhenhai Rd. 55#, 361000, Xiamen, Fujian, China
- Xiamen Municipal Clinical Research Center for Immune Diseases, 361000, Xiamen, Fujian, China
- Xiamen Key Laboratory of Rheumatology and Clinical Immunology, 361000, Xiamen, Fujian, China
| | - Peishi Rao
- Department of Rheumatology and Clinical Immunology, School of Medicine, The First Affiliated Hospital of Xiamen University, Xiamen University, Zhenhai Rd. 55#, 361000, Xiamen, Fujian, China
- Xiamen Municipal Clinical Research Center for Immune Diseases, 361000, Xiamen, Fujian, China
- Xiamen Key Laboratory of Rheumatology and Clinical Immunology, 361000, Xiamen, Fujian, China
| | - Yangchun Chen
- Department of Rheumatology and Clinical Immunology, School of Medicine, The First Affiliated Hospital of Xiamen University, Xiamen University, Zhenhai Rd. 55#, 361000, Xiamen, Fujian, China
- Xiamen Municipal Clinical Research Center for Immune Diseases, 361000, Xiamen, Fujian, China
- Xiamen Key Laboratory of Rheumatology and Clinical Immunology, 361000, Xiamen, Fujian, China
| | - Yingying Shi
- Department of Rheumatology and Clinical Immunology, School of Medicine, The First Affiliated Hospital of Xiamen University, Xiamen University, Zhenhai Rd. 55#, 361000, Xiamen, Fujian, China
- Xiamen Municipal Clinical Research Center for Immune Diseases, 361000, Xiamen, Fujian, China
- Xiamen Key Laboratory of Rheumatology and Clinical Immunology, 361000, Xiamen, Fujian, China
| | - Jie Chen
- Department of Rheumatology and Clinical Immunology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, 330006, Nanchang, China
| | - Guixiu Shi
- Department of Rheumatology and Clinical Immunology, School of Medicine, The First Affiliated Hospital of Xiamen University, Xiamen University, Zhenhai Rd. 55#, 361000, Xiamen, Fujian, China.
- Xiamen Municipal Clinical Research Center for Immune Diseases, 361000, Xiamen, Fujian, China.
- Xiamen Key Laboratory of Rheumatology and Clinical Immunology, 361000, Xiamen, Fujian, China.
| | - Yuan Liu
- Department of Rheumatology and Clinical Immunology, School of Medicine, The First Affiliated Hospital of Xiamen University, Xiamen University, Zhenhai Rd. 55#, 361000, Xiamen, Fujian, China.
- Xiamen Municipal Clinical Research Center for Immune Diseases, 361000, Xiamen, Fujian, China.
- Xiamen Key Laboratory of Rheumatology and Clinical Immunology, 361000, Xiamen, Fujian, China.
| | - Shiju Chen
- Department of Rheumatology and Clinical Immunology, School of Medicine, The First Affiliated Hospital of Xiamen University, Xiamen University, Zhenhai Rd. 55#, 361000, Xiamen, Fujian, China.
- Xiamen Municipal Clinical Research Center for Immune Diseases, 361000, Xiamen, Fujian, China.
- Xiamen Key Laboratory of Rheumatology and Clinical Immunology, 361000, Xiamen, Fujian, China.
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Bertram J, Nieri C, Reed L, Gillespie MB. Sialendoscopy Findings Associated with Positive Minor Salivary Gland Biopsy. Laryngoscope 2024; 134:1183-1189. [PMID: 37776242 DOI: 10.1002/lary.31085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 08/27/2023] [Accepted: 09/20/2023] [Indexed: 10/02/2023]
Abstract
OBJECTIVES To determine the sialendoscopy findings associated with positive findings on minor salivary gland biopsy. STUDY DESIGN Single-center retrospective study. METHODS Patients ≥18 years old who underwent sialendoscopy from 2016 to 2022 and were evaluated for SS via labial minor salivary gland biopsy. Biopsy positive and negative patients were compared on the primary outcome measure of sialendoscopy findings. Data were abstracted from the sialendoscopy operative notes and included involved gland, location of ductal pathology, and the presence of scarring, stenosis, mucus plugs, webs, and dilations. Additional characteristics included demographics, presenting symptoms, caffeine or tobacco, use of drying medications, and need for additional treatments. RESULTS The final cohorts included 22 biopsy positive and 21 biopsy negative patients with a total of 42 glands in the biopsy positive and 37 glands in the biopsy negative groups. Biopsy positive patients were found to require dilation at the hilum and distal duct at significantly higher rates than biopsy negative patients (p < 0.0001). However, there was no statistical difference in scarring, stenosis severity, mucus, webs, or dilations between each group. CONCLUSION The outcomes of this study suggest that there are no distinct sialendoscopy findings associated with biopsy positive patients. The presence of significant distal stenosis on sialendoscopy may be associated with positive minor salivary biopsy. Other endoscopic parameters are likely more consistent with non-specific chronic sialadenitis. LEVEL OF EVIDENCE 3 Laryngoscope, 134:1183-1189, 2024.
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Affiliation(s)
- Jessica Bertram
- Department of Otolaryngology, University of Tennessee Health Science Center, Memphis, Tennessee, U.S.A
| | - Chad Nieri
- Department of Otolaryngology, University of Tennessee Health Science Center, Memphis, Tennessee, U.S.A
| | - Leighton Reed
- Department of Otolaryngology, University of Tennessee Health Science Center, Memphis, Tennessee, U.S.A
| | - M Boyd Gillespie
- Department of Otolaryngology, University of Tennessee Health Science Center, Memphis, Tennessee, U.S.A
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Hong J, Cheng H, Wang P, Wu Y, Lu S, Zhou Y, Wang XB, Zhu X. CXCL9 may serve as a potential biomarker for primary Sjögren's syndrome with extra-glandular manifestations. Arthritis Res Ther 2024; 26:26. [PMID: 38229121 PMCID: PMC10792874 DOI: 10.1186/s13075-023-03229-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 12/03/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Primary Sjögren's syndrome (pSS) is an autoimmune condition that causes harm to exocrine glands and also has extra-glandular manifestations (EGM). pSS patients with EGM have a worse prognosis than those with only sicca symptoms. Previous studies have shown that the minor salivary glands (MSG) of pSS patients exhibit a unique profile of cytokines and chemokines compared to healthy controls. However, there is a lack of research comparing pSS with EGM (pSS-EGM) and pSS without EGM (pSS-non-EGM). This study aims to explore potential biomarkers associated with pSS, particularly pSS with EGM. METHODS By utilizing RNA sequencing, we conducted an analysis on the gene expression profiles of MSG in 63 patients diagnosed with pSS, as well as 12 non-pSS individuals. Furthermore, we also investigated the MSG of pSS patients, both with and without EGM. Through bioinformatics analysis, we identified genes with differential expression (DEGs) and determined the core hub genes using PPI network. We then analyzed the top 20 DEGs and their correlation with the patients' clinical characteristics, and validated our findings using peripheral blood plasma. RESULTS A total of 725 differentially expressed genes (DEGs) were identified in the comparison between pSS and non-pSS groups, and 727 DEGs were observed between pSS-EGM and pSS-non-EGM. It is noteworthy that the expression levels of CXCL9 were higher in both pSS patients and pSS-EGM when compared to the control group. Taking into consideration the significance of the top 20 DEGs in relation to clinical parameters and the central hub genes, we ultimately chose CXCL9. In comparison to the non-pSS group, pSS patients exhibited notably greater expression of the CXCL9 gene in the MSG, as well as higher levels of CXCL9 protein in their plasma (p < 0.001). Furthermore, the expression of the CXCL9 gene and levels of CXCL9 protein were notably higher in pSS patients accompanied by EGM and those with SSA antibodies. Additionally, a correlation was found between the expression of the CXCL9 gene and the EULAR Sjogren's Syndrome Disease Activity Index (ESSDAI), as well as with immunoglobulin G (IgG) levels and erythrocyte sedimentation rate (ESR). Meanwhile, the protein levels of CXCL9 were found to be correlated with IgG levels and ESSDAI. CONCLUSION CXCL9 proves to be a valuable biomarker in pSS, specifically due to its strong ability to differentiate between pSS patients with EGM and those without EGM. There is a significant correlation between CXCL9 and various clinical parameters both at the gene and protein level. Therefore, CXCL9 could be a potential target for future treatment of pSS.
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Affiliation(s)
- Jingwei Hong
- Rheumatology Department, First Affiliated Hospital of Wenzhou Medical University, Nanbai Xiang Street, Ouhai District, Wenzhou, China
| | - Hui Cheng
- Rheumatology Department, First Affiliated Hospital of Wenzhou Medical University, Nanbai Xiang Street, Ouhai District, Wenzhou, China
| | - Ping Wang
- Rheumatology Department, First Affiliated Hospital of Wenzhou Medical University, Nanbai Xiang Street, Ouhai District, Wenzhou, China
| | - Yanzhi Wu
- Rheumatology Department, First Affiliated Hospital of Wenzhou Medical University, Nanbai Xiang Street, Ouhai District, Wenzhou, China
| | - Saisai Lu
- Rheumatology Department, First Affiliated Hospital of Wenzhou Medical University, Nanbai Xiang Street, Ouhai District, Wenzhou, China
| | - Yan Zhou
- Rheumatology Department, First Affiliated Hospital of Wenzhou Medical University, Nanbai Xiang Street, Ouhai District, Wenzhou, China
| | - Xiao Bing Wang
- Rheumatology Department, First Affiliated Hospital of Wenzhou Medical University, Nanbai Xiang Street, Ouhai District, Wenzhou, China.
- Department of Rheumatology and Immunology, Shanghai Changzheng Hospital, Second Affiliated Hospital of Naval Medical University, Shanghai, China.
| | - Xiaofang Zhu
- Rheumatology Department, First Affiliated Hospital of Wenzhou Medical University, Nanbai Xiang Street, Ouhai District, Wenzhou, China.
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Lee AYS, Wang JJ, Gordon TP, Reed JH. Phases and Natural History of Sjögren's Disease: A New Model for an Old Disease? Arthritis Care Res (Hoboken) 2023; 75:1580-1587. [PMID: 36063396 PMCID: PMC10953327 DOI: 10.1002/acr.25011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 08/23/2022] [Accepted: 08/30/2022] [Indexed: 01/07/2023]
Abstract
Sjögren's disease (SjD) is an archetypal and heterogenous autoimmune disorder that is characterized by exocrine glandular dysfunction. A proportion of patients develop severe extraglandular manifestations, such as cryoglobulinemia, and have an increased risk of lymphoma, both of which can adversely affect quality of life and occasionally mortality. As with most autoimmune disorders, the pathogenesis is poorly understood and difficult to predict, and, frustratingly, there is a lack of targeted therapies to cure this disease. We review the disease manifestations of SjD and propose a staged model for understanding the evolution of pathology. In longitudinal studies, most patients remain relatively stable in terms of their laboratory and clinical parameters. However, in the setting of various risk factors, a proportion of patients develop severe symptoms and/or lymphoma. We discuss potential underlying mechanisms for disease progression and the strengths and limitations of using a staged model to correlate the pathogenesis and spectrum of manifestations in SjD. Ultimately, understanding how and why some patients remain relatively stable, whereas others progress and develop florid systemic disease and a fraction develop lymphoma, is key to developing preventative and therapeutic treatments.
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Affiliation(s)
- Adrian Y. S. Lee
- The Westmead Institute for Medical ResearchUniversity of Sydney, Westmead Hospital, NSW Health PathologyWestmeadNew South WalesAustralia
| | - Jing Jing Wang
- SA Pathology and Flinders UniversityBedford ParkSouth AustraliaAustralia
| | - Tom P. Gordon
- SA Pathology and Flinders UniversityBedford ParkSouth AustraliaAustralia
| | - Joanne H. Reed
- The Westmead Institute for Medical ResearchUniversity of SydneyWestmeadNew South WalesAustralia
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Carvajal Alegria G, Depinoy T, Devauchelle-Pensec V, Jousse-Joulin S, Marhadour T, Guellec D, Marcorelles P, Pers JO, Saraux A, Cornec D. Diagnostic utility of a second minor salivary gland biopsy in patients with suspected Sjögren's syndrome: A retrospective cohort study. Joint Bone Spine 2023; 90:105459. [PMID: 36108904 DOI: 10.1016/j.jbspin.2022.105459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/29/2022] [Accepted: 09/07/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To determine whether repeated minor salivary gland biopsy (MSGB) has a clinical diagnostic utility in patients with suspicion of Sjögren's syndrome (SS). METHODS Clinical, biological, pathological data and physician's diagnosis after each MSGB from patients with suspected primary or secondary SS who had benefited from 2 MSGB at Brest University Hospital between January 1st, 1990 and January 14th, 2015, were retrospectively collected. We compared the characteristics of patients with and without first positive MSGB, concordance between the MSGB, and analyzed the modifications of diagnosis after the second MSGB. RESULTS Ninety-three patients were included, first MSGB was positive for 23 and negative for 70. Patients with first positive MSGB had more often renal involvement (P<0.05) and hypergammaglobulinemia (P=0.01), anti-SSA antibodies (P<0.05) and positive second biopsy with focus score ≥ 1 or Chisholm>2 (P<0.01). The mean time between the 2 MSGB was 5.7±4.3 years. The concordance between the results of the 2 biopsies was low (κ = 0.34). MSGB influenced diagnostic's change in 10 cases where the second MSGB was always guided by new specific clinical manifestations. CONCLUSION We observed a low concordance between 2 MSGB in patients with suspected pSS in our study. Despite this variability, performing a second MSGB changed the initial diagnosis in only a minority of the patients and was particularly useful when clinical manifestations had deeply evolved.
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Affiliation(s)
- Guillermo Carvajal Alegria
- Rheumatology Department, CHRU de Brest, site Cavale Blanche, Brest, France; Inserm, LabEx IGO, UMR1227, Lymphocytes B et Autoimmunité, Université de Bretagne Occidentale, Brest, France
| | - Thibaud Depinoy
- Rheumatology Department, CHRU de Brest, site Cavale Blanche, Brest, France
| | - Valérie Devauchelle-Pensec
- Rheumatology Department, CHRU de Brest, site Cavale Blanche, Brest, France; Inserm, LabEx IGO, UMR1227, Lymphocytes B et Autoimmunité, Université de Bretagne Occidentale, Brest, France
| | - Sandrine Jousse-Joulin
- Rheumatology Department, CHRU de Brest, site Cavale Blanche, Brest, France; Inserm, LabEx IGO, UMR1227, Lymphocytes B et Autoimmunité, Université de Bretagne Occidentale, Brest, France
| | - Thierry Marhadour
- Rheumatology Department, CHRU de Brest, site Cavale Blanche, Brest, France
| | - Dewi Guellec
- Rheumatology Department, CHRU de Brest, site Cavale Blanche, Brest, France; CIC Inserm 1412, CHRU de Brest, Brest, France
| | | | - Jacques-Olivier Pers
- Inserm, LabEx IGO, UMR1227, Lymphocytes B et Autoimmunité, Université de Bretagne Occidentale, Brest, France
| | - Alain Saraux
- Rheumatology Department, CHRU de Brest, site Cavale Blanche, Brest, France; Inserm, LabEx IGO, UMR1227, Lymphocytes B et Autoimmunité, Université de Bretagne Occidentale, Brest, France
| | - Divi Cornec
- Rheumatology Department, CHRU de Brest, site Cavale Blanche, Brest, France; Inserm, LabEx IGO, UMR1227, Lymphocytes B et Autoimmunité, Université de Bretagne Occidentale, Brest, France.
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Muacevic A, Adler JR. Association Between Vitamin D and Minor Salivary Gland Inflammation. Cureus 2022; 14:e32160. [PMID: 36601215 PMCID: PMC9807185 DOI: 10.7759/cureus.32160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2022] [Indexed: 12/05/2022] Open
Abstract
Objective There has been increasing research regarding the effects of vitamin D on autoimmune disorders. There is some evidence of a correlation between vitamin D levels and sicca symptoms. We attempted to evaluate the correlation between vitamin D levels and inflammation of the minor salivary gland (MSG). Methods Data for 214 patients who had undergone MSG biopsy were reviewed. Eighteen patients with other autoimmune/neoplastic processes were excluded. Seventy-seven of 196 patients had serum Vitamin D levels available and were selected for this retrospective study. Demographic, clinical, and immunological features, extra-glandular manifestations, autoantibodies, and clinical laboratory tests were collected and compared between patient groups with a focus score (FS) of 0 and 1 or more. Results Out of 77, 29 patients had an FS of 0 while 48 had an FS of 1 or more. Mean vitamin D levels were noted to be lower in patients with an FS of 1 when compared to patients with an FS of 1 or more. Conclusion In this study, patients with an FS of 1 were noted to have low vitamin D levels but this association was not seen at a higher FS.
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de Oliveira FR, Motta ACF, Módulo CM, Garcia DM, Chiorini JA, Louzada-Junior P, Rocha EM. Clinical and laboratory evaluation of sicca complaints: distinctive aspects of primary, secondary and non-Sjogren syndrome. Adv Rheumatol 2022; 62:23. [DOI: 10.1186/s42358-022-00255-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 06/19/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Sjögren Syndrome (SS) is a systemic autoimmune disease with a wide spectrum of manifestations that can lead to misdiagnosis. This study describes and compares demographic, clinical, serological, and histopathological data from subjects with SS and non-Sjögren Syndrome (NSS). It also details specific features within the primary SS (pSS) and secondary SS (sSS) groups identifying sub-groups.
Methods
The sample included individuals referred to an academic medical center in Brazil for investigation of SS from 2012 to 2020. Patients were retrospectively classified as primary SS (pSS), secondary SS (sSS), or NSS, based on the American-European Consensus Group criteria (AECG-2002), after multi-professional clinical and laboratory evaluation.
Results
A total of 676 individuals were screened and 510 (75.4%) completed the assessments; 198 patients were classified as pSS, 149 as sSS, and 163 as NSS. Symptoms and glandular dysfunction tests were similar in the groups. Concerning pSS, extraglandular manifestations were present in 59% of patients; the elderly had more dry symptoms and peripheral neurological disorders; and 2.5% developed non-Hodgkin lymphoma. In sSS, each overlap promoted distinct clinical and laboratory variants. Several alternative diagnoses were identified as a cause of sicca complex in NSS group.
Conclusions
The diagnosis of SS remains a challenge behind dryness. Up to 31% of the suspected cases had other conditions associated to the symptoms. Histopathological analysis of LSG and SSa determined the diagnostic. Aging in pSS and overlap disease in sSS were responsible for distinct phenotypes and characteristic sub-groups in SS.
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Imaging Activated-T-Lymphocytes in the Salivary Glands of Patients with Sjögren's Syndrome by 99mTc-Interleukin-2: Diagnostic and Therapeutic Implications. J Clin Med 2022; 11:jcm11154368. [PMID: 35955984 PMCID: PMC9369053 DOI: 10.3390/jcm11154368] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 07/23/2022] [Accepted: 07/25/2022] [Indexed: 12/12/2022] Open
Abstract
Background: Sjögren’s syndrome (SS) is a progressive autoimmune disease characterized by local mononuclear cell infiltration of the salivary and lachrymal glands. Labial biopsy demonstrates local infiltration by Th1 cells that produce pro-inflammatory cytokines, such as interleukin-2 (IL2). The aim of this study was to assess the utility of 99mTc-labelled-IL2 (99mTc-IL2) in evaluating in vivo the extent and severity of lympho-mononuclear cell infiltration in the salivary glands of patients with SS. Methods: We investigated 48 patients with primary SS and 27 control subjects using 99mTc-IL2 scintigraphy. Furthermore, in a subgroup of 30 patients, we also performed 99mTc-pertechnetate scintigraphy (99mTcO4−) for evaluation of the salivary gland function. Results: 99mTc-IL2 uptake in the salivary glands of SS patients was higher than in the control subjects (1.30 ± 0.16 vs. 0.83 ± 0.08 for parotids and 1.36 ± 0.15 vs. 1.16 ± 0.07 for submandibular glands; p < 0.0001). The salivary gland uptake of 99mTc-IL2 in patients with a longer history of disease was lower compared with the recently diagnosed patients. A significant direct correlation was found between the uptake of 99mTc-IL2 and histology. Conclusions: 99mTc-IL2 scintigraphy showed that the degree of lymphocytic infiltration of major salivary glands is variable in patients with different disease durations. Patients with a high 99mTc-IL2 uptake could be efficiently treated with immuno-modulatory drugs and the efficacy of treatment could be followed-up by 99mTc-IL2 scintigraphy.
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Liao R, Yang HT, Li H, Liu LX, Li K, Li JJ, Liang J, Hong XP, Chen YL, Liu DZ. Recent Advances of Salivary Gland Biopsy in Sjögren's Syndrome. Front Med (Lausanne) 2022; 8:792593. [PMID: 35083248 PMCID: PMC8784519 DOI: 10.3389/fmed.2021.792593] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 11/29/2021] [Indexed: 11/13/2022] Open
Abstract
Sjögren's syndrome (SS) is a chronic, systemic, inflammatory autoimmune disease characterized by lymphocyte proliferation and progressive damage to exocrine glands. The diagnosis of SS is challenging due to its complicated clinical manifestations and non-specific signs. Salivary gland biopsy plays an important role in the diagnosis of SS, especially with anti-Sjögren's syndrome antigen A (SSA) and anti-SSB antibody negativity. Histopathology based on biopsy has clinical significance for disease stratification and prognosis evaluation, such as risk assessment for the development of non-Hodgkin's lymphoma. Furthermore, histopathological changes of salivary gland may be implicated in evaluating the efficacy of biological agents in SS. In this review, we summarize the histopathological features of salivary gland, the mechanism of histopathological changes and their clinical significance, as well as non-invasive imaging techniques of salivary glands as a potential alternative to salivary gland biopsy in SS.
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Affiliation(s)
- Rui Liao
- The Second Clinical Medical College, Jinan University (Shenzhen People's Hospital), Shenzhen, China
| | - Hai-Tao Yang
- The Second Clinical Medical College, Jinan University (Shenzhen People's Hospital), Shenzhen, China
| | - Heng Li
- Department of Rheumatology and Immunology, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Li-Xiong Liu
- Department of Rheumatology and Immunology, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Kai Li
- Department of Rheumatology and Immunology, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Jing-Jing Li
- Department of Rheumatology and Immunology, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Jie Liang
- The Second Clinical Medical College, Jinan University (Shenzhen People's Hospital), Shenzhen, China
| | - Xiao-Ping Hong
- Department of Rheumatology and Immunology, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Yu-Lan Chen
- Department of Rheumatology and Immunology, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Dong-Zhou Liu
- Department of Rheumatology and Immunology, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
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Benchabane S, Slimani-Kaddouri A, Acheli D, Bendimerad-Iratene T, Mesbah R, Touil-Boukoffa C. Association between increased Bcl-2, Fas and FasL levels and inflammation extent in labial salivary glands during primary Sjögren's syndrome. Endocr Metab Immune Disord Drug Targets 2021; 22:328-338. [PMID: 34370657 DOI: 10.2174/1871530321666210809155147] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/31/2021] [Accepted: 06/03/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Primary Sjögren syndrome (pSS) is a chronic autoimmune disease characterized by epithelial atrophy, mononuclear infiltration in exocrine glands resulting in defective function of these glands. In pSS, atrophy of the epithelium is caused by an increased amount of apoptosis. OBJECTIVE The main aim of this study is to investigate the role of the apoptosis-related factors by studying Bcl-2, Fas and FasL expression in relation to the extent of inflammation as well as the effect of therapy on the expression of these mediators. METHODS In pSS patients (n=62) documented for their serological and clinical features, Fas, FasL and Bcl-2 plasma levels were assessed using enzyme-linked immunosorbent assays. In the same context, we investigated their expression by immunohistochemistry analysis in the labial salivary glands samples in association with the extent of inflammation. RESULTS Interestingly, our results indicated that in pSS patients, the plasmatic Bcl-2, Fas and FasL levels, which appear to be associated with the severity of inflammation and were significantly elevated in comparison to the healthy controls. Moreover, a significant decrease in all these factors was observed in patients after combined corticosteroids-hydroxychloroquine therapy. Importantly, we report a strong positive correlation between Bcl-2 and NO levels. The immunohistochemical staining reveals a strong Bcl-2 expression in infiltrating mononuclear cells and a total absence in the acinar cells. The Bcl-2 level varies according to the severity of the pathology. However, the expression of Fas and FasL was less important and predominantly localized in infiltrating mononuclear cells. CONCLUSION Our current study highlights the involvement of Bcl-2, Fas and FasL in pSS glands injury. These factors may act as useful predictor markers of a clinical course in pSS suggesting a novel approach in the pSS patients monitoring.
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Affiliation(s)
- Sarah Benchabane
- Laboratory of Cellular and Molecular Biology (LBCM), Cytokines and NO Synthases Group, Faculty of Biological Sciences, University of Sciences and Technology Houari Boumediene (USTHB), Algiers. Algeria
| | | | - Dahbia Acheli
- Internal Medicine Department, Douera Hospital, Algiers. Algeria
| | | | - Redouane Mesbah
- Anatomical Pathology Service, Issad Hassani Hospital (Beni-Messous), Algiers. Algeria
| | - Chafia Touil-Boukoffa
- Laboratory of Cellular and Molecular Biology (LBCM), Cytokines and NO Synthases Group, Faculty of Biological Sciences, University of Sciences and Technology Houari Boumediene (USTHB), Algiers. Algeria
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11
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Zhu X, Lu S, Zhu L, Yu M, Wei T, Zhu X, Chen D, Chen C. CXCR2 May Serve as a Useful Index of Disease Activity in Interstitial Lung Disease Associated With Primary Sjögren's Syndrome. Front Mol Biosci 2021; 8:640779. [PMID: 34055876 PMCID: PMC8155469 DOI: 10.3389/fmolb.2021.640779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 04/26/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Primary Sjögren's syndrome (pSS) is a chronic systemic autoimmune disease characterized by typical autoantibody production and lymphocytic-mediated exocrine gland damage. Interstitial lung disease (ILD) is a common complication of pSS and can be associated with a poor prognosis. However, the pathogenesis of ILD in pSS is still unclear. Methods: In this study, we used RNA sequencing to investigate the gene-expression profile of the minor salivary glands (MSGs) from 36 patients with ILD-pSS and 128 patients with non-ILD-pSS. Results: In the remarkably enriched chemokine-mediated signaling pathway, C-X-C motif chemokine receptor 2 (CXCR2), a receptor for interleukin-8, which participates in the activation of neutrophils, was found to be significantly elevated in both MSG and plasma from pSS patients with vs. without ILD (p < 0.001). Furthermore, the CXCR2 expression level in MSG and plasma was significantly associated with the diffusing capacity of the lungs for carbon monoxide, erythrocyte sedimentation rate, and EULAR Sjögren's Syndrome disease Activity Index in ILD-pSS. Conclusion: Therefore, with its potential role in ILD progression in patients with pSS and its strong association with clinical manifestations of the disease, CXCR2 may serve as a useful index for disease activity in ILD associated with pSS.
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Affiliation(s)
- Xiaofang Zhu
- Department of Rheumatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Saisai Lu
- Department of Rheumatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Lixia Zhu
- Department of Rheumatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Mengjiao Yu
- Department of Rheumatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Tingting Wei
- Department of Rheumatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaochun Zhu
- Department of Rheumatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Dan Chen
- Department of Rheumatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Chengshui Chen
- Department of Pneumology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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12
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Auteri S, Alberti ML, Fernández ME, Blanco G, Rayá M, Guman G, Garbarino MC, Carballo OG, Caro F. Occult primary Sjögren Syndrome in patients with interstitial pneumonia with autoimmune features. Respir Med 2021; 182:106405. [PMID: 33894442 DOI: 10.1016/j.rmed.2021.106405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/26/2021] [Accepted: 04/08/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION/OBJECTIVES To define the performance of Minor Salivary Gland Biopsy (MSGB) and Dry Eye Tests (DET) to detect occult Sjögren Syndrome (SS) among Interstitial Pneumonia with Autoimmune Features (IPAF) patients. METHODS Prospective study. Interstitial Lung Disease (ILD) patients without defined Connective Tissue Disease and one or more IPAF classification domains or xerophthalmia were included. MSGB, Schirmer's test (ST) and Ocular Staining Score (OSS) were performed in a blinded manner by experienced specialists. MSGB with ≥1 focus of lymphocytes and Dry Eye Test (DET) with OSS ≥ 5 and/or ST < 5 s were considered positive. SS was diagnosed according to the ACR 2016 criteria. RESULTS 534 patients on the first consult were screened. 67 patients had at least one IPAF criteria, 53 (79.1%) female, mean age (SD) 64.2 years old (10.8). Positive ST in 36 (53.7%), positive OSS in 29 (43.3%) and positive MSGB in 36 (53.7%) were found. Finally, 27 (40.3%) met SS diagnostic criteria. 25 (37.3%) and 18 (26.8%) of them did not report dry eyes or dry mouth, respectively. 53 (79.1%) had negative anti SSA/Ro, 57 (85.1%) had negative anti LA/SSB, 30 (44.7%) had negative ANA, and 52 (77.6%) had negative RF, respectively. A significantly higher proportion of ANA (+), anti-SSA/Ro (+), anti-SSB/La (+), positive DET and positive MSGB were found in the SS population. CONCLUSIONS A significant proportion of patients with occult SS were found in our study. MSGB and DET may be considered in the evaluation of IPAF patients.
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Affiliation(s)
- Santiago Auteri
- María Ferrer Hospital, Interstitial Lung Disease Unit, Buenos Aires, Argentina
| | - María L Alberti
- María Ferrer Hospital, Interstitial Lung Disease Unit, Buenos Aires, Argentina
| | - Martin E Fernández
- María Ferrer Hospital, Interstitial Lung Disease Unit, Buenos Aires, Argentina
| | | | - Mercedes Rayá
- María Ferrer Hospital, Interstitial Lung Disease Unit, Buenos Aires, Argentina
| | - Gabriela Guman
- María Ferrer Hospital, Interstitial Lung Disease Unit, Buenos Aires, Argentina
| | | | | | - Fabián Caro
- María Ferrer Hospital, Interstitial Lung Disease Unit, Buenos Aires, Argentina.
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13
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Sebastian A, Woytala P, Madej M, Proc K, Czesak-Woytala K, Sebastian M, Zub K, Wiland P. Is it possible to not perform salivary gland biopsy in targeted patients according to unstimulated salivary flow results in patients with suspected Sjögren's syndrome? Rheumatol Int 2021; 41:1125-1131. [PMID: 33844038 PMCID: PMC8079304 DOI: 10.1007/s00296-021-04840-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 03/08/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION/OBJECTIVE Xerostomia is one of the main symptoms of primary Sjögren's syndrome (pSS). The unstimulated salivary flow (UWS) test is one of the objective Sjögren's syndrome classification criteria used to assess xerostomia's severity. The study's objective was to evaluate UWS rate measurements (with a threshold rate of 0.1 mL/min) in the screening of patients suspected with pSS, presenting with xerostomia in whom labial salivary gland biopsy (LSGB) should be performed. We will try to answer whether it is possible not to perform LSGB in targeted patients according to UWS results? We analyze the correlation between UWS value and focus score (FS) and anti-SSA antibodies. METHODS The study group consisted of subjects above 18 years of age with a subjective feeling of oral dryness. RESULTS A total of 105 subjects were qualified for the study. The final diagnosis of pSS was made in 44 patients according to the classification criteria from 2016. No age differences were identified between pSS patients and control group subjects (patients with dry mouth without autoimmune background). UWS rates were significantly lower in pSS patients than in the control group. No association was identified between UWS and focus score (FS) ≥ 1 in LSGB. No differences were observed between anti-SSA-positive and anti-SSA-negative patients in terms of age, UWS rates, FS. CONCLUSION LSGB should be performed in all suspected pSS cases regardless of the UWS rate value, particularly in subjects without specific anti-SSA antibodies. In patients with suspected pSS, only less than one-half of the UWS measurements are below the value of 0.1 mL/min adopted as the threshold in the classification criteria for pSS.
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Affiliation(s)
- Agata Sebastian
- Department of Rheumatology and Internal Medicine, Medical University of Wroclaw, Borowska 213, 50-556, Wroclaw, Poland.
| | - Patryk Woytala
- Department of Rheumatology and Internal Medicine, Medical University of Wroclaw, Borowska 213, 50-556, Wroclaw, Poland
| | - Marta Madej
- Department of Rheumatology and Internal Medicine, Medical University of Wroclaw, Borowska 213, 50-556, Wroclaw, Poland
| | - Krzysztof Proc
- Department of Rheumatology and Internal Medicine, Medical University of Wroclaw, Borowska 213, 50-556, Wroclaw, Poland
| | | | - Maciej Sebastian
- Department of General, Minimally Invasive and Endocrine Surgery, Medical University of Wroclaw, Wroclaw, Poland
| | - Krzysztof Zub
- Department and Clinic of Otolaryngology-Head and Neck Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Piotr Wiland
- Department of Rheumatology and Internal Medicine, Medical University of Wroclaw, Borowska 213, 50-556, Wroclaw, Poland
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14
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Li F, Liu Z, Zhang B, Jiang S, Wang Q, Du L, Xue H, Zhang Y, Jin M, Zhu X, Brown MA, Wu J, Wang X. Circular RNA sequencing indicates circ-IQGAP2 and circ-ZC3H6 as noninvasive biomarkers of primary Sjögren's syndrome. Rheumatology (Oxford) 2021; 59:2603-2615. [PMID: 32250392 DOI: 10.1093/rheumatology/keaa163] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 02/22/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES This study aims to characterize the expression profiles of circRNAs in primary Sjogren's Syndrome (pSS) and examine the potential of noninvasive circular RNAs (circRNAs) as biomarkers of pSS. METHODS We performed RNA sequencing of minor salivary gland (MSG) biopsies from four pSS and four non-pSS individuals (subjects undergoing MSG biopsies but not meeting 2012 or 2016 ACR classification criteria for SS). Differentially expressed circRNAs were identified by DESeq2, and confirmed by quantitative real-time PCR in the MSGs as well as in plasma exosomes in 37 pSS and 14 non-pSS subjects. Discriminatory capacity testing using receiver operating characteristic analysis was used to evaluate the performance of circRNAs as diagnostic biomarkers for pSS. RESULTS Circ-IQGAP2 and circ-ZC3H6 had significantly upregulated expression in the MSGs of pSS patients, and this elevated expression was confirmed by quantitative real-time PCR of plasma exosome RNA. The expression of these circRNAs also showed significant correlation with both clinical features, serum IgG level and MSG focus scores. Receiver operating characteristic analysis showed that the indices comprised of both the two circRNAs and clinical features were better able to distinguish pSS from non-pSS subjects with high mean areas under the curve of 0.93 in the MSGs and 0.92 in the plasma exosomes. CONCLUSION This study indicated the potential roles of circ-IQGAP2 and circ-ZC3H6 as noninvasive biomarkers for the diagnosis of pSS.
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Affiliation(s)
- Fengxia Li
- Institute of Genomic Medicine, Wenzhou Medical University
| | - Zhenwei Liu
- Institute of Genomic Medicine, Wenzhou Medical University
| | - Bing Zhang
- Institute of Genomic Medicine, Wenzhou Medical University
| | - Shan Jiang
- Institute of Genomic Medicine, Wenzhou Medical University
| | - Qiongdan Wang
- Institute of Genomic Medicine, Wenzhou Medical University.,Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University
| | - Lifeng Du
- Institute of Genomic Medicine, Wenzhou Medical University
| | - Huangqi Xue
- Institute of Genomic Medicine, Wenzhou Medical University
| | - Yu Zhang
- Institute of Genomic Medicine, Wenzhou Medical University
| | - Mengmeng Jin
- Department of Rheumatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaochun Zhu
- Department of Rheumatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Matthew A Brown
- Guy's & St Thomas NHS Foundation Trust and King's College London NIHR Biomedical Research Centre, London, UK.,Centre for Precision Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jinyu Wu
- Institute of Genomic Medicine, Wenzhou Medical University
| | - Xiaobing Wang
- Department of Rheumatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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15
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Aqrawi LA, Jensen JL, Fromreide S, Galtung HK, Skarstein K. Expression of NGAL-specific cells and mRNA levels correlate with inflammation in the salivary gland, and its overexpression in the saliva, of patients with primary Sjögren's syndrome. Autoimmunity 2020; 53:333-343. [PMID: 32686529 DOI: 10.1080/08916934.2020.1795140] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Salivary gland involvement is a characteristic feature of primary Sjögren's syndrome (pSS), where tissue destruction is mediated by infiltrating immune cells, and may be accompanied by the presence of adipose tissue. Optimally diagnosing this multifactorial disease requires the incorporation of additional routines. Screening for disease-specific biomarkers in biological fluid could be a promising approach to increase diagnostic accuracy. We have previously investigated disease biomarkers in saliva and tear fluid of pSS patients, identifying Neutrophil gelatinase-associated lipocalin (NGAL) as the most upregulated protein in pSS. In the current study, we aimed to explore for the first time NGAL expression at the site of inflammation in the pSS disease target organ. Immunohistochemical staining was conducted on minor salivary gland biopsies from 11 pSS patients and 11 non-SS sicca subjects, targeting NGAL-specific cells. Additional NGAL/PNAd double staining was performed to study NGAL expression in high endothelial venules, known as specialised vascular structures. Moreover, NGAL mRNA expression was measured utilising quantitative real-time polymerase chain reaction (qRT-PCR) on minor salivary gland biopsies from 15 pSS patients and 7 non-SS sicca individuals that served as tissue controls. Our results demonstrated NGAL expression in acinar and ductal epithelium within the salivary gland of pSS patients, where significantly greater levels of acinar NGAL were observed in pSS patients (p < .0018) when compared to non-SS subjects. Also, acinar expression positively correlated with focus score values (r 2 = 0.54, p < .02), while ductal epithelial expression showed a negative such correlation (r 2 = 0.74, p < .003). Some PNAD+ endothelial venules also expressed NGAL. An increase in NGAL staining with increased fatty replacement was also observed in pSS patients. Concurringly, a 27% increase in NGAL mRNA levels were also detected in the minor salivary glands of pSS patients when compared to non-SS tissue control subjects. In conclusion, there is a positive association between increase in NGAL expression and inflammation in the pSS disease target organ, which also coincides with its previously demonstrated upregulation in the saliva of pSS patients. Additional functional analyses are needed to better understand the immunological implications of this potential biomarker.
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Affiliation(s)
- Lara A Aqrawi
- Department of Oral Surgery and Oral Medicine, Institute of Clinical Odontology, University of Oslo, Oslo, Norway
| | - Janicke Liaaen Jensen
- Department of Oral Surgery and Oral Medicine, Institute of Clinical Odontology, University of Oslo, Oslo, Norway
| | - Siren Fromreide
- Gade Laboratory for Pathology, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | | | - Kathrine Skarstein
- Gade Laboratory for Pathology, Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Pathology, Haukeland University Hospital, Bergen, Norway
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16
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Distinct Salivary Gland Features in Sjögren's Syndrome and Lupus Erythematosus Sialadenite. Am J Dermatopathol 2019; 42:407-413. [PMID: 31592858 DOI: 10.1097/dad.0000000000001535] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Primary Sjögren's syndrome (pSS) is an important cause of xerostomia, and the presence of this symptom in lupus erythematosus (LE) is usually referred to as secondary SS. Although these diseases share many clinical and laboratory aspects, the histopathological changes of minor salivary glands (MSG) have been widely evaluated to determine whether this damage is specific for each disease. Based on this query, the aim of this study was to analyze morphological findings of minor salivary glands in pSS or LE. METHODS Two groups of 30 (MSG) from patients with pSS and LE were histopathologically evaluated, and the results were statistically analyzed using the two-tailed Fisher exact test. RESULTS The morphological changes were distinct among the groups and statistically significant. In pSS, the most evident features were the focal lymphocytic ductal aggression, with the focus score ≥1 and the periductal fibroplasia, while in LE, perivascular inflammatory infiltrate, spongiosis of ductal cells not associated with the exocytosis, and hyalinization of the periductal basement membrane were detected. CONCLUSIONS These results indicated that in each disorder, MSG have their specific morphological changes, which lead to xerostomia, and the impairment of MSG in LE is probably due to a lupus sialadenitis.
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17
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Park JS, Kim SM, Choi J, Jung KA, Hwang SH, Yang S, Kwok SK, Cho ML, Park SH. Interleukin-21-mediated suppression of the Pax3-Id3 pathway exacerbates the development of Sjögren's syndrome via follicular helper T cells. Cytokine 2019; 125:154834. [PMID: 31491724 DOI: 10.1016/j.cyto.2019.154834] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 08/26/2019] [Accepted: 08/27/2019] [Indexed: 11/26/2022]
Abstract
Sjögren's syndrome (SS) is a systemic autoimmune disease with severe dysfunction of glandular secretory function mediated by T and B lymphocyte infiltration into the exocrine glands, including the salivary and lacrimal glands. Follicular helper T (Tfh) cells exacerbate the disease by causing B cell hyperactivity. Inhibitor of DNA binding 3 (Id3) deficiency causes activation of Tfh cells and is known to be a clinical manifestation of human SS disease. In this study, we investigated the mechanism of action of Pax3, which is reduced in SS and can interact with Id3, in NOD/ShiLtJ mice as an animal model of SS. Treatment with interleukin (IL)-21, a major cytokine secreted from Tfh cells, suppressed Pax3 and Id3 expression via STAT3 in splenic T cells in vitro. Administration of pCMV14-3xFlag PAX3 vector improved the severity of SS by reducing the number of Tfh cells in NOD/ShiLtJ mice. Application of IL-21R-Fc increased the number of Pax3- and Id3-positive cells in the salivary glands, while reducing the proportion of Tfh cells and IL-17-producing T cells in NOD/ShiLtJ mice. The salivary glands from SS patients showed decreased levels of Pax3 or Id3 expression compared with healthy controls. Our findings regarding reinforcement of the Pax3-Id3 signal pathway may facilitate the development of novel therapeutic strategies for SS.
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Affiliation(s)
- Jin-Sil Park
- The Rheumatism Research Center, Catholic Research Institute of Medical Science, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Sung-Min Kim
- The Rheumatism Research Center, Catholic Research Institute of Medical Science, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - JeongWon Choi
- The Rheumatism Research Center, Catholic Research Institute of Medical Science, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Kyung-Ah Jung
- The Rheumatism Research Center, Catholic Research Institute of Medical Science, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Sun-Hee Hwang
- The Rheumatism Research Center, Catholic Research Institute of Medical Science, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - SeungCheon Yang
- The Rheumatism Research Center, Catholic Research Institute of Medical Science, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Seung-Ki Kwok
- The Rheumatism Research Center, Catholic Research Institute of Medical Science, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; Divison of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Mi-La Cho
- The Rheumatism Research Center, Catholic Research Institute of Medical Science, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; Department of Medical Lifescience, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; Department of Biomedicine & Health Sciences, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea.
| | - Sung-Hwan Park
- The Rheumatism Research Center, Catholic Research Institute of Medical Science, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; Divison of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea.
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18
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Leverenz DL, St. Clair EW. Recent advances in the search for a targeted immunomodulatory therapy for primary Sjögren's syndrome. F1000Res 2019; 8:F1000 Faculty Rev-1532. [PMID: 31508200 PMCID: PMC6719673 DOI: 10.12688/f1000research.19842.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/22/2019] [Indexed: 12/20/2022] Open
Abstract
Primary Sjögren's syndrome is a chronic autoimmune disease characterized by salivary and lacrimal gland dysfunction, leading to substantial morbidity and reduced quality of life. Many patients with primary Sjögren's syndrome also have extraglandular systemic complications, some of which can be organ- or life-threatening. Over the last decade, numerous targeted immunomodulatory therapies for primary Sjögren's syndrome have failed to show a benefit in clinical trials, and as yet no disease-modifying therapy has been approved for this disease. Herein, we provide an updated review of the clinical trial landscape for primary Sjögren's syndrome and the numerous efforts to move the field forward, including the development of new classification criteria and outcome measures, the results of recent clinical trials in this field, the challenges faced in the search for effective therapies, and the expanding pipeline of novel therapies under development.
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Affiliation(s)
- David L. Leverenz
- Department of Medicine, Division of Rheumatology and Immunology, School of Medicine, Duke University, 40 Duke Medicine Circle, Durham, NC, 27110, USA
| | - E. William St. Clair
- Department of Medicine, Division of Rheumatology and Immunology, School of Medicine, Duke University, 40 Duke Medicine Circle, Durham, NC, 27110, USA
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19
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Aqrawi LA, Galtung HK, Guerreiro EM, Øvstebø R, Thiede B, Utheim TP, Chen X, Utheim ØA, Palm Ø, Skarstein K, Jensen JL. Proteomic and histopathological characterisation of sicca subjects and primary Sjögren's syndrome patients reveals promising tear, saliva and extracellular vesicle disease biomarkers. Arthritis Res Ther 2019; 21:181. [PMID: 31366407 PMCID: PMC6670195 DOI: 10.1186/s13075-019-1961-4] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 07/19/2019] [Indexed: 12/21/2022] Open
Abstract
Background Mononuclear cell infiltration of exocrine glands, production of Ro/SSA and La/SSB autoantibodies, along with oral and ocular dryness, are characteristic features of primary Sjögren’s syndrome (pSS). Non-SS sicca subjects, an underexplored group in relation to pSS, display similar sicca symptoms, with possible mild signs of inflammation in their salivary glands, yet with no serological detection of autoantibody production. In this study, we investigated inflammatory manifestations in the salivary gland tissue, tear fluid and saliva of non-SS subjects, as compared to pSS patients and healthy individuals. Methods Fifteen non-SS, 10 pSS and 10 healthy subjects were included in the analyses. Histological evaluation of salivary gland biopsies was performed. Liquid chromatography-mass spectrometry (LC-MS) was conducted on tear fluid and stimulated whole saliva, and proteomic biomarker profiles were generated. Extracellular vesicle (EVs) isolation and characterisation from both fluids were also combined with LC-MS. The LC-MS data were analysed for quantitative differences between patient and control groups using Scaffold. Database for Annotation, Visualization and Integrated Discovery (DAVID) and Functional Enrichment Analysis Tool (FunRich) were applied for functional analyses. Results Histopathological evaluation of salivary gland biopsies showed implications of milder inflammation in non-SS subjects through mononuclear cell infiltration, fibrosis and fatty replacement, as compared to pSS patients. Although unaffected in the non-SS group, upregulation of proinflammatory pathways and proteins involved in ubiquitination (LMO7 and HUWE1) and B cell differentiation (TPD52) were detected in tear fluid of pSS patients. Moreover, overexpression of proteins STOM, ANXA4 and ANXA1, regulating cellular innate and adaptive immunological pathways, were further identified in EVs from tear fluid of pSS patients. Finally, whole saliva and EVs isolated from whole saliva of pSS patients expressed proteins vital for innate MHC class I cellular regulation (NGAL) and T cell activation (CD44). Conclusions Non-SS sicca subjects may show implications of mild inflammation in their glandular tissue, while their protein profile was strikingly more similar to healthy controls than to pSS patients. Hence, the tear and salivary biomarkers identified could be implemented as potential non-invasive diagnostic tools that may aid in increasing diagnostic accuracy when evaluating non-SS subjects and pSS patients and monitoring disease progression. Electronic supplementary material The online version of this article (10.1186/s13075-019-1961-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lara A Aqrawi
- Department of Oral Surgery and Oral Medicine, University of Oslo, Oslo, Norway
| | - Hilde Kanli Galtung
- Department of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway.
| | - Eduarda M Guerreiro
- Department of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Reidun Øvstebø
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - Bernd Thiede
- Department of Biosciences, University of Oslo, Oslo, Norway
| | - Tor Paaske Utheim
- Department of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway.,Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway.,Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Oslo, Norway
| | - Xiangjun Chen
- Department of Oral Surgery and Oral Medicine, University of Oslo, Oslo, Norway.,The Norwegian Dry Eye Clinic, Oslo, Norway
| | - Øygunn Aass Utheim
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway.,The Norwegian Dry Eye Clinic, Oslo, Norway
| | - Øyvind Palm
- Department of Rheumatology, Oslo University Hospital, Oslo, Norway
| | - Kathrine Skarstein
- Gade Laboratory for Pathology, Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Pathology, Haukeland University Hospital, Bergen, Norway
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20
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He ZC, Sun C, Jiang WW. A model for comprehensive oral biological age score with oral and systemic clinical parameters. J Oral Pathol Med 2019; 49:335-341. [PMID: 31152564 DOI: 10.1111/jop.12890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 05/28/2019] [Accepted: 05/29/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Biological age reflects the functional status of an individual. The purpose of the study was to develop a model for estimating oral biological age with oral and systemic parameters. METHODS A total of 248 subjects who had a routine health check were assessed with oral and general clinical examination. Chi-square test was performed to screen oral clinical candidate indicators. General parameters were analyzed by Pearson correlation coefficient and principal component analysis to develop a general biological age score. A final comprehensive model of oral biological age score was established by combining oral and general biological age score. RESULTS A total of eight oral indicators (mucosal blood blister, mucosal dryness, impacted tooth, missing teeth, residual crowns, dental calculus, gingival hyperemia, and gingival recession) and 10 general clinical indicators (triglyceride, creatinine, blood urea nitrogen, glucose, total cholesterol, mean erythrocyte hemoglobin concentration, mean erythrocyte hemoglobin, uric acid, body weight, and systolic blood pressure) were selected for oral and general biological age score, respectively (r > 0.25, P < 0.05). A model of comprehensive oral biological age score was then formed by principal component analysis: 0.046 triglyceride + 0.010 creatinine + 0.141 blood urea nitrogen + 0.048 glucose + 0.068 total cholesterol + 0.014 mean erythrocyte hemoglobin concentration + 0.082 mean erythrocyte hemoglobin + 0.001 uric acid + 0.020 body weight + 0.005 systolic blood pressure + 0.037 oral biological age score -10.908. The score was increased accordingly with CA. CONCLUSION Oral biological age can be easily estimated clinically by the model of comprehensive oral biological age score using oral and systemic clinical parameters by general practitioners.
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Affiliation(s)
- Zhi-Chao He
- Department of Oral Mucosal Diseases, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai, China.,Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
| | - Chen Sun
- Department of Oral Mucosal Diseases, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai, China.,Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
| | - Wei-Wen Jiang
- Department of Oral Mucosal Diseases, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai, China.,Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
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21
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Fox R, Dixon R, Guarrasi V, Krubel S. Treatment of primary Sjögren's syndrome with hydroxychloroquine: a retrospective, open-label study. Lupus 2019. [DOI: 10.1177/0961203396005001081] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives To determine whether patients with primary Sjögren's syndrome (SS), diagnosed according to San Diego criteria, had improvement in their laboratory or clinical features during treatment with hydroxychloroquine (6–7 mg/kg/day) for at least two years., Methods: The study population included 50 consecutive patients with primary SS who were diagnosed according to San Diego criteria, and in whom hydroxychloroquine was suggested as treatment. This group included 10 patients who were early dropouts (side effects or desire not to take antimalarial drugs) and 40 patients who received drugs for at least two years (range 24-48 months). In a subset of SS patients, values for ESR (westergren) and quantitative immunoglobulins were available for comparison. Improvement with therapy was defined as: (a) ≥20% improvement in variables of tear flow (Schirmer's test I) or corneal integrity (rose Bengal): (b) ≥20% salivary function (flow rate); and (c) improvement in at least two of the following measures: physicians assessment of global disease activity by ≥ 20%, patient assessment of improvement in pain or fatigue by ≥20%, and ESR improved by ≥20mm/ hr. Results In a retrospective study of SS patients who completed the trial, a significant improvement was noted in ocular symptoms (pain and dryness) in patients (55 and 57%) and improved corneal integrity (rose Bengal straining) in 53% of patients. The Schirmer's test was improved by ≥ 2 mm/5 minutes in 50% in patients. Improvement was noted in oral symptoms (pain and dryness) in patients (57 and 60%) and salivary flow rate was increased in 82% of patients. In a subset of SS patients evaluated, the ESR improved by ≥20mm/hr in 17/32 patients (53%) and quantitative IgG level by ≥20% in 8/13 patients (61%). Physician global assessment of overall patient status and patient assessment of overall status indicated improvement in over 62% of patients. Conclusion In a retrospective study of patients fulfilling San Diego Criteria for SS, we found: (a) sustained improvement of local symptoms (painful eyes, painful mouth) and improvement of systemic manifestations (arthralgias and myalgias) after treatment with hydroxychloroquine 6-7 mg/kg/day over mean three-year follow-up; (b) laboratory analysis showed a significant improvement in their ESR and their quantitative IgG levels; (c) no significant late toxicity was observed in this study cohort. A prospective study of hydroxychloroquine in patients fulfilling San Diego criteria for SS is indicated.
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Affiliation(s)
- Ri Fox
- Division of Rheumatology, Scripps Clinic and Research Foundation, La Jolla, California, USA
| | - R Dixon
- Division of Rheumatology, Scripps Clinic and Research Foundation, La Jolla, California, USA
| | - V Guarrasi
- Division of Rheumatology, Scripps Clinic and Research Foundation, La Jolla, California, USA
| | - S Krubel
- Division of Rheumatology, Scripps Clinic and Research Foundation, La Jolla, California, USA
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22
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Lee J, Lee J, Kwok S, Baek S, Jang SG, Hong S, Min J, Choi SS, Lee J, Cho M, Park S. JAK
‐1 Inhibition Suppresses Interferon‐Induced
BAFF
Production in Human Salivary Gland. Arthritis Rheumatol 2018; 70:2057-2066. [DOI: 10.1002/art.40589] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 06/12/2018] [Indexed: 12/22/2022]
Affiliation(s)
- Jaeseon Lee
- The Catholic University of Korea Seoul Republic of Korea
| | - Jennifer Lee
- The Catholic University of Korea Seoul St. Mary's Hospital Seoul Republic of Korea
| | - Seung‐Ki Kwok
- The Catholic University of Korea Seoul St. Mary's Hospital Seoul Republic of Korea
| | - SeungYe Baek
- The Catholic University of Korea Seoul Republic of Korea
| | - Se Gwang Jang
- The Catholic University of Korea Seoul Republic of Korea
| | - Seung‐Min Hong
- The Catholic University of Korea Seoul Republic of Korea
| | - Jae‐Woong Min
- Kangwon National University Chuncheon Republic of Korea
| | - Sun Shim Choi
- Kangwon National University Chuncheon Republic of Korea
| | - Juhyun Lee
- The Catholic University of Korea Seoul Republic of Korea
| | - Mi‐La Cho
- The Catholic University of Korea Seoul Republic of Korea
| | - Sung‐Hwan Park
- The Catholic University of Korea Seoul St. Mary's Hospital Seoul Republic of Korea
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23
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Keshet N, Aricha A, Friedlander-Barenboim S, Aframian DJ, Nadler C. Novel parotid sialo-cone-beam computerized tomography features in patients with suspected Sjogren's syndrome. Oral Dis 2018; 25:126-132. [PMID: 30070035 DOI: 10.1111/odi.12946] [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: 02/19/2018] [Revised: 06/19/2018] [Accepted: 07/11/2018] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Sjogren's syndrome (SjS) causes salivary gland impairment leading to oral dryness. Parotid sialo-cone-beam computerized tomography (sialo-CBCT) demonstrates ductal architecture and to a lesser extent gland activity. This study characterizes radiographic features of patients suspected for SjS and looks for a possible correlation with the diagnosis of SjS. METHODS The clinical and radiographic data of suspected SjS/dry mouth patients referred for sialo-CBCT in 2011-2014 were reviewed retrospectively. Two observers studied the scans for various radiographic features including duct morphology, level of branching, ductopenia and sialectasia. These features were analysed taking the specific clinical data and two sets of SjS criteria: The 2002 American-European Consensus Group (AECG) and the 2012 American College of Rheumatology (ACR) Group. RESULTS Sialo-CBCT scans of 67-referred patients suffering from dry mouth (115 parotid glands) were included. Intraradiographic association was found between ductopenia and all other radiographic parameters. Minimal, yet important, radiographic differences were found between left and right parotid glands. AECG-confirmed-SjS patients showed strong correlation with radiographic features, whereas ACR 2012-confirmed-SjS patients did not. CONCLUSION Sialo-CBCT demonstrates novel radiographic features which may clarify the diagnosis of SjS. Further studies are needed to determine the role of sialo-CBCT in diagnosis of SjS.
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Affiliation(s)
- Naama Keshet
- Department of Oral Medicine, Sedation, and Maxillofacial Imaging, Sjogren's Syndrome Center, Hebrew University Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Adi Aricha
- Department of Oral Medicine, Sedation, and Maxillofacial Imaging, Sjogren's Syndrome Center, Hebrew University Hadassah School of Dental Medicine, Jerusalem, Israel.,Oro-Maxillofacial Imaging, Department of Oral Medicine, Sedation, and Maxillofacial Imaging, Hebrew University Hadassah School of Dental Medicine, Jerusalem, Israel
| | | | - Doron J Aframian
- Department of Oral Medicine, Sedation, and Maxillofacial Imaging, Sjogren's Syndrome Center, Hebrew University Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Chen Nadler
- Department of Oral Medicine, Sedation, and Maxillofacial Imaging, Sjogren's Syndrome Center, Hebrew University Hadassah School of Dental Medicine, Jerusalem, Israel.,Oro-Maxillofacial Imaging, Department of Oral Medicine, Sedation, and Maxillofacial Imaging, Hebrew University Hadassah School of Dental Medicine, Jerusalem, Israel
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24
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Pinheiro JB, Tirapelli C, Silva CHLD, Komesu MC, Petean FC, Louzada Junior P, León JE, Motta ACF. Oral Nodular Lesions in Patients with Sjögren's Syndrome: Unusual Oral Implications of a Systemic Disorder. Braz Dent J 2018; 28:405-412. [PMID: 29297564 DOI: 10.1590/0103-6440201601013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 02/14/2017] [Indexed: 12/30/2022] Open
Abstract
Sjögren's syndrome (SS) is a systemic chronic autoimmune disorder affecting the lacrimal and salivary glands. SS may manifest as primary SS (pSS) or secondary SS (sSS), the latter occurring in the context of another autoimmune disorder. In both cases, the dry eyes and mouth affect the patient's quality of life. Late complications may include blindness, dental tissue destruction, oral candidiasis and lymphoma. This paper reports two cases of SS, each of them presenting unusual oral nodular lesion diagnosed as relapsed MALT lymphoma and mucocele. The importance of the diagnosis, treatment and management of the oral lesions by a dentist during the care of SS patients is emphasized, as the oral manifestations of SS may compromise the patient's quality of life.
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Affiliation(s)
- Juliana Barchelli Pinheiro
- Department of Dental Material and Prosthesis, School of Dentistry of Ribeirão Preto, USP - Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Camila Tirapelli
- Department of Dental Material and Prosthesis, School of Dentistry of Ribeirão Preto, USP - Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Claudia Helena Lovato da Silva
- Department of Dental Material and Prosthesis, School of Dentistry of Ribeirão Preto, USP - Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Marilena Chinali Komesu
- Department of Morphology, Physiology and Pathology, School of Dentistry of Ribeirão Preto, USP - Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Flávio Calil Petean
- Department of Internal Medicine, Medical School of Ribeirão Preto, USP - Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Paulo Louzada Junior
- Department of Internal Medicine, Medical School of Ribeirão Preto, USP - Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Jorge Esquiche León
- Department of Stomatology, Public Oral Health and Forensic Dentistry, School of Dentistry of Ribeirão Preto, USP - Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Ana Carolina Fragoso Motta
- Department of Stomatology, Public Oral Health and Forensic Dentistry, School of Dentistry of Ribeirão Preto, USP - Universidade de São Paulo, Ribeirão Preto, SP, Brazil
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25
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Kakugawa T, Sakamoto N, Ishimoto H, Shimizu T, Nakamura H, Nawata A, Ito C, Sato S, Hanaka T, Oda K, Kido T, Miyamura T, Nakashima S, Aoki T, Nakamichi S, Obase Y, Saito K, Yatera K, Ishimatsu Y, Nakayama T, Korogi Y, Kawakami A, Tanaka Y, Mukae H. Lymphocytic focus score is positively related to airway and interstitial lung diseases in primary Sjögren's syndrome. Respir Med 2018; 137:95-102. [PMID: 29605220 DOI: 10.1016/j.rmed.2018.02.023] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 01/31/2018] [Accepted: 02/28/2018] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Although high-resolution computed tomography (HRCT) is useful for the characterization of minute morphological changes in the lungs, no study has investigated risk factors for lung involvement detected by HRCT in patients with Sjögren's syndrome with or without respiratory symptoms. The aim of the current study was to investigate risk factors for lung involvement in patients with primary Sjögren's syndrome detected by HRCT, with a particular focus on airway and interstitial lung diseases. METHODS We performed a retrospective cohort study of patients with primary Sjögren's syndrome and investigated risk factors for lung involvement detected by HRCT. A total of 101 patients with primary Sjögren's syndrome with initial HRCT examinations were enrolled. RESULTS Higher age, dry mouth, and higher labial gland biopsy focus scores (≥4) were risk factors for airway diseases (odds ratio [OR] 1.064 confidence interval [CI] 1.026-1.102, OR 8.795 CI 2.317-33.378 and OR 3.261 CI 1.100-9.675, respectively) in the multivariable analysis. Higher age, male sex, and higher labial gland biopsy focus scores (≥4) were risk factors for interstitial lung diseases (OR 1.078 CI 1.032-1.127, OR 12.178 CI 1.121-132.307 and OR 3.954 CI 1.423-10.987, respectively) in the multivariable analysis. The presence of anti-T-lymphotropic virus type 1 antibodies was significantly more common in patients with airway diseases. CONCLUSIONS This study showed significant associations of labial gland biopsy focus scores and dry mouth with pulmonary manifestations in patients with primary Sjögren's syndrome. Focus scores as well as dry mouth may reflect lymphoproliferative activity in the lungs in patients with primary Sjögren's syndrome.
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Affiliation(s)
- Tomoyuki Kakugawa
- Department of Respiratory Medicine, Unit of Translational Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
| | - Noriho Sakamoto
- Department of Respiratory Medicine, Unit of Translational Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hiroshi Ishimoto
- Department of Respiratory Medicine, Unit of Translational Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Toshimasa Shimizu
- Department of Immunology and Rheumatology, Unit of Advanced Preventive Medical Sciences, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hideki Nakamura
- Department of Immunology and Rheumatology, Unit of Advanced Preventive Medical Sciences, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Aya Nawata
- Department of Pathology, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan; The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Chiyo Ito
- Department of Respiratory Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Shuntaro Sato
- Clinical Research Center, Nagasaki University Hospital, Nagasaki, Japan; Division of Biostatistics, Kurume University School of Medicine, Kurume, Japan
| | - Tetsuya Hanaka
- Department of Respiratory Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Keishi Oda
- Department of Respiratory Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Takashi Kido
- Department of Respiratory Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Takuto Miyamura
- Department of Respiratory Medicine, Unit of Translational Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Shota Nakashima
- Department of Respiratory Medicine, Unit of Translational Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takatoshi Aoki
- Department of Radiology, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Seiko Nakamichi
- Department of General Medicine, Nagasaki University School of Medicine, Nagasaki, Japan
| | - Yasushi Obase
- Department of Respiratory Medicine, Unit of Translational Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kazuyoshi Saito
- Department of Rheumatology, Tobata General Hospital, Kitakyushu, Japan
| | - Kazuhiro Yatera
- Department of Respiratory Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Yuji Ishimatsu
- Department of Cardiopulmonary Rehabilitation Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Toshiyuki Nakayama
- Department of Pathology, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Yukunori Korogi
- Department of Radiology, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Atsushi Kawakami
- Department of Immunology and Rheumatology, Unit of Advanced Preventive Medical Sciences, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yoshiya Tanaka
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Hiroshi Mukae
- Department of Respiratory Medicine, Unit of Translational Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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26
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Low-level laser therapy for xerostomia in primary Sjögren’s syndrome: a randomized trial. Clin Rheumatol 2017; 37:729-736. [DOI: 10.1007/s10067-017-3898-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 10/19/2017] [Accepted: 10/27/2017] [Indexed: 10/18/2022]
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27
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Yang HX, Wang J, Wen YB, Fei YY, Jiang MD, Zhou MY, Zhang W, Li H, Li XM, Zhang FC, Li XW, Zhang X, Chen LM. Renal involvement in primary Sjögren's syndrome: A retrospective study of 103 biopsy-proven cases from a single center in China. Int J Rheum Dis 2017; 21:223-229. [PMID: 28941123 DOI: 10.1111/1756-185x.13182] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
AIM To retrospectively investigate the features of renal involvements in patients with primary Sjögren's syndrome (pSS) with biopsy results. METHODS A total of 2096 pSS inpatients at Peking Union Medical College Hospital in China from 2005 to 2015 were identified. Patients with biopsy-proven renal involvement (SS-renal) and matched controls (SS-only) were recruited. The clinical and pathologic features as well as treatments and outcomes were systematically analyzed. RESULTS One hundred and three pSS nephritis (inpatients had biopsy-proven renal involvement. Tubulointerstitial 53, 51.5%) was the prominent pathologic pattern with glomerulonephritis (GN) present in 50 (48.5%) of the renal lesions. The patterns of GN lesions included membranous nephropathy (37, 35.9%), mesangial proliferative glomerulonephritis (six, 5.8%) or immunoglobulin A nephropathy (three, 2.9%), minimal change disease (four, 3.9%) and focal segmental glomerulosclerosis (three, 2.9%). Compared to SS-only patients, SS-renal patients had fewer dry eyes and positive objective xerostomia (P < 0.05). They presented with a significantly lower incidence of interstitial lung disease (ILD), leukocytopenia and elevated immunoglobulin G levels (P < 0.05). They received a larger initial dosage of corticosteroid and had a higher mortality rate (P < 0.05). CONCLUSION This Chinese SS-renal population with biopsy results has diverse pathologic patterns and distinct clinical features. They are characterized with prominent renal-associated and mild SS-associated features. They received more vigorous treatment but had poorer prognosis.
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Affiliation(s)
- Hua-Xia Yang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Clinical Immunology Center, Chinese Academy of Medical Sciences and Peking Union Medical College and The Ministry of Education Key Laboratory, Beijing, China
| | - Jing Wang
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu-Bing Wen
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yun-Yun Fei
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Clinical Immunology Center, Chinese Academy of Medical Sciences and Peking Union Medical College and The Ministry of Education Key Laboratory, Beijing, China
| | - Meng-Di Jiang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Clinical Immunology Center, Chinese Academy of Medical Sciences and Peking Union Medical College and The Ministry of Education Key Laboratory, Beijing, China
| | - Meng-Yu Zhou
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wen Zhang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Clinical Immunology Center, Chinese Academy of Medical Sciences and Peking Union Medical College and The Ministry of Education Key Laboratory, Beijing, China
| | - Hang Li
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xue-Mei Li
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Feng-Chun Zhang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Clinical Immunology Center, Chinese Academy of Medical Sciences and Peking Union Medical College and The Ministry of Education Key Laboratory, Beijing, China
| | - Xue-Wang Li
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xuan Zhang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Clinical Immunology Center, Chinese Academy of Medical Sciences and Peking Union Medical College and The Ministry of Education Key Laboratory, Beijing, China
| | - Li-Meng Chen
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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28
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Fisher BA, Jonsson R, Daniels T, Bombardieri M, Brown RM, Morgan P, Bombardieri S, Ng WF, Tzioufas AG, Vitali C, Shirlaw P, Haacke E, Costa S, Bootsma H, Devauchelle-Pensec V, Radstake TR, Mariette X, Richards A, Stack R, Bowman SJ, Barone F. Standardisation of labial salivary gland histopathology in clinical trials in primary Sjögren's syndrome. Ann Rheum Dis 2017; 76:1161-1168. [PMID: 27965259 PMCID: PMC5530351 DOI: 10.1136/annrheumdis-2016-210448] [Citation(s) in RCA: 161] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 10/28/2016] [Accepted: 11/19/2016] [Indexed: 12/31/2022]
Abstract
Labial salivary gland (LSG) biopsy is used in the classification of primary Sjögren's syndrome (PSS) and in patient stratification in clinical trials. It may also function as a biomarker. The acquisition of tissue and histological interpretation is variable and needs to be standardised for use in clinical trials. A modified European League Against Rheumatism consensus guideline development strategy was used. The steering committee of the ad hoc working group identified key outstanding points of variability in LSG acquisition and analysis. A 2-day workshop was held to develop consensus where possible and identify points where further discussion/data was needed. These points were reviewed by a subgroup of experts on PSS histopathology and then circulated via an online survey to 50 stakeholder experts consisting of rheumatologists, histopathologists and oral medicine specialists, to assess level of agreement (0-10 scale) and comments. Criteria for agreement were a mean score ≥6/10 and 75% of respondents scoring ≥6/10. Thirty-nine (78%) experts responded and 16 points met criteria for agreement. These points are focused on tissue requirements, identification of the characteristic focal lymphocytic sialadenitis, calculation of the focus score, identification of germinal centres, assessment of the area of leucocyte infiltration, reporting standards and use of prestudy samples for clinical trials. We provide standardised consensus guidance for the use of labial salivary gland histopathology in the classification of PSS and in clinical trials and identify areas where further research is required to achieve evidence-based consensus.
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Affiliation(s)
- Benjamin A Fisher
- Rheumatology Research Group and Arthritis Research UK Rheumatoid Arthritis Pathogenesis Centre of Excellence (RACE), University of Birmingham, Birmingham, UK
- Department of Rheumatology, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Roland Jonsson
- Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
| | - Troy Daniels
- Department of Orofacial Sciences, University of California San Francisco, San Francisco California, USA
| | - Michele Bombardieri
- Centre for Experimental Medicine and Rheumatology, Queen Mary University of London, London, UK
| | - Rachel M Brown
- Department of Pathology, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Peter Morgan
- Department of Pathology, King's College London, London, UK
| | | | - Wan-Fai Ng
- Musculoskeletal Research Group and NIHR Biomedical Research Centre in Ageing and Chronic Diseases, Newcastle University, Newcastle, UK
| | | | - Claudio Vitali
- Section of Rheumatology, Casa di Cura di Lecco, Lecco, Italy
| | - Pepe Shirlaw
- Department of Oral Medicine, King's College London, London, UK
| | - Erlin Haacke
- Department of Pathology, University of Groningen, Groningen, The Netherlands
| | - Sebastian Costa
- Department of Pathology, Brest University Hospital, Brest, France
| | - Hendrika Bootsma
- Department of Rheumatology and Clinical Immunology, University of Groningen, Groningen, The Netherlands
| | | | - Timothy R Radstake
- Department of Rheumatology and Clinical Immunology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Xavier Mariette
- Rheumatology Department, Université Paris-Sud, Assistance Publique-Hôpitaux de Paris, INSERM U1184, Le Kremlin-Bicêtre, France
| | - Andrea Richards
- Department of Oral Medicine, Dental Hospital, Birmingham, UK
| | - Rebecca Stack
- Rheumatology Research Group and Arthritis Research UK Rheumatoid Arthritis Pathogenesis Centre of Excellence (RACE), University of Birmingham, Birmingham, UK
| | - Simon J Bowman
- Rheumatology Research Group and Arthritis Research UK Rheumatoid Arthritis Pathogenesis Centre of Excellence (RACE), University of Birmingham, Birmingham, UK
- Department of Rheumatology, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Francesca Barone
- Rheumatology Research Group and Arthritis Research UK Rheumatoid Arthritis Pathogenesis Centre of Excellence (RACE), University of Birmingham, Birmingham, UK
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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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Fox RI. Standardisation of labial salivary gland biopsies in Sjogren's syndrome: importance for the practicing rheumatologist. Ann Rheum Dis 2017; 76:1159-1160. [PMID: 28254788 DOI: 10.1136/annrheumdis-2016-210851] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 01/14/2017] [Accepted: 02/06/2017] [Indexed: 11/03/2022]
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Aqrawi LA, Galtung HK, Vestad B, Øvstebø R, Thiede B, Rusthen S, Young A, Guerreiro EM, Utheim TP, Chen X, Utheim ØA, Palm Ø, Jensen JL. Identification of potential saliva and tear biomarkers in primary Sjögren's syndrome, utilising the extraction of extracellular vesicles and proteomics analysis. Arthritis Res Ther 2017; 19:14. [PMID: 28122643 PMCID: PMC5264463 DOI: 10.1186/s13075-017-1228-x] [Citation(s) in RCA: 153] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 01/12/2017] [Indexed: 12/19/2022] Open
Abstract
Background There is a long-lasting need for non-invasive, more accurate diagnostic techniques when evaluating primary Sjögren’s syndrome (pSS) patients. Incorporation of additional diagnostics involving screening for disease-specific biomarkers in biological fluid is a promising concept that requires further investigation. In the current study we aimed to explore novel disease biomarkers in saliva and tears from pSS patients. Methods Liquid chromatography-mass spectrometry (LC-MS) was performed on stimulated whole saliva and tears from 27 pSS patients and 32 healthy controls, and salivary and tear proteomic biomarker profiles were generated. LC-MS was also combined with size exclusion chromatography to isolate extracellular vesicles (EVs) from both fluids. Nanoparticle tracking analysis was conducted on joint fractions from the saliva and tears to determine size distribution and concentration of EVs. Further EV characterisation was performed by immunoaffinity capture of CD9-positive EVs using magnetic beads, detected by flow cytometry. The LC-MS data were analysed for quantitative differences between patient and control groups using Scaffold, and the proteins were further analysed using the Database for Annotation, Visualization and Integrated Discovery (DAVID), for gene ontology overrepresentation, and the Search Tool for the Retrieval of Interacting Genes/Proteins for protein-protein interaction network analysis. Results Upregulation of proteins involved in innate immunity (LCN2), cell signalling (CALM) and wound repair (GRN and CALML5) were detected in saliva in pSS. Saliva EVs also displayed biomarkers critical for activation of the innate immune system (SIRPA and LSP1) and adipocyte differentiation (APMAP). Tear analysis indicated overexpression of proteins involved in TNF-α signalling (CPNE1) and B cell survival (PRDX3). Moreover, neutrophil gelatinase-associated lipocalin was upregulated in saliva and tears in pSS. Consistently, DAVID analysis demonstrated pathways of the adaptive immune response in saliva, of cellular component assembly for saliva EVs, and of metabolism and protein folding in tears in pSS patients. Conclusions LC-MS of saliva and tears from pSS patients, solely and in combination with size-exclusion chromatography allowed screening for possible novel biomarkers encompassing both salivary and lacrimal disease target organs. This approach could provide additional diagnostic accuracy in pSS, and could possibly also be applied for staging and monitoring the disease. Electronic supplementary material The online version of this article (doi:10.1186/s13075-017-1228-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lara A Aqrawi
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Oslo, Norway.
| | | | - Beate Vestad
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - Reidun Øvstebø
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - Bernd Thiede
- Department of Biosciences, University of Oslo, Oslo, Norway
| | - Shermin Rusthen
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Alix Young
- Department of Cariology and Gerodontology, University of Oslo, Oslo, Norway
| | | | - Tor Paaske Utheim
- Department of Oral Biology, University of Oslo, Oslo, Norway.,Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway.,The Norwegian Dry Eye Clinic, Oslo, Norway
| | | | - Øygunn Aass Utheim
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway.,Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
| | - Øyvind Palm
- Department of Rheumatology, Oslo University Hospital, Oslo, Norway
| | - Janicke Liaaen Jensen
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Oslo, Norway
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Chen S, Wang Y, Chen S, Wu Q, Chen S. Virtual Touch Quantification of the Salivary Glands for Diagnosis of Primary Sjögren Syndrome. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:2607-2613. [PMID: 27872417 DOI: 10.7863/ultra.16.01085] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 02/24/2016] [Accepted: 03/13/2016] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To investigate the value of salivary gland stiffness measured by Virtual Touch quantification (VTQ; Siemens Medical Solutions, Erlangen, Germany) for assessment of primary Sjögren syndrome. METHODS Fifty-four patients with primary Sjögren syndrome, 35 patients without primary Sjögren syndrome (patients with dry mouth and dry eye symptoms), and 52 healthy control volunteers were included in this study. Patients with primary Sjögren syndrome were classified as early or advanced stage by labial gland biopsies. All participants underwent B-mode sonography, on which the salivary glands (parotid and submandibular) were identified and VTQ measurements of shear wave velocity (SWV) were obtained. The diagnostic performance of SWV was evaluated by sensitivity and specificity at the optimum cutoff point and the area under the receiver operating characteristic curve. RESULTS For submandibular glands, the mean SWV ± SD values were 2.25 ± 0.34 m/s in patients with early-stage primary Sjögren, 1.84 ± 0.20 m/s in patients without primary Sjögren syndrome, and 1.82 ± 0.27 m/s in healthy controls (P< .001). With cutoff values of 2.15 and 2.10 m/s to separate patients with early-stage primary Sjögren syndrome from those without Sjögren syndrome and healthy controls, the sensitivity and specificity were 77.1% and 85.4% and 79.2% and 83.9%, respectively. For parotid glands, the SWV values were 2.78 ± 0.82 m/s in patients with early-stage primary Sjögren syndrome, 1.93 ± 0.33 m/s, in patients without primary Sjögren syndrome, and 1.85 ± 0.31 m/s in healthy controls (P < .001). With cutoff values of 2.18 and 2.10 m/s to separate patients with early-stage primary Sjögren syndrome from those without Sjögren syndrome and healthy controls, the sensitivity and specificity were 89.3 % and 75.3% and 91.4% and 80.0%. CONCLUSIONS The VTQ technique might be a useful noninvasive strategy for assessment of salivary glands in the early stage of primary Sjögren syndrome.
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Affiliation(s)
- Shaoqi Chen
- Department of Ultrasound, First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Yukai Wang
- Department of Rheumatism, Central Hospital of Shantou, Shantou, China
| | - Shaoxing Chen
- Department of Community Monitoring, First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Qiulin Wu
- Guangdong Province Key Laboratory of Medical Molecular Imaging, Shantou University, Shantou, China
| | - Shigao Chen
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota USA
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Cutolo M, Damjanov N, Ruaro B, Zekovic A, Smith V. Imaging of connective tissue diseases: Beyond visceral organ imaging? Best Pract Res Clin Rheumatol 2016; 30:670-687. [DOI: 10.1016/j.berh.2016.10.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 10/10/2016] [Accepted: 10/11/2016] [Indexed: 10/20/2022]
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Skarstein K, Aqrawi LA, Øijordsbakken G, Jonsson R, Jensen JL. Adipose tissue is prominent in salivary glands of Sjögren's syndrome patients and appears to influence the microenvironment in these organs. Autoimmunity 2016; 49:338-46. [PMID: 27206986 DOI: 10.1080/08916934.2016.1183656] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
A minor salivary gland (SG) biopsy with focal lymphocytic sialadenitis and a focus score of ≥1 is today's widely accepted pathological finding confirming the SG component of Sjögren's syndrome (SS). Adipocytes can occupy a large percentage of the SG area although little is known about their significance in SS lesions. This study aimed to characterise adipose tissue infiltration in labial SG biopsies from 27 SS patients and 28 non-SS sicca controls. Biopsies were evaluated by one oral pathologist and assessed for focus score, acinar atrophy, fatty replacement and non-specific chronic inflammation. Moreover, to explore the SG microenvironment, immunohistochemical staining of paraffin-embedded SG tissue was performed using interleukin-6 (IL-6). The fatty replacement was evident in all SS patients possessing autoantibodies (Ro/SSA and/or La/SSB) as well as a positive SG biopsy (focus score ≥1). Additionally, 62% of SS patients having autoantibodies but a negative biopsy showed fatty infiltration (FI) while non-SS controls demonstrated fatty replacement in only 32% of the cases. Overall, the SS group (mean age 53.0 years) had a significantly higher incidence (p value 0.005) of FI than the non-SS controls (mean age 54.8 years). Interestingly, adipocytes were located in IL-6 rich areas, and IL-6 positive adipocytes were detected. As fat deposition seems to be more recurrent in SGs affected by SS, we propose the assessment of adipose tissue replacement as a helpful tool for diagnostic evaluation in SS. Detection of IL-6 positive adipocytes suggests their involvement in immune reactions. Still, functional studies are needed to investigate the SG microenvironment further.
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Affiliation(s)
- Kathrine Skarstein
- a Gade Laboratory for Pathology, Department of Clinical Medicine, University of Bergen , Bergen , Norway .,b Department of Pathology , Haukeland University Hospital , Bergen , Norway
| | - Lara A Aqrawi
- a Gade Laboratory for Pathology, Department of Clinical Medicine, University of Bergen , Bergen , Norway .,c Department of Oral Surgery and Oral Medicine , University of Oslo , Oslo , Norway
| | - Gunnvor Øijordsbakken
- a Gade Laboratory for Pathology, Department of Clinical Medicine, University of Bergen , Bergen , Norway
| | - Roland Jonsson
- d Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen , Bergen , Norway , and.,e Department of Rheumatology , Haukeland University Hospital , Bergen , Norway
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Benchabane S, Boudjelida A, Toumi R, Belguendouz H, Youinou P, Touil-Boukoffa C. A case for IL-6, IL-17A, and nitric oxide in the pathophysiology of Sjögren's syndrome. Int J Immunopathol Pharmacol 2016; 29:386-97. [PMID: 27207443 DOI: 10.1177/0394632016651273] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 04/26/2016] [Indexed: 12/31/2022] Open
Abstract
Sjögren's syndrome (SS) is an autoimmune epithelitis characterized by mononuclear cell (MNC) infiltration of the lacrimal and salivary glands (SG), as well as the presence of serum autoantibodies. This condition is a growing public health concern in Algeria. Herein, we sought to determine if the levels of interleukin (IL)-6, IL-17A, and nitric oxide (NO), were correlated with the extent of MNC infiltration. The expression of inducible NO synthase (NOS2) and CD68 was measured in the SG of all patients, but not in those of the normal controls (NCs). We included 44 primary Sjögren's syndrome (pSS) patients and 15 NCs in this study; we found that the expression of NOS2 and CD68 was elevated in all of the SG of SS patients. Additionally, the serum and saliva levels of IL-6, IL-17A, and NO were higher in the pSS patients, compared with the NCs. Furthermore, the NOS2-induced excess NO was associated with the extent of the MNC infiltration, and thereby with tissue injury. It is also important to note that there were correlations between the levels of IL-6, IL-17A, and NO. Such findings indicate that through the effects of NO, IL-17A participates in the pathophysiology of the disease. With the purpose of improving both the diagnosis and prognosis, IL-6, IL-17A, and NO should be assayed in the serum and saliva of patients suspected of SS.
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Affiliation(s)
- Sarah Benchabane
- University of Sciences, Laboratory of Cellular and Molecular Biology, Cyokines and NO Synthases Group, Faculty of Biological Sciences, Algeria
| | | | - Ryma Toumi
- University of Sciences, Laboratory of Cellular and Molecular Biology, Cyokines and NO Synthases Group, Faculty of Biological Sciences, Algeria
| | - Houda Belguendouz
- University of Sciences, Laboratory of Cellular and Molecular Biology, Cyokines and NO Synthases Group, Faculty of Biological Sciences, Algeria
| | - Pierre Youinou
- Laboratory of Excellence (Labex) IGO, and INSERM ERI29, European University of Brit-tany, Brest, France
| | - Chafia Touil-Boukoffa
- University of Sciences, Laboratory of Cellular and Molecular Biology, Cyokines and NO Synthases Group, Faculty of Biological Sciences, Algeria
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Aksoy A, Solmaz D, Can G, Cetin P, Balci A, Akar S, Birlik M, Akkoc N, Onen F. Increased Frequency of Hand Osteoarthritis in Patients with Primary Sjögren Syndrome Compared with Systemic Lupus Erythematosus. J Rheumatol 2016; 43:1068-71. [PMID: 27036385 DOI: 10.3899/jrheum.150841] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE In daily practice, we noticed that hand osteoarthritis (OA) was commonly associated with primary Sjögren syndrome (pSS). Therefore, we aimed to investigate its prevalence in patients with pSS in a controlled study. METHODS The study included patients with pSS and controls with systemic lupus erythematosus (SLE). Standard hand/wrist radiographs were obtained and classified according to the Kellgren-Lawrence system. "Erosive hand OA" was defined according to the Verbruggen-Veys classification. RESULTS There were 114 patients with pSS (110 women, 51.0 yrs) and 34 patients with SLE (33 women, 42.4 yrs). Among 114 patients with pSS, 42.7% had radiographic, 30.3% symptomatic, and 16.0% erosive hand OA. The prevalences of radiographic (45.5%) and erosive hand OA (14.4%) in 90 patients with pSS with age- and sex-matched patients with SLE were significantly higher than those in patients with SLE (14.7% and 0.0%, p = 0.007 and p = 0.012, respectively). Interobserver reliabilities for diagnosing radiographic and erosive OA were found to be good (ĸ = 0.780 and ĸ = 0.788, respectively). Intraobserver reliabilities for diagnosing radiographic and erosive OA were also good (ĸ = 0.784 and ĸ = 0.825 for FO, and ĸ = 0.722 and ĸ = 0.800 for AB, respectively). The frequency of hand OA in patients with pSS was found to be increased with increasing age (r = 0.513). The mean age of those with erosive hand OA was significantly higher than those without erosive OA (p < 0.001). CONCLUSION This study suggests that pSS, conversely to SLE, is more frequently associated with hand OA.
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Affiliation(s)
- Adem Aksoy
- From the Department of Internal Medicine, and Division of Rheumatology, and Department of Radiology, Dokuz Eylul University School of Medicine, Izmir, Turkey.A. Aksoy, MD, Department of Internal Medicine, Dokuz Eylul University School of Medicine; D. Solmaz, MD, Department of Internal Medicine, Division of Rheumatology, Dokuz Eylul University School of Medicine; G. Can, MD, Department of Internal Medicine, Division of Rheumatology, Dokuz Eylul University School of Medicine; P. Cetin, MD, Department of Internal Medicine, Division of Rheumatology, Dokuz Eylul University School of Medicine; A. Balci, MD, Department of Radiology, Dokuz Eylul University School of Medicine; S. Akar, MD, Department of Internal Medicine, Division of Rheumatology, Dokuz Eylul University School of Medicine; M. Birlik, MD, Department of Internal Medicine, Division of Rheumatology, Dokuz Eylul University School of Medicine; N. Akkoc, MD, Professor, Department of Internal Medicine, Division of Rheumatology, Dokuz Eylul University School of Medicine; F. Onen, MD, Department of Internal Medicine, Division of Rheumatology, Dokuz Eylul University School of Medicine
| | - Dilek Solmaz
- From the Department of Internal Medicine, and Division of Rheumatology, and Department of Radiology, Dokuz Eylul University School of Medicine, Izmir, Turkey.A. Aksoy, MD, Department of Internal Medicine, Dokuz Eylul University School of Medicine; D. Solmaz, MD, Department of Internal Medicine, Division of Rheumatology, Dokuz Eylul University School of Medicine; G. Can, MD, Department of Internal Medicine, Division of Rheumatology, Dokuz Eylul University School of Medicine; P. Cetin, MD, Department of Internal Medicine, Division of Rheumatology, Dokuz Eylul University School of Medicine; A. Balci, MD, Department of Radiology, Dokuz Eylul University School of Medicine; S. Akar, MD, Department of Internal Medicine, Division of Rheumatology, Dokuz Eylul University School of Medicine; M. Birlik, MD, Department of Internal Medicine, Division of Rheumatology, Dokuz Eylul University School of Medicine; N. Akkoc, MD, Professor, Department of Internal Medicine, Division of Rheumatology, Dokuz Eylul University School of Medicine; F. Onen, MD, Department of Internal Medicine, Division of Rheumatology, Dokuz Eylul University School of Medicine
| | - Gercek Can
- From the Department of Internal Medicine, and Division of Rheumatology, and Department of Radiology, Dokuz Eylul University School of Medicine, Izmir, Turkey.A. Aksoy, MD, Department of Internal Medicine, Dokuz Eylul University School of Medicine; D. Solmaz, MD, Department of Internal Medicine, Division of Rheumatology, Dokuz Eylul University School of Medicine; G. Can, MD, Department of Internal Medicine, Division of Rheumatology, Dokuz Eylul University School of Medicine; P. Cetin, MD, Department of Internal Medicine, Division of Rheumatology, Dokuz Eylul University School of Medicine; A. Balci, MD, Department of Radiology, Dokuz Eylul University School of Medicine; S. Akar, MD, Department of Internal Medicine, Division of Rheumatology, Dokuz Eylul University School of Medicine; M. Birlik, MD, Department of Internal Medicine, Division of Rheumatology, Dokuz Eylul University School of Medicine; N. Akkoc, MD, Professor, Department of Internal Medicine, Division of Rheumatology, Dokuz Eylul University School of Medicine; F. Onen, MD, Department of Internal Medicine, Division of Rheumatology, Dokuz Eylul University School of Medicine
| | - Pinar Cetin
- From the Department of Internal Medicine, and Division of Rheumatology, and Department of Radiology, Dokuz Eylul University School of Medicine, Izmir, Turkey.A. Aksoy, MD, Department of Internal Medicine, Dokuz Eylul University School of Medicine; D. Solmaz, MD, Department of Internal Medicine, Division of Rheumatology, Dokuz Eylul University School of Medicine; G. Can, MD, Department of Internal Medicine, Division of Rheumatology, Dokuz Eylul University School of Medicine; P. Cetin, MD, Department of Internal Medicine, Division of Rheumatology, Dokuz Eylul University School of Medicine; A. Balci, MD, Department of Radiology, Dokuz Eylul University School of Medicine; S. Akar, MD, Department of Internal Medicine, Division of Rheumatology, Dokuz Eylul University School of Medicine; M. Birlik, MD, Department of Internal Medicine, Division of Rheumatology, Dokuz Eylul University School of Medicine; N. Akkoc, MD, Professor, Department of Internal Medicine, Division of Rheumatology, Dokuz Eylul University School of Medicine; F. Onen, MD, Department of Internal Medicine, Division of Rheumatology, Dokuz Eylul University School of Medicine
| | - Ali Balci
- From the Department of Internal Medicine, and Division of Rheumatology, and Department of Radiology, Dokuz Eylul University School of Medicine, Izmir, Turkey.A. Aksoy, MD, Department of Internal Medicine, Dokuz Eylul University School of Medicine; D. Solmaz, MD, Department of Internal Medicine, Division of Rheumatology, Dokuz Eylul University School of Medicine; G. Can, MD, Department of Internal Medicine, Division of Rheumatology, Dokuz Eylul University School of Medicine; P. Cetin, MD, Department of Internal Medicine, Division of Rheumatology, Dokuz Eylul University School of Medicine; A. Balci, MD, Department of Radiology, Dokuz Eylul University School of Medicine; S. Akar, MD, Department of Internal Medicine, Division of Rheumatology, Dokuz Eylul University School of Medicine; M. Birlik, MD, Department of Internal Medicine, Division of Rheumatology, Dokuz Eylul University School of Medicine; N. Akkoc, MD, Professor, Department of Internal Medicine, Division of Rheumatology, Dokuz Eylul University School of Medicine; F. Onen, MD, Department of Internal Medicine, Division of Rheumatology, Dokuz Eylul University School of Medicine
| | - Servet Akar
- From the Department of Internal Medicine, and Division of Rheumatology, and Department of Radiology, Dokuz Eylul University School of Medicine, Izmir, Turkey.A. Aksoy, MD, Department of Internal Medicine, Dokuz Eylul University School of Medicine; D. Solmaz, MD, Department of Internal Medicine, Division of Rheumatology, Dokuz Eylul University School of Medicine; G. Can, MD, Department of Internal Medicine, Division of Rheumatology, Dokuz Eylul University School of Medicine; P. Cetin, MD, Department of Internal Medicine, Division of Rheumatology, Dokuz Eylul University School of Medicine; A. Balci, MD, Department of Radiology, Dokuz Eylul University School of Medicine; S. Akar, MD, Department of Internal Medicine, Division of Rheumatology, Dokuz Eylul University School of Medicine; M. Birlik, MD, Department of Internal Medicine, Division of Rheumatology, Dokuz Eylul University School of Medicine; N. Akkoc, MD, Professor, Department of Internal Medicine, Division of Rheumatology, Dokuz Eylul University School of Medicine; F. Onen, MD, Department of Internal Medicine, Division of Rheumatology, Dokuz Eylul University School of Medicine
| | - Merih Birlik
- From the Department of Internal Medicine, and Division of Rheumatology, and Department of Radiology, Dokuz Eylul University School of Medicine, Izmir, Turkey.A. Aksoy, MD, Department of Internal Medicine, Dokuz Eylul University School of Medicine; D. Solmaz, MD, Department of Internal Medicine, Division of Rheumatology, Dokuz Eylul University School of Medicine; G. Can, MD, Department of Internal Medicine, Division of Rheumatology, Dokuz Eylul University School of Medicine; P. Cetin, MD, Department of Internal Medicine, Division of Rheumatology, Dokuz Eylul University School of Medicine; A. Balci, MD, Department of Radiology, Dokuz Eylul University School of Medicine; S. Akar, MD, Department of Internal Medicine, Division of Rheumatology, Dokuz Eylul University School of Medicine; M. Birlik, MD, Department of Internal Medicine, Division of Rheumatology, Dokuz Eylul University School of Medicine; N. Akkoc, MD, Professor, Department of Internal Medicine, Division of Rheumatology, Dokuz Eylul University School of Medicine; F. Onen, MD, Department of Internal Medicine, Division of Rheumatology, Dokuz Eylul University School of Medicine
| | - Nurullah Akkoc
- From the Department of Internal Medicine, and Division of Rheumatology, and Department of Radiology, Dokuz Eylul University School of Medicine, Izmir, Turkey.A. Aksoy, MD, Department of Internal Medicine, Dokuz Eylul University School of Medicine; D. Solmaz, MD, Department of Internal Medicine, Division of Rheumatology, Dokuz Eylul University School of Medicine; G. Can, MD, Department of Internal Medicine, Division of Rheumatology, Dokuz Eylul University School of Medicine; P. Cetin, MD, Department of Internal Medicine, Division of Rheumatology, Dokuz Eylul University School of Medicine; A. Balci, MD, Department of Radiology, Dokuz Eylul University School of Medicine; S. Akar, MD, Department of Internal Medicine, Division of Rheumatology, Dokuz Eylul University School of Medicine; M. Birlik, MD, Department of Internal Medicine, Division of Rheumatology, Dokuz Eylul University School of Medicine; N. Akkoc, MD, Professor, Department of Internal Medicine, Division of Rheumatology, Dokuz Eylul University School of Medicine; F. Onen, MD, Department of Internal Medicine, Division of Rheumatology, Dokuz Eylul University School of Medicine
| | - Fatos Onen
- From the Department of Internal Medicine, and Division of Rheumatology, and Department of Radiology, Dokuz Eylul University School of Medicine, Izmir, Turkey.A. Aksoy, MD, Department of Internal Medicine, Dokuz Eylul University School of Medicine; D. Solmaz, MD, Department of Internal Medicine, Division of Rheumatology, Dokuz Eylul University School of Medicine; G. Can, MD, Department of Internal Medicine, Division of Rheumatology, Dokuz Eylul University School of Medicine; P. Cetin, MD, Department of Internal Medicine, Division of Rheumatology, Dokuz Eylul University School of Medicine; A. Balci, MD, Department of Radiology, Dokuz Eylul University School of Medicine; S. Akar, MD, Department of Internal Medicine, Division of Rheumatology, Dokuz Eylul University School of Medicine; M. Birlik, MD, Department of Internal Medicine, Division of Rheumatology, Dokuz Eylul University School of Medicine; N. Akkoc, MD, Professor, Department of Internal Medicine, Division of Rheumatology, Dokuz Eylul University School of Medicine; F. Onen, MD, Department of Internal Medicine, Division of Rheumatology, Dokuz Eylul University School of Medicine.
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Lee KE, Park DJ, Choi SE, Kang JH, Yim YR, Kim JE, Lee JW, Wen L, Kim TJ, Park YW, Lee JS, Yoon KC, Lee SS. Chemokine (C-X-C Motif) Ligand 1 (CXCL1) Expression in the Minor Salivary Glands of Sjögren's Syndrome Patients. JOURNAL OF RHEUMATIC DISEASES 2016. [DOI: 10.4078/jrd.2016.23.5.297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Kyung-Eun Lee
- Division of Rheumatology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Dong-Jin Park
- Division of Rheumatology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Sung-Eun Choi
- Division of Rheumatology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Ji-Hyoun Kang
- Division of Rheumatology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Yi-Rang Yim
- Division of Rheumatology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Ji-Eun Kim
- Division of Rheumatology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Jeong-Won Lee
- Division of Rheumatology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Lihui Wen
- Division of Rheumatology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Tae-Jong Kim
- Division of Rheumatology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Yong-Wook Park
- Division of Rheumatology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Ji Shin Lee
- Department of Pathology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Kyung Chul Yoon
- Department of Ophthalmology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Shin-Seok Lee
- Division of Rheumatology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
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Astorri E, Sutcliffe N, Richards PS, Suchak K, Pitzalis C, Bombardieri M, Tappuni AR. Ultrasound of the salivary glands is a strong predictor of labial gland biopsy histopathology in patients with sicca symptoms. J Oral Pathol Med 2015; 45:450-4. [DOI: 10.1111/jop.12387] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Elisa Astorri
- Centre for Experimental Medicine & Rheumatology; William Harvey Research Institute; Barts and The London School of Medicine and Dentistry; Queen Mary University of London; London UK
| | - Nurhan Sutcliffe
- Department of Rheumatology; Barts Health NHS Trust and Queen Mary University of London; London UK
| | | | - Krishna Suchak
- Institute of Dentistry; Barts and The London School of Medicine and Dentistry; Queen Mary University of London; London UK
| | - Costantino Pitzalis
- Centre for Experimental Medicine & Rheumatology; William Harvey Research Institute; Barts and The London School of Medicine and Dentistry; Queen Mary University of London; London UK
| | - Michele Bombardieri
- Centre for Experimental Medicine & Rheumatology; William Harvey Research Institute; Barts and The London School of Medicine and Dentistry; Queen Mary University of London; London UK
| | - Anwar R. Tappuni
- Institute of Dentistry; Barts and The London School of Medicine and Dentistry; Queen Mary University of London; London UK
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Hall JC, Baer AN, Shah AA, Criswell LA, Shiboski CH, Rosen A, Casciola-Rosen L. Molecular Subsetting of Interferon Pathways in Sjögren's Syndrome. Arthritis Rheumatol 2015; 67:2437-46. [PMID: 25988820 DOI: 10.1002/art.39204] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 05/12/2015] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Sjögren's syndrome (SS) is an autoimmune disease that targets the salivary and lacrimal glands. While all patients demonstrate inflammatory infiltration and abnormal secretory function in the target tissues, the disease features, pathology, and clinical course can vary. Activation of distinct inflammatory pathways may drive disease heterogeneity. The purpose of this study was to investigate whether activation of the interferon (IFN) pathway correlates with key phenotypic features. METHODS Clinical data and 1 labial salivary gland (stored frozen) were obtained from each of 82 participants (53 patients with primary SS and 29 control subjects) in the Sjögren's International Collaborative Clinical Alliance (SICCA) registry. Salivary gland lysates were immunoblotted with markers of type I or type II IFN, and patterns of IFN activity were determined by hierarchical clustering. Correlations between SS phenotypic features and IFN activity in the salivary gland were performed. RESULTS A total of 58% of the SS participants had high IFN activity and differed significantly from those with low IFN activity (higher prevalence of abnormal findings on sialometry, leukopenia, hyperglobulinemia, high-titer antinuclear antibody, anti-SSA, and high focus score on labial salivary gland [LSG] biopsy). Three distinct patterns of IFN were evident: type I-predominant, type II-predominant, and type I/II mixed IFN. These groups were clinically indistinguishable except for the LSG focus score, which was highest in those with type II-predominant IFN. CONCLUSION The SS phenotype includes distinct molecular subtypes, which are segregated by the magnitude and pattern of IFN responses. Associations between IFN pathways and disease activity suggest that IFNs are relevant therapeutic targets in SS. Patients with distinct patterns of high IFN activity are clinically similar, demonstrating that IFN-targeting therapies must be selected according to the specific pathway(s) that is active in vivo in the individual patient.
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Affiliation(s)
- John C Hall
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alan N Baer
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ami A Shah
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lindsey A Criswell
- University of California, San Francisco School of Medicine, University of California, San Francisco School of Dentistry, and Rosalind Russell/Ephraim P. Engleman Rheumatology Research Center, San Francisco, California
| | | | - Antony Rosen
- Johns Hopkins University School of Medicine, Baltimore, Maryland
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Local and Systemic IKKε and NF-κB Signaling Associated with Sjögren's Syndrome Immunopathogenesis. J Immunol Res 2015; 2015:534648. [PMID: 26380323 PMCID: PMC4563092 DOI: 10.1155/2015/534648] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 08/09/2015] [Accepted: 08/12/2015] [Indexed: 12/27/2022] Open
Abstract
The activated NF-κB signaling pathway plays an important role in pathogenesis of primary Sjögren's syndrome (pSS). The inhibitor of κB (IκB) kinase (IKK) family such as IKKα, IKKβ, IKKγ, and IKKε, is required for this signaling. Our aim was to investigate the role of IKKα/β/γ/ε in patients with untreated pSS. In minor salivary glands from pSS patients, phosphorylated IKKε (pIKKε), pIκBα, and pNF-κB p65 (p-p65) were highly expressed in ductal epithelium and infiltrating mononuclear cells by immunohistochemistry, compared to healthy individuals. pIKKα/β and pIKKγ were both negative. And pIKKε positively related to expression of p-p65. Furthermore, pIKKε and p-p65 expression significantly correlated with biopsy focus score and overall disease activity. Meanwhile, in peripheral blood mononuclear cells from pSS patients, pIKKε, total IKKε, pIKKα/β, and p-p65 were significantly increased by western blot, compared to healthy controls. However, there was no difference in IKKγ and IκBα between pSS patients and healthy individuals. These results demonstrated an abnormality of IKKε, IκBα, and NF-κB in pSS, suggesting a potential target of treatment for pSS based on the downregulation of IKKε expression and deregulation of NF-κB pathway.
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Alunno A, Caneparo V, Carubbi F, Bistoni O, Caterbi S, Bartoloni E, Giacomelli R, Gariglio M, Landolfo S, Gerli R. Interferon gamma-inducible protein 16 in primary Sjögren's syndrome: a novel player in disease pathogenesis? Arthritis Res Ther 2015; 17:208. [PMID: 26271464 PMCID: PMC4536589 DOI: 10.1186/s13075-015-0722-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 07/21/2015] [Indexed: 11/19/2022] Open
Abstract
Introduction There is evidence that interferon is involved in the pathogenesis of primary Sjögren’s syndrome (pSS). The interferon-inducible IFI16 protein, normally expressed in cell nuclei, may be overexpressed, mislocalized in the cytoplasm and secreted in the extracellular milieu in several autoimmune disorders. This leads to tolerance breaking to this self-protein with consequent development of anti-IFI16 antibodies. The aim of this study was to identify the pathogenic and clinical significance of IFI16 and anti-IFI16 in pSS. Methods IFI16 and anti-IFI16 were assessed in the serum of 67 pSS patients and over 100 healthy donors by enzyme-linked immunosorbent assay. IFI16 was also evaluated by immunohistochemistry in minor salivary glands of 15 pSS patients and 10 subjects with sicca symptoms but without any clinical, serological or histological features of pSS. Results pSS patients display higher serum levels of both IFI16 and anti-IFI16 compared to healthy donors. IFI16 concentration was directly correlated with disease duration and focus score and inversely correlated with age at diagnosis. Moreover, IFI16 positivity was associated with concurrent positivity for rheumatoid factor. Interestingly, the direct correlation between IFI16 positivity and focus score was independent of disease duration and age at diagnosis. pSS minor salivary glands display marked expression and cytoplasmic mislocalization of IFI16 by acinar and ductal epithelial cells as well as infiltrating lymphocytes and peri/intralesional endothelium compared to minor salivary glands with normal architecture or nonspecific chronic sialadenitis. Within the mononuclear cell infiltrate, IFI16 expression appears to parallel the distribution of T lymphocytes. Conclusion Our data suggest that the IFI16 protein may be involved in the pathogenesis of glandular inflammation occurring in pSS.
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Affiliation(s)
- Alessia Alunno
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy.
| | - Valeria Caneparo
- Virology Unit, Department of Translational Medicine, Novara Medical School, Novara, Italy.
| | - Francesco Carubbi
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
| | - Onelia Bistoni
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy.
| | - Sara Caterbi
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy.
| | - Elena Bartoloni
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy.
| | - Roberto Giacomelli
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
| | - Marisa Gariglio
- Virology Unit, Department of Translational Medicine, Novara Medical School, Novara, Italy.
| | - Santo Landolfo
- Viral Pathogenesis Unit, Department of Public Health and Pediatric Sciences, Turin Medical School, Turin, Italy.
| | - Roberto Gerli
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy.
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Qiao L, Wang Q, Fei Y, Zhang W, Xu Y, Zhang Y, Zhao Y, Zeng X, Zhang F. The Clinical Characteristics of Primary Sjogren's Syndrome With Neuromyelitis Optica Spectrum Disorder in China: A STROBE-Compliant Article. Medicine (Baltimore) 2015; 94:e1145. [PMID: 26181553 PMCID: PMC4617097 DOI: 10.1097/md.0000000000001145] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of the present study was to analyze the clinical characteristics of primary Sjogren's syndrome (pSS) with neuromyelitis optica spectrum disorder (NMOSD). We retrospectively reviewed the medical records of 616 patients who were admitted to the Peking Union Medical College Hospital from 1985 to 2013. Of these patients, 43 developed NMOSD. The median duration of symptoms was 60 months and 72% of the patients experienced neurological complications onset in the pSS with NMOSD group. Twenty-one out of 43 patients had neuromyelitis optica (NMO), and 22 exhibited a limited form of NMO. Serum anti-aquaporin-4 (AQP4) antibody positivity was detected in 89.3% of the patients. A total of 60.5% of the patients (26 patients) complained of dry mouth, 72.1% were positive for objective xerostomia, 53.5% complained of dry eyes, and 74.4% had a positive ocular test. Biopsy of the minor salivary glands was performed in 33 patients, 28 of whom (84.8%) had a lymphocytic focus score of ≥1. Anti-Ro/SSA or anti-La/SSB antibodies were detected in 41 patients (95.3%). Compared with the pSS patients without NMOSD, the incidences of xerophthalmia, xerostomia, arthritis, interstitial lung disease, and renal tubular acidosis were significantly lower in the patients with NMOSD. NMOSD is a neurologic complication of pSS. The presence of anti-AQP4 antibody may be a predictor for pSS patients with NMOSD. Neurological manifestations are prominent in these patients. In clinical scenarios involving pSS or NMOSD, rheumatologists and neurologists should be aware of this association and perform the appropriate tests.
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Affiliation(s)
- Lin Qiao
- From the Department of Rheumatology and Clinical Immunology(LQ,WQ,YF,WZ,Yan Zhao,XZ,FZ); and Department of Neurology(YX,Yao Zhang), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Fisher BA, Brown RM, Bowman SJ, Barone F. A review of salivary gland histopathology in primary Sjögren's syndrome with a focus on its potential as a clinical trials biomarker. Ann Rheum Dis 2015; 74:1645-50. [PMID: 26034044 DOI: 10.1136/annrheumdis-2015-207499] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 05/10/2015] [Indexed: 11/04/2022]
Abstract
Salivary gland changes, characterised by a focal lymphocytic sialadenitits, play an important role in the diagnosis of primary Sjögren's syndrome (PSS) and were first described over 40 years ago. Recent evidence suggests that minor salivary gland biopsy may also provide information useful for prognostication and stratification, yet difficulties may arise in the histopathological interpretation and scoring, and evidence exists that reporting is variable. With the increasing number of actual and proposed clinical trials in PSS, we review the evidence that might support the role of histopathology as a biomarker for stratification and response to therapy and highlight areas where further validation work is required.
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Affiliation(s)
- Benjamin A Fisher
- Rheumatology Research Group, University of Birmingham, Birmingham, UK Department of Rheumatology, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Rachel M Brown
- Department of Pathology, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Simon J Bowman
- Department of Rheumatology, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Francesca Barone
- Rheumatology Research Group, University of Birmingham, Birmingham, UK Department of Rheumatology, University Hospitals Birmingham NHS Trust, Birmingham, UK
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Knopf A, Hofauer B, Thürmel K, Meier R, Stock K, Bas M, Manour N. Diagnostic utility of Acoustic Radiation Force Impulse (ARFI) imaging in primary Sjoegren`s syndrome. Eur Radiol 2015; 25:3027-34. [PMID: 25861884 DOI: 10.1007/s00330-015-3705-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 01/26/2015] [Accepted: 03/04/2015] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The purpose of the study was to assess the diagnostic utility of acoustic radiation force impulse (ARFI) imaging in primary Sjögren's syndrome (pSS). METHODS One hundred fifty-seven patients with sicca symptoms and/or salivary gland swelling were included. Sicca symptoms, Schirmer test, unstimulated whole saliva (UWS), SS-A/B antibodies, and histology were assessed according to American-European Consensus group (AECG) criteria. All patients underwent high-resolution ultrasound and ARFI imaging of the parotid (PG) and submandibular glands (SMG). RESULTS Seventy patients were classified as having pSS. The remaining 87 patients suffered from idiopathic sicca (n = 24), rheumatoid arthritis (n = 12), sarcoidosis (n = 9), cutaneous/systemic lupus erythematosus (n = 7), scleroderma (n = 2), dermatomyositis (n = 1), HBV/HCV (n = 2), and panarteritis nodosa (n = 1), and disorders in 29 patients were classified as not otherwise specified. ARFI values of the PG were significantly higher in the pSS versus non-pSS groups (2.86 ± 0.07 m/s vs. 2.15 ± 0.11 m/s, p < 0.0001). ARFI imaging demonstrated diagnostic sensitivity and specificity of 81 % and 67 %, respectively. CONCLUSIONS In addition to histology, ARFI imaging was the most important diagnostic tool for identifying early pSS. KEY POINTS • Early stages in Sjögren's syndrome become apparent with major salivary gland enlargements. • Schirmer and unstimulated whole saliva tests demonstrated insufficient sensitivity/specificity for early-stage diagnosis. • Acoustic radiation force impulse imaging is a reliable tool for diagnosing early disease stages.
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Affiliation(s)
- Andreas Knopf
- Hals-Nasen-Ohrenklinik und Poliklinik, Technische Universität München, Ismaningerstrasse 22, 81675, München, Germany,
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Papageorgiou A, Ziogas DC, Mavragani CP, Zintzaras E, Tzioufas AG, Moutsopoulos HM, Voulgarelis M. Predicting the outcome of Sjogren's syndrome-associated non-hodgkin's lymphoma patients. PLoS One 2015; 10:e0116189. [PMID: 25723713 PMCID: PMC4344229 DOI: 10.1371/journal.pone.0116189] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 12/08/2014] [Indexed: 01/14/2023] Open
Abstract
Background Non-Hodgkin's lymphoma (NHL) development in Sjögren’s syndrome (SS) remains a potentially lethal complication and efforts should focus on the identification of predictors that could aid in appropriate therapeutic decisions. Methods In order to identify potential prognostic factors for outcome in SS-associated NHL, we retrospectively analyzed a cohort of 77 patients, diagnosed with NHL according to WHO classification criteria and meeting the American-European Consensus Classification (AECC) criteria for SS and examined the effect of SS-activity (defined as the EULAR SS disease activity index-ESSDAI) in the prognosis of SS-related NHLs, as defined in terms of overall and event-free survivals (OS and EFS). An event was defined as lymphoma relapse, treatment failure, disease progression, histological transformation or death. The effect of NHL clinical and laboratory characteristics was also investigated. Results MALT lymphomas constituted the majority (66.2%) of lymphomas. During the follow-up (median = 57.93 months), the 5-year OS was 90.91% (95% CI: 82.14–95.80%) and the EFS was 77.92% (95% CI: 67.37–85.82%). Patients with high ESSDAI score at lymphoma diagnosis had a greater risk for death (OR = 5.241, 95% CI: 1.034–26.568) or for event (OR = 4.317, 95% CI: 1.146–9.699, p = 0.008). These patients had also significantly worse EFS (HR = 4.541, 95% CI: 1.772–11.637) and OS (HR = 5.946, 95% CI: 1.259–28.077). In addition, post-chemotherapy ESSDAI improvement was significantly lower in patients who had experienced an event (p = 0.005). An unfavorable International prognostic index (IPI) score (high-intermediate/high) was associated with high risk of death and event (OR = 13.867, 95% CI: 2.656–72.387 and OR = 12.589, 95% CI: 3.911–40.526, respectively), worse EFS (log-rank p<0.001, HR = 8.718, 95% CI: 3.477–21.858), as well as with worse OS (log-rank p<0.001, HR = 11.414, 95% CI: 2.414–53.974). After adjustment for identified risk factors, IPI score retained a significant prognostic role following by a strong effect of ESSDAI in survival outcomes. Conclusions At the point of NHL diagnosis, IPI and ESSDAI might be proved useful predictive tools in SS-associated lymphoma prognosis, directing to a more patient-tailored approach.
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Affiliation(s)
- Aristea Papageorgiou
- Department of Pathophysiology, School of Medicine, University of Athens, Athens, Greece
| | - Dimitrios C. Ziogas
- Department of Pathophysiology, School of Medicine, University of Athens, Athens, Greece
| | - Clio P. Mavragani
- Department of Physiology, School of Medicine, University of Athens, Athens, Greece
| | - Elias Zintzaras
- Department of Biomathematics, School of Medicine, University of Thessaly, Larissa, Greece
| | | | | | - Michael Voulgarelis
- Department of Pathophysiology, School of Medicine, University of Athens, Athens, Greece
- * E-mail:
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Giovelli RA, Santos MCS, Serrano ÉV, Valim V. Clinical characteristics and biopsy accuracy in suspected cases of Sjögren's syndrome referred to labial salivary gland biopsy. BMC Musculoskelet Disord 2015; 16:30. [PMID: 25887888 PMCID: PMC4332430 DOI: 10.1186/s12891-015-0482-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 01/27/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Labial salivary gland biopsy (LSGB) is the most important diagnostic tool for the diagnosis of Sjögren's syndrome (SS), but its diagnostic value is rarely studied. This study assessed the sensibility and specificity of LSGB, and the clinical profiles of patients who were referred for biopsy. METHODS Retrospective analysis of the histopathological reports from LSGB and medical report data from patients who underwent LSGB between 2008 and 2011 was conducted. RESULTS About 290 biopsies were performed and 74 were excluded due to insufficient clinical data. Of the 216 patients, 0.46% was carrier of hepatitis C virus, 30.1% had primary SS (pSS), and 8.8% had secondary SS (sSS). Of the samples, 94.3% presented dryness symptoms, 51.6% experienced dryness only, 42.7% had systemic manifestations, and 66.9% presented low unstimulated salivary flow and/or Schirmer's test. LSGB was necessary in 67.6% to confirm the presence of SS based on the American-European Consensus Group 2002 criteria (AECG). Based on specialist's opinion, sensibility level was 86.57%, and specificity was 97.43%. Positive predictive value (PPV) was 95%, and negative predictive value (NPV) was 92.6%. Determined accuracy was 93.3%. Concordance (kappa coefficient) of LSGB and specialist's opinion was 0.851, and LSGB with AECG criteria was 0.806. Of the 98 patients referred with fibromyalgia and dryness, 36.7% had SS and LSBG focus score of ≥ 1. Patients with SS were older, and showed more severe lachrymal and salivary dysfunctions, greater frequency of fibromyalgia, anti-nuclear antibodies (ANA), anti-SSA-Ro, and anti-SSB-La. CONCLUSIONS Labial salivary gland biopsy has high sensibility, specificity, positive and negative predictive values for diagnosis of pSS. In the clinical practice, it is useful, especially for those patients with glandular dysfunctions and negative antibodies.
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Affiliation(s)
- Raquel A Giovelli
- Medical Clinic Department, Center of Health Science, Federal University of Espírito Santo, Vitória, Brazil.
- Universitary Hospital Cassiano Antônio de Moraes, Av. Marechal Campos, 1460, CEP 29040-090, Vitória, Brazil.
| | - Maria C S Santos
- Pathology Department, Center of Health Science, Federal University of Espírito Santo, Vitória, Brazil.
- Universitary Hospital Cassiano Antônio de Moraes, Av. Marechal Campos, 1460, CEP 29040-090, Vitória, Brazil.
| | - Érica V Serrano
- Universitary Hospital Cassiano Antônio de Moraes, Av. Marechal Campos, 1460, CEP 29040-090, Vitória, Brazil.
| | - Valéria Valim
- Medical Clinic Department, Center of Health Science, Federal University of Espírito Santo, Vitória, Brazil.
- Universitary Hospital Cassiano Antônio de Moraes, Av. Marechal Campos, 1460, CEP 29040-090, Vitória, Brazil.
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Miranda-Rius J, Brunet-Llobet L, Lahor-Soler E, Farré M. Salivary Secretory Disorders, Inducing Drugs, and Clinical Management. Int J Med Sci 2015; 12:811-24. [PMID: 26516310 PMCID: PMC4615242 DOI: 10.7150/ijms.12912] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 09/02/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Salivary secretory disorders can be the result of a wide range of factors. Their prevalence and negative effects on the patient's quality of life oblige the clinician to confront the issue. AIM To review the salivary secretory disorders, inducing drugs and their clinical management. METHODS In this article, a literature search of these dysfunctions was conducted with the assistance of a research librarian in the MEDLINE/PubMed Database. RESULTS Xerostomia, or dry mouth syndrome, can be caused by medication, systemic diseases such as Sjögren's Syndrome, glandular pathologies, and radiotherapy of the head and neck. Treatment of dry mouth is aimed at both minimizing its symptoms and preventing oral complications with the employment of sialogogues and topical acting substances. Sialorrhea and drooling, are mainly due to medication or neurological systemic disease. There are various therapeutic, pharmacologic, and surgical alternatives for its management. The pharmacology of most of the substances employed for the treatment of salivary disorders is well-known. Nevertheless, in some cases a significant improvement in salivary function has not been observed after their administration. CONCLUSION At present, there are numerous frequently prescribed drugs whose unwanted effects include some kind of salivary disorder. In addition, the differing pathologic mechanisms, and the great variety of existing treatments hinder the clinical management of these patients. The authors have designed an algorithm to facilitate the decision making process when physicians, oral surgeons, or dentists face these salivary dysfunctions.
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Affiliation(s)
- Jaume Miranda-Rius
- 1. Departament d'Odontostomatologia. Facultat d'Odontologia. Universitat de Barcelona, Barcelona, Spain
| | - Lluís Brunet-Llobet
- 2. Servei d'Odontologia. Hospital Sant Joan de Déu. Universitat de Barcelona, Barcelona, Spain
| | - Eduard Lahor-Soler
- 1. Departament d'Odontostomatologia. Facultat d'Odontologia. Universitat de Barcelona, Barcelona, Spain
| | - Magí Farré
- 3. Clinical Pharmacology Unit. Hospital Universitari Germans Trias i Pujol-IGTP and Hospital del Mar Medical Research Institute (IMIM). Facultat de Medicina. Universitat Autònoma de Barcelona, Barcelona, Spain
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Costa S, Quintin-Roue I, Lesourd A, Jousse-Joulin S, Berthelot JM, Hachulla E, Hatron PY, Goeb V, Vittecoq O, Pers JO, Marcorelles P, Nowak E, Saraux A, Devauchelle-Pensec V. Reliability of histopathological salivary gland biopsy assessment in Sjogren's syndrome: a multicentre cohort study. Rheumatology (Oxford) 2014; 54:1056-64. [DOI: 10.1093/rheumatology/keu453] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Indexed: 01/08/2023] Open
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Carubbi F, Alunno A, Cipriani P, Bartoloni E, Baldini C, Quartuccio L, Priori R, Valesini G, De Vita S, Bombardieri S, Gerli R, Giacomelli R. A retrospective, multicenter study evaluating the prognostic value of minor salivary gland histology in a large cohort of patients with primary Sjögren’s syndrome. Lupus 2014; 24:315-20. [DOI: 10.1177/0961203314554251] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective The objective of this report is to investigate the prognostic value of minor salivary glands (MSG) assessment, routinely performed with hematoxilin-eosin (H&E) staining, for the diagnosis of primary Sjögren’s syndrome (pSS). Methods We retrospectively evaluated clinical, serological and histological features of 794 pSS patients. H&E-stained sections were assessed using the Chisholm and Mason grading system and/or the focus score (FS). Results FS allowed the identification of a number of differences in the disease spectrum, and its prognostic role was further confirmed by quantifying the association between FS value and clinical/serological variables with binary logistic regression. Moreover, hypocomplementemia and FS resulted the only variables associated with lymphoma at univariate analysis, and FS appeared to be associated with lymphoma independently on complement fraction concentrations. Conversely, when patients were divided according to the Chisholm and Mason grading system, we failed to observe any significant difference between subgroups. Conclusion In addition to its diagnostic role, our data seem to support that the routine assessment of MSG-FS with H&E staining is useful to predict at the time of diagnosis the adverse outcomes, such as lymphoma and extraglandular manifestations, that complicate the pSS course. On this basis, it should be recommended that an MSG biopsy be performed even in those patients displaying clinical and serological criteria, allowing the diagnosis of pSS independent of histological status.
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Affiliation(s)
- F Carubbi
- Department of Biotechnological and Applied Clinical Sciences, Rheumatology Unit, University of L’Aquila, L’Aquila, Italy
| | - A Alunno
- Department of Medicine, Rheumatology Unit, University of Perugia, Perugia, Italy
| | - P Cipriani
- Department of Biotechnological and Applied Clinical Sciences, Rheumatology Unit, University of L’Aquila, L’Aquila, Italy
| | - E Bartoloni
- Department of Medicine, Rheumatology Unit, University of Perugia, Perugia, Italy
| | - C Baldini
- Rheumatology Unit, University of Pisa, Pisa, Italy
| | - L Quartuccio
- Rheumatology Clinic, DSMB, University of Udine, Udine, Italy
| | - R Priori
- Rheumatology Unit, La Sapienza University of Rome, Rome, Italy
| | - G Valesini
- Rheumatology Unit, La Sapienza University of Rome, Rome, Italy
| | - S De Vita
- Rheumatology Clinic, DSMB, University of Udine, Udine, Italy
| | | | - R Gerli
- Department of Medicine, Rheumatology Unit, University of Perugia, Perugia, Italy
| | - R Giacomelli
- Department of Biotechnological and Applied Clinical Sciences, Rheumatology Unit, University of L’Aquila, L’Aquila, Italy
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Reksten TR, Jonsson MV. Sjögren's syndrome: an update on epidemiology and current insights on pathophysiology. Oral Maxillofac Surg Clin North Am 2014; 26:1-12. [PMID: 24287189 DOI: 10.1016/j.coms.2013.09.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Primary Sjögren's syndrome (pSS) is an autoimmune chronic inflammatory disorder affecting 0.2% to 3.0% of the population, with a 9:1 female to male ratio. Features are oral and ocular dryness, local and systemic autoantibody production, and progressive focal mononuclear cell infiltration in the affected salivary and lacrimal glands. Lymphoma is the most severe complication of pSS, occurring in 4% to 5% of patients. Genetic studies identified an association with HLA and susceptibility genes in cytokine genes and genes involved in B-cell differentiation. Genetic variations may help explain why disease manifestations differ among patients and supports the hypothesis of certain distinct disease phenotypes.
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Affiliation(s)
- Tove R Reksten
- Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, The Laboratory Building, 5th Floor, Haukeland University Hospital, Bergen N-5021, Norway
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