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Thurtle E, Grosjean A, Steenackers M, Strege K, Barcelos G, Goswami P. Epidemiology of Sjögren's: A Systematic Literature Review. Rheumatol Ther 2024; 11:1-17. [PMID: 37948031 PMCID: PMC10796897 DOI: 10.1007/s40744-023-00611-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 10/11/2023] [Indexed: 11/12/2023] Open
Abstract
INTRODUCTION Primary Sjögren's is a multi-system autoimmune disease affecting patients' physical, mental, and emotional wellbeing. The epidemiology of Sjögren's is not well understood, and up-to-date epidemiological evidence is needed to improve knowledge and awareness of Sjögren's among patients and healthcare professionals, and to ascertain the global burden of disease. The objective of this research was to conduct a de novo systematic literature review (SLR) to identify and synthesise evidence on global epidemiology of primary Sjögren's. METHODS This SLR was conducted in May 2021 by searching MEDLINE and Embase databases, relevant conference proceedings, websites of registries, and health technology assessment agencies and databases. Publications were systematically screened for English language articles reporting on the incidence, prevalence, age at symptom onset, and age at diagnosis for people with primary Sjögren's. RESULTS Of 3510 records identified, 68 publications were included, representing 62 unique studies. Studies reported on age at symptom onset (16/62; 25.8%) and age at diagnosis (43/62; 69.4%) more frequently than incidence (7/62; 11.3%) and prevalence (9/62; 14.5%). Primary Sjögren's was found to have the highest incidence and prevalence in females and in older age groups (incidence: ≥65 years; prevalence: ≥75 years). Average age at onset and diagnosis of primary Sjögren's ranged between 34-57 years and 40-67 years, respectively. CONCLUSIONS This SLR identified a paucity of incidence and prevalence data for primary Sjögren's, highlighting a need for further epidemiological studies. The global Sjögren's community must work together to follow the defined classification criteria of primary Sjögren's and reporting guidelines for incidence and prevalence data to allow for meaningful epidemiological comparisons across studies, settings, and countries.
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Affiliation(s)
| | - Alice Grosjean
- Sjögren's Patients Association for Western Switzerland, Vevey, Switzerland
| | - Monia Steenackers
- Novartis International AG, Novartis Pharma AG, Fabrikstrasse 2, 4056, Basel, Switzerland
| | | | - Giovanna Barcelos
- Novartis International AG, Novartis Pharma AG, Fabrikstrasse 2, 4056, Basel, Switzerland
| | - Pushpendra Goswami
- Novartis International AG, Novartis Pharma AG, Fabrikstrasse 2, 4056, Basel, Switzerland.
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2
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Triantafyllias K, Bach M, Otto M, Schwarting A. Diagnostic Value of Labial Minor Salivary Gland Biopsy: Histological Findings of a Large Sicca Cohort and Clinical Associations. Diagnostics (Basel) 2023; 13:3117. [PMID: 37835860 PMCID: PMC10573002 DOI: 10.3390/diagnostics13193117] [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: 08/24/2023] [Revised: 09/14/2023] [Accepted: 09/27/2023] [Indexed: 10/15/2023] Open
Abstract
(1) Background: The aim of this study was to analyze labial minor salivary gland biopsy (MSGB) findings of a large sicca cohort and to examine their associations with Sjogren's syndrome (SS)-associated laboratory markers, phenotypic characteristics and systemic manifestations. Moreover, we sought to explore the ability of MSGB to identify SS patients among subjects with pre-diagnosed fibromyalgia (FM). (2) Methods: Included were all patients of three rheumatology departments having undergone a diagnostic MSGB within 9 years. Next to the examination of histological and immunohistochemical findings, we focused on activity and chronicity parameters of the underlying disease, autoantibodies, presence of systemic and hematologic involvement, as well as chronic pain and SS comorbidities. (3) Results: Among the 678 included patients, 306 (45.1%) had a positive focus score (FS). The remaining patients (n = 372) served as control subjects. There were significant correlations between FS and hypergammaglobulinemia (p < 0.001), ANA and rheumatoid factor positivity (both; p < 0.001), a weak significant correlation with erythrocyte sedimentation rate (rho = 0.235; p < 0.001) and a negative correlation with nicotine use (p = 0.002). Within the primary SS subgroup, FS was associated significantly with glandular enlargement (p = 0.007) and systemic hematologic manifestations (p = 0.002). Next to FS, CD20 cell staining showed an excellent diagnostic performance in the diagnosis of SS by an area under the curve of 0.822 (95%CI 0.780-0.864; p < 0.001). Interestingly, 42.1% of all patients with fibromyalgia (FM) having received an MSGB could be diagnosed with SS. (4) Conclusion: By examining one of the largest cohorts in the literature, we could show that MSGB histological and immunohistochemical findings not only play a key role in the classification and diagnosis of SS but could also provide important information regarding SS phenotype and systemic manifestations. Furthermore, MSGB may help differentiate patients with FM from patients with subclinical SS who suffer primarily from chronic pain.
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Affiliation(s)
- Konstantinos Triantafyllias
- Department of Rheumatology, Acute Rheumatology Center, 55543 Bad Kreuznach, Germany
- Department of Internal Medicine I, Division of Rheumatology and Clinical Immunology, University Medical Center, Johannes Gutenberg University, 55131 Mainz, Germany;
| | - Mirjam Bach
- Department of Internal Medicine I, Division of Rheumatology and Clinical Immunology, University Medical Center, Johannes Gutenberg University, 55131 Mainz, Germany;
| | - Mike Otto
- Institute for Pathology, 54292 Trier, Germany
| | - Andreas Schwarting
- Department of Rheumatology, Acute Rheumatology Center, 55543 Bad Kreuznach, Germany
- Department of Internal Medicine I, Division of Rheumatology and Clinical Immunology, University Medical Center, Johannes Gutenberg University, 55131 Mainz, Germany;
- Department of Rheumatology, Karl-Aschoff Clinic, 55543 Bad Kreuznach, Germany
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Goel RR, Jeranko M, Jones L, Bishnoi A, Meysami A. Diagnostic Utility of Minor Salivary Gland Biopsy for Primary Sjögren Syndrome in Patients With Negative Anti-SSA Antibodies. Cureus 2023; 15:e46207. [PMID: 37905256 PMCID: PMC10613453 DOI: 10.7759/cureus.46207] [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: 09/29/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Sjögren syndrome is a systemic autoimmune disease characterized by lacrimal and salivary gland inflammation resulting in dry eyes and mouth. Although it is a common disease, diagnosis can be challenging due to its heterogeneous presentation. A positive minor salivary gland biopsy is mandatory to fulfill the 2016 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) classification criteria for primary Sjögren syndrome in patients who are seronegative for anti-SSA/Ro antibodies. The objective of our study was to evaluate the validity of minor salivary gland biopsy for patients who are SSA antibody-negative yet are suspected of having primary Sjögren syndrome because of compelling symptoms. METHODS We conducted a retrospective chart review of adult patients with a negative anti-SSA antibody test who underwent minor salivary gland biopsy to assess suspected Sjögren syndrome at Henry Ford Rheumatology Clinics between January 2005 and December 2019. Patient characteristics and clinical features are described. Sensitivity, specificity, positive predictive value, and negative predictive value are assessed. RESULTS A total of 47 patients were included: 46 (97.9%) females and one (2.1%) male. The mean age was 57.2 ± 13.8 years. There were 14 (29.8%) patients who had a positive minor salivary gland biopsy result and 15 (31.9%) patients who had a final diagnosis of Sjögren syndrome. Minor salivary gland biopsy had 93.3% sensitivity (95% confidence interval (CI): 68%-99.8%), 100% specificity (95% CI: 89.1%-100%), 100% positive predictive value (95% CI: 76.8%-100%), and 97% negative predictive value (95% CI: 84.2%-99.9%). CONCLUSION The diagnostic value of minor salivary gland biopsy is high for patients who do not have anti-SSA antibodies yet are suspected of having Sjögren syndrome. The results of the study support the consideration of routine minor salivary gland biopsy for identifying Sjögren syndrome in these patients.
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Affiliation(s)
- Rohit R Goel
- Rheumatology, Henry Ford Health System, Detroit, USA
| | - Mark Jeranko
- Rheumatology, Colorado Center for Arthritis and Osteoporosis, Englewood, USA
| | - Lamont Jones
- Otolaryngology, Henry Ford Health System, Detroit, USA
| | - Amita Bishnoi
- Rheumatology, Henry Ford Health System, Detroit, USA
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Valdez RMA, Melo TS, Santos-Silva AR, Duarte A, Gueiros LA. Adverse post-operative events of salivary gland biopsies: A systematic review and meta-analysis. J Oral Pathol Med 2021; 51:152-159. [PMID: 34363247 DOI: 10.1111/jop.13229] [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: 05/16/2021] [Revised: 06/22/2021] [Accepted: 07/08/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The study aimed to perform a systematic review and meta-analysis of the complications following major and minor salivary gland biopsy. MATERIALS AND METHODS Observational studies assessing postoperative complications of minor salivary gland biopsy and indexed at Medline/PubMed, EMBASE, Cinahl, LILACS, or Scopus were selected. This review was registered under the protocol number: CRD42020211169. The level of significance considered was 0.05, and the R software (The R Foundation) was used for the meta-analysis. RESULTS Twenty-seven studies reporting 3208 patients were included in this review. The combined prevalence of postsurgical complications was 11% (95% CI, 8 to 13%, p = 0.01). The percentage of the combined prevalence of neurological complications was 3% (95% CI, 1-6%, p = 0.01). The surgical technique did not influence the frequency of overall and neurological complications. CONCLUSION Minor salivary gland biopsies are a safe and predictable procedure that should be performed on the lower lip. Postoperative complications are more common than previously reported, but permanent complaints are uncommon.
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Affiliation(s)
- Remberto M A Valdez
- Oral Medicine Unit, Departamento de Clínica e Odontologia Preventiva, Universidade Federal de Pernambuco, Recife, Brazil
| | - Thayanara S Melo
- Oral Medicine Unit, Departamento de Clínica e Odontologia Preventiva, Universidade Federal de Pernambuco, Recife, Brazil
| | - Alan R Santos-Silva
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
| | - Angela Duarte
- Rheumatology Unit, Hospital das Clínicas, Universidade Federal de Pernambuco, Recife, Brazil
| | - Luiz A Gueiros
- Oral Medicine Unit, Departamento de Clínica e Odontologia Preventiva, Universidade Federal de Pernambuco, Recife, Brazil
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Zeng B, Guo M, Yu K, Sun L, Lin W, Pan D, Chen X, Xu M. Handheld spatial frequency domain imager for noninvasive Sjögren's syndrome labial salivary gland biopsy. BIOMEDICAL OPTICS EXPRESS 2021; 12:5057-5072. [PMID: 34513242 PMCID: PMC8407847 DOI: 10.1364/boe.426683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/17/2021] [Accepted: 07/07/2021] [Indexed: 06/13/2023]
Abstract
A labial salivary gland biopsy (LSGB) plays an essential role in diagnosing Sjögren's syndrome (SS), but its clinical application is limited due to its invasiveness. Here, we present a handheld single snapshot multiple-frequency demodulation-spatial frequency domain imaging (SSMD-SFDI) device for a rapid optical biopsy of labial salivary glands noninvasively. The structural and physiological parameters of lower lip mucosa were obtained from the light reflectance of the layered oral mucosa. The recovered parameters were found to correlate strongly with the progression of SS. In our pilot study on 15 healthy subjects and 183 SS patients, a support vector machine (SVM) classifier using the measured parameters distinguished healthy subjects, LSGB I, II, III, and IV patients in sequence with AUCs of 0.979, 0.898, 0.906, and 0.978, respectively. Critical structural and physiological alterations in the mucosa due to SS were further identified and used to assess its risk using an explainable neural network. The handheld spatial frequency domain imager may serve as a valuable label-free and noninvasive tool for early diagnosing and surveying SS.
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Affiliation(s)
- Bixin Zeng
- Institute of Lasers and Biomedical Photonics, Biomedical Engineering College, Wenzhou Medical University, Wenzhou, Zhejiang, 325035, China
- These authors contributed equally
| | - Mingrou Guo
- Institute of Lasers and Biomedical Photonics, Biomedical Engineering College, Wenzhou Medical University, Wenzhou, Zhejiang, 325035, China
- These authors contributed equally
| | - Kangyuan Yu
- Institute of Lasers and Biomedical Photonics, Biomedical Engineering College, Wenzhou Medical University, Wenzhou, Zhejiang, 325035, China
| | - Li Sun
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325035, China
| | - Weihao Lin
- Institute of Lasers and Biomedical Photonics, Biomedical Engineering College, Wenzhou Medical University, Wenzhou, Zhejiang, 325035, China
| | - Da Pan
- Institute of Lasers and Biomedical Photonics, Biomedical Engineering College, Wenzhou Medical University, Wenzhou, Zhejiang, 325035, China
| | - Xiaowei Chen
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325035, China
| | - Min Xu
- Institute of Lasers and Biomedical Photonics, Biomedical Engineering College, Wenzhou Medical University, Wenzhou, Zhejiang, 325035, China
- Department of Physics and Astronomy, Hunter College and the Graduate Center, The City University of New York, 695 Park Avenue, New York, NY 10065, USA
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Izzetti R, Ferro F, Vitali S, Nisi M, Fonzetti S, Oranges T, Donati V, Caramella D, Baldini C, Gabriele M. Ultra-high frequency ultrasonography (UHFUS)-guided minor salivary gland biopsy: A promising procedure to optimize labial salivary gland biopsy in Sjögren's syndrome. J Oral Pathol Med 2021; 50:485-491. [PMID: 33501696 DOI: 10.1111/jop.13162] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 11/05/2020] [Accepted: 01/21/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Sjögren's syndrome (SS) is an autoimmune disease characterized by an inflammatory infiltrate of exocrine salivary and lachrymal glands. Diagnosis is complex, and minor salivary gland biopsy and subsequent focus score (FS) calculation appear of extreme importance in the diagnostic work-up of the disease. Ultra-high frequency ultrasonography (UHFUS) is a recently introduced diagnostic technique, which is gaining an increasingly important role in intraoral imaging. This study aims at exploring the usefulness of UHFUS for obtaining valuable labial salivary gland samples to assess the histopathological features of SS patients. METHODS Patients with clinical suspect of SS and eligible for minor salivary gland biopsy were enrolled. UHFUS scan of the lower lip was performed. Glandular echostructure was classified according to Outcome Measures in Rheumatology (OMERACT) scoring system. The glands to be sampled were selected on the basis of UHFUS evaluation and biopsied. The areas of the samples were recorded and compared with those obtained without UHFUS guidance. The correlation between UHFUS grade and labial gland FS was also assessed. RESULTS The areas of the samples obtained with UHFUS guidance were significantly higher (7.25 ± 3.98 mm2 ) than those obtained by conventional procedures (5.79 ± 3.49 mm2 , P = .02). UHFUS correlated significantly with the salivary gland FS (r = .532, P = .001). CONCLUSION UHFUS seems a promising tool in SS diagnostic algorithm, being able to provide a valuable support to the biopsy procedure. Further studies are mandatory to confirm the role of UHFUS in SS.
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Affiliation(s)
- Rossana Izzetti
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, Unit of Dentistry and Oral Surgery, University of Pisa, Pisa, Italy
| | - Francesco Ferro
- Department of Clinical and Experimental Medicine, Unit of Rheumatology, University of Pisa, Pisa, Italy
| | - Saverio Vitali
- Department of Translational Research and of New Technologies in Medicine and Surgery, Diagnostic and Interventional Radiology, University of Pisa, Pisa, Italy
| | - Marco Nisi
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, Unit of Dentistry and Oral Surgery, University of Pisa, Pisa, Italy
| | - Silvia Fonzetti
- Department of Clinical and Experimental Medicine, Unit of Rheumatology, University of Pisa, Pisa, Italy
| | - Teresa Oranges
- Department of Clinical and Experimental Medicine, Unit of Dermatology, University of Pisa, Pisa, Italy
| | - Valentina Donati
- Unit of Anatomic Pathology II, University Hospital of Pisa, Pisa, Italy
| | - Davide Caramella
- Department of Translational Research and of New Technologies in Medicine and Surgery, Diagnostic and Interventional Radiology, University of Pisa, Pisa, Italy
| | - Chiara Baldini
- Department of Clinical and Experimental Medicine, Unit of Rheumatology, University of Pisa, Pisa, Italy
| | - Mario Gabriele
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, Unit of Dentistry and Oral Surgery, University of Pisa, Pisa, Italy
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Toward better outcomes in Sjögren's syndrome: The promise of a stratified medicine approach. Best Pract Res Clin Rheumatol 2020; 34:101475. [PMID: 32005417 DOI: 10.1016/j.berh.2019.101475] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Sjögren's syndrome is a systemic autoimmune disease defined by its targeted inflammation of the salivary and lacrimal glands, resulting in dry mouth and eyes in the majority and persistent or recurrent salivary gland enlargement in a minority of those affected. Involvement of major organs, an increased risk of lymphoma, and autoantibodies against ubiquitous cellular ribonucleoproteins define some of its systemic features. Those affected have a high symptom burden and the development of disease-modifying therapies is thus an urgent need. A stratified medicine approach offers promise as a means of targeting specific therapies to patients for whom the mechanism of action is most relevant. Implementation of this approach will require an understanding of the pathophysiological processes underlying different patient subsets, and then identifying or developing a drug that targets this pathway. Such therapies would be most effective if implemented early in the disease course before the advent of adverse outcomes or glandular damage. This review will provide a disease overview followed by an analysis of the feasibility of a stratified medicine approach, focusing on the disease heterogeneity, predictors of disease progression and adverse outcomes, and recent advances in the development of relevant outcome measures and new therapies.
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Wicheta S, Van der Groen T, Faquin WC, August M. Discrepancies in Interpretation of the Minor Salivary Gland Biopsy in the Diagnosis of Sjögren Syndrome. J Oral Maxillofac Surg 2019; 77:1628-1635. [DOI: 10.1016/j.joms.2019.01.052] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 01/31/2019] [Accepted: 01/31/2019] [Indexed: 02/07/2023]
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Comini LV, Lazio MS, Taverna C, Luparello P, Maggiore G, Martelli F, Novelli L, Santoro GP. A new, easy, and swift technique for minor salivary gland biopsy in Sjogren's syndrome. Laryngoscope 2019; 130:873-875. [PMID: 31165491 DOI: 10.1002/lary.28094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 05/13/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Lara Valentina Comini
- Clinic of Otorhinolaryngology-Head and Neck Surgery, University of Florence, Florence, Italy
| | - Maria Silvia Lazio
- Clinic of Otorhinolaryngology-Head and Neck Surgery, University of Florence, Florence, Italy
| | - Cecilia Taverna
- Institute of Histopathology and Molecular Diagnosis, Careggi University Hospital, Florence, Italy
| | - Paolo Luparello
- Clinic of Otorhinolaryngology-Head and Neck Surgery, University of Florence, Florence, Italy
| | - Giandomenico Maggiore
- Clinic of Otorhinolaryngology-Head and Neck Surgery, University of Florence, Florence, Italy
| | - Federica Martelli
- Clinic of Otorhinolaryngology-Head and Neck Surgery, University of Florence, Florence, Italy
| | - Luca Novelli
- Institute of Histopathology and Molecular Diagnosis, Careggi University Hospital, Florence, Italy
| | - Giovanni Paolo Santoro
- Division of Head and Neck and Robotic Surgery, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Laryngological manifestations of Sjögren's syndrome. Reumatologia 2019; 57:37-44. [PMID: 30858629 PMCID: PMC6409826 DOI: 10.5114/reum.2019.83237] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 01/28/2019] [Indexed: 11/24/2022] Open
Abstract
Sjögren’s syndrome (SS) is a systemic autoimmune disease characterized by lymphocytic infiltration of exocrine glands and a range of extra-glandular features. The most common and earliest symptoms are oral and ocular dryness. The aim of this study is to present the most common otolaryngological manifestations of SS, their pathomechanism and possible aetiology. The most common oral signs and symptoms are xerostomia, tooth decay, fungal infections, traumatic oral lesions, dysphagia, dysgeusia, and inflammation of the salivary glands. The salivary glands of SS patients are characterised by chronic inflammation. The presence of foci is thus a hallmark of SS. A biopsy can be taken from either the labial or the parotid salivary gland. The most significant complication of SS is the development of lymphoproliferative malignancy, which occurs in about 5% of SS patients. The ultrasonic greyscale scoring system, glandular volume measurement, and intraglandular power Doppler ultrasonography are specific ultrasound parameters of SS.
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Utility of Novel Autoantibodies in the Diagnosis of Sjögren's Syndrome Among Patients With Dry Eye. Cornea 2018; 37:405-411. [PMID: 29504954 DOI: 10.1097/ico.0000000000001471] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE To investigate the value of 3 novel autoantibodies [salivary protein 1 (SP1), carbonic anhydrase 6 (CA6), and parotid secretory protein (PSP)] in differentiating Sjögren's syndrome (SS)-related dry eye from non-SS dry eye. METHODS Forty-six dry eye patients with SS (SS dry eye), 14 dry eye patients without SS (non-SS dry eye), and 25 controls were included. The 2012 American College of Rheumatology classification criteria were used for the diagnosis of SS. After a detailed review of systems, the Ocular Surface Disease Index questionnaire, Schirmer test without anesthesia, tear film breakup time, and ocular surface staining were performed to assess dry eye. All participants underwent serological testing using a commercially available finger prick kit. RESULTS Thirty-seven patients with SS (80.4%) had a positive traditional autoantibody and 28 (60.9%) had a positive novel autoantibody. Traditional autoantibodies were absent in all non-SS dry eye patients and controls. Novel autoantibodies were present in 7/14 (50%) non-SS dry eye patients and 4/25 (16%) controls. Among 3 novel autoantibodies, anti-CA6 was significantly more prevalent in the SS and non-SS dry eye groups than in controls (52.2% vs. 42.9% vs. 8.0%, P = 0.001). Dry eye patients with positive anti-CA6 alone were significantly younger than patients with only traditional autoantibodies. Anti-CA6 was associated with worse dry eye signs and symptoms. CONCLUSIONS Anti-CA6 was the most prevalent novel autoantibody in patients with dry eye, and was associated with younger age and more severe disease. Longitudinal studies are needed to determine whether anti-CA6 is a marker for early SS or perhaps another form of an autoimmune dry eye disease.
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Wicheta S, Van der Groen T, Faquin WC, August M. Minor Salivary Gland Biopsy-An Important Contributor to the Diagnosis of Sjögren Syndrome. J Oral Maxillofac Surg 2017. [PMID: 28648912 DOI: 10.1016/j.joms.2017.05.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE Sjögren syndrome (SS), although commonly associated with xerostomia and xerophthalmia, can present with extraglandular manifestations that make definitive diagnosis difficult. The 2 leading diagnostic classification systems include a positive minor salivary gland biopsy (MSGB) result as a major inclusion criterion. The purpose of this study was to better define the role of the MSGB in establishing a diagnosis of SS in a cohort of referred patients. MATERIALS AND METHODS This is a retrospective cohort study of patients referred to the Massachusetts General Hospital Department of Oral and Maxillofacial Surgery (Boston, MA) over a 5-year period to establish a diagnosis of SS. Inclusion criteria were complete information regarding presenting symptoms, reason for referral, and findings at MSGB. Incomplete records and referral for reasons other than presumptive SS resulted in exclusion. The MSGB and its role in definitive diagnosis based on accepted classification systems were evaluated for sensitivity, specificity, and positive and negative predictive values. Other variables of interest (demographics, pattern of referral, and symptomology) are described for the cohort. RESULTS Eighty-seven patients met the inclusion criteria. The mean age was 48.3 years (range, 19 to 74 yr) and 75 were women (86.2%). Fifteen MSGB results (17.2%) were positive based on the focus score histologic criteria. In 12 of 15 cases, the positive MSGB result allowed for a definitive diagnosis (80%). In 3 cases, other criteria allowed diagnosis without the contribution of the MSGB (sensitivity of MSGB, 80.0%; specificity, 87.5%; positive predictive value, 57.1%; negative predictive value, 95.5%). CONCLUSION The MSGB is an important contributor to a diagnosis of SS. When serology was negative, the MSGB often was the criterion that allowed the diagnosis to be established. It is the most frequently positive of the major criteria used by the 2 classification systems in current use.
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Affiliation(s)
- Sarah Wicheta
- Student, Harvard School of Dental Medicine, Boston, MA
| | | | - William C Faquin
- Professor, Department of Pathology, Massachusetts General Hospital, Massachusetts General Hospital, Boston, MA
| | - Meredith August
- Associate Professor, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA.
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