1
|
Popescu A, Hickernell J, Paulson A, Aouhab Z. Neurological and Psychiatric Clinical Manifestations of Sjögren Syndrome. Curr Neurol Neurosci Rep 2024; 24:293-301. [PMID: 38981949 DOI: 10.1007/s11910-024-01352-z] [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] [Accepted: 06/17/2024] [Indexed: 07/11/2024]
Abstract
PURPOSE OF REVIEW Sjögren Syndrome is a systemic autoimmune disorder that presents mainly with sicca symptoms, but frequently affects other body systems which can lead to a wide variety of manifestations. Understanding the neurological and psychiatric manifestations of Sjögren Syndrome can help with an earlier diagnosis of this disease and leads to better clinical outcomes. RECENT FINDINGS We provide an updated overview of the central neurological manifestations, peripheral neurological manifestations and psychiatric manifestations and their diagnosis when associated with primary Sjögren Syndrome. The epidemiology and clinical features of the neurological and psychiatric manifestations are derived from different cohort studies and review articles that were selected from PubMed searches conducted between January 2024 and March 2024. The absence of diagnostic criteria and the scarcity of large, robust studies makes the recognition of the neurological and psychiatric manifestations of Sjögren Syndrome more difficult. Maintaining a high index of suspicion in clinical practice and a close collaboration between the Neurologist and the Rheumatologist will facilitate the diagnosis and management of these patients.
Collapse
Affiliation(s)
- Alexandra Popescu
- Department of Rheumatology, Loyola University Medical Center, 2160 S. First Avenue, Maywood, Il, 60153, USA.
| | - John Hickernell
- Department of Rheumatology, Loyola University Medical Center, 2160 S. First Avenue, Maywood, Il, 60153, USA
| | - Anisha Paulson
- Department of Rheumatology, Loyola University Medical Center, 2160 S. First Avenue, Maywood, Il, 60153, USA
| | - Zineb Aouhab
- Department of Rheumatology, Loyola University Medical Center, 2160 S. First Avenue, Maywood, Il, 60153, USA
| |
Collapse
|
2
|
Rathore T, Dattatri M. Exploring Sjögren's syndrome through interdisciplinary perspectives: a concise review. J Immunoassay Immunochem 2024; 45:153-177. [PMID: 38748045 DOI: 10.1080/15321819.2024.2353766] [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] [Indexed: 06/25/2024]
Abstract
Dr. Henrik Sjögren after whom Sjögren's Syndrome is named, was a Swedish ophthalmologist who identified the syndrome which had three main symptoms namely, dry eyes, dry mouth, and arthritis. His contributions also highlighted the systemic complications of the syndrome which made our understanding of this disease better. Since then, there have been several studies on Sjögren's Syndrome (SS) of which two of them have changed the perception of the disease's prevalence. The first was a British study in the late 1990s which indicated this syndrome was no more a rare condition. The second is a 2008 study in the US which placed the syndrome as the second most prevalent autoimmune disease after rheumatoid arthritis (RA). Being one of the most prevalent autoimmune disease, there is a pressing need for a more profound and comprehensive understanding of the syndrome. This review endeavors to offer a comprehensive overview of the disease, encompassing its prevalence, manifestations, mechanisms, genetic factors, diagnostic methods, and treatment options. This review additionally offers the āyurvedic viewpoint on SS and its symptoms. This supplementary insight has the potential to contribute to the development of an integrated and holistic approach to managing the condition.
Collapse
Affiliation(s)
- Tanisha Rathore
- Department of Chemistry and Biochemistry, M. S. Ramaiah College of Arts, Science and Commerce, Bengaluru, India
| | - Mayur Dattatri
- Department of Sanskrit, M. S. Ramaiah College of Arts, Science and Commerce, Bengaluru, India
| |
Collapse
|
3
|
Zehrfeld N, Abelmann M, Benz S, Zippel CL, Beider S, Kramer E, Seeliger T, Sogkas G, Gödecke V, Ahrenstorf G, Armbruster FP, Skripuletz T, Witte T, Derda AA, Sonnenschein K, Ernst D. Primary Sjögren's syndrome independently promotes premature subclinical atherosclerosis. RMD Open 2024; 10:e003559. [PMID: 38663882 PMCID: PMC11043759 DOI: 10.1136/rmdopen-2023-003559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 04/12/2024] [Indexed: 04/28/2024] Open
Abstract
OBJECTIVES Cardiovascular comorbidities are common in patients with autoimmune diseases. This study investigates the extent of subclinical atherosclerosis in patients with primary Sjögren's syndrome (pSS). Correlations with clinical factors such as organ involvement (OI) or disease activity were analysed and oxLDL antibodies (oxLDL ab) were measured as potential biomarkers of vascular damage. METHODS Patients with pSS were consecutively included from the rheumatology outpatient clinic. Age- and sex-matched controls were recruited (2:1 ratio). Data collection was performed by a standardised questionnaire and Doppler ultrasound to evaluate the plaque extent and carotid intima-media thickness (cIMT). Propensity score matching included all cardiovascular risk (CVR) factors and corresponding laboratory markers. RESULTS Data were available for 299 participants (199 pSS/100 controls), aged 59.4 years (50.6-65.0), 19.1% male. After matching, the pSS cohort had greater cIMT (p<0.001) and plaque extent (OR=1.82; 95% CI 1.14 to 2.95). Subgroup analyses of patients with pSS revealed that OI was associated with increased cIMT (p=0.025) and increased plaque occurrence compared with patients without OI (OR=1.74; 95% CI 1.02 to 3.01). OxLDL ab tended to be lower in patients with plaque (p=0.052). Correlations of higher Oxidized Low Density Lipoprotein (oxLDL) ab with EULAR Sjögren's Syndrome Disease Activity Index (p<0.001) and anti-Sjögren's-syndrome-related antigen A autoantibodies (SSA/Ro antibodies) (p=0.026) were observed. CONCLUSIONS Subclinical atherosclerosis occurs earlier and more severely in patients with pSS. The difference in cIMT between pSS and controls seems mainly driven by patients with OI, suggesting that this subgroup is particularly at risk. OxLDL ab might protect against atherosclerotic progression in patients with pSS. CVR stratification and preventive medications such as Hydroxymethylglutaryl-CoA (HMG-CoA) reductase inhibitors should be discussed and further longitudinal studies are needed.
Collapse
Affiliation(s)
- Nadine Zehrfeld
- Rheumatology & Immunology, Hannover Medical School, Hannover, Lower Saxony, Germany
| | - Malin Abelmann
- Cardiology & Angiology, Hannover Medical School, Hannover, Lower Saxony, Germany
| | - Sabrina Benz
- Faculty of Social Sciences, University of Mannheim, Mannheim, Germany
| | - Clara Luisa Zippel
- Rheumatology & Immunology, Hannover Medical School, Hannover, Lower Saxony, Germany
| | - Sonja Beider
- Rheumatology & Immunology, Hannover Medical School, Hannover, Lower Saxony, Germany
| | - Emelie Kramer
- Rheumatology & Immunology, Hannover Medical School, Hannover, Lower Saxony, Germany
| | - Tabea Seeliger
- Neurology, Hannover Medical School, Hannover, Lower Saxony, Germany
| | - Georgios Sogkas
- Rheumatology & Immunology, Hannover Medical School, Hannover, Lower Saxony, Germany
| | - Vega Gödecke
- Rheumatology & Immunology, Hannover Medical School, Hannover, Lower Saxony, Germany
| | - Gerrit Ahrenstorf
- Rheumatology & Immunology, Hannover Medical School, Hannover, Lower Saxony, Germany
| | | | | | - Torsten Witte
- Rheumatology & Immunology, Hannover Medical School, Hannover, Lower Saxony, Germany
| | - Anselm Arthur Derda
- Cardiology & Angiology, Hannover Medical School, Hannover, Lower Saxony, Germany
| | | | - Diana Ernst
- Rheumatology & Immunology, Hannover Medical School, Hannover, Lower Saxony, Germany
| |
Collapse
|
4
|
Zehrfeld N, Witte T, Ernst D. [Update on Sjögren's syndrome : Diagnostics, treatment, and challenges]. Z Rheumatol 2024; 83:217-228. [PMID: 38498147 DOI: 10.1007/s00393-024-01493-z] [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: 02/26/2024] [Indexed: 03/20/2024]
Abstract
Sjögren's syndrome (SjS) is the most common connective tissue disease with a prevalence of 1:200. Predominantly affecting women, SjS is associated with destruction of the exocrine glands, leading to xerophthalmia and xerostomia. In over 50% of patients, there are also extraglandular manifestations, leading to multiple organ manifestations including polyneuropathies and interstitial lung disease as well as symptoms such as fatigue and arthralgia. Diagnostic procedures include biomarkers, in particular anti-SS-A/Ro antibodies, histology of salivary glands, and salivary gland sonography. There are currently no licensed immunosuppressive drugs for SjS, so current treatment is often based on off-label use of drugs. The European League Against Rheumatism (EULAR) has recently published treatment recommendations based on the prevailing organ manifestations. Several promising controlled trials with novel compounds and concepts are currently in progress.
Collapse
Affiliation(s)
| | | | - Diana Ernst
- Klinik für Immunologie und Rheumatologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
| |
Collapse
|
5
|
Cao X, Guo J, Yang Y, Yu Z, Pan H, Zhou W. Clinical characteristics of Guillain-Barré syndrome in patients with primary Sjögren's syndrome. Sci Rep 2024; 14:5783. [PMID: 38461210 PMCID: PMC10924922 DOI: 10.1038/s41598-024-56365-y] [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: 10/07/2023] [Accepted: 03/05/2024] [Indexed: 03/11/2024] Open
Abstract
To investigate the clinical characteristics of Guillain-Barré syndrome (GBS) in patients with primary Sjögren's syndrome (SS). Records of patients with positive anti-SSA antibodies hospitalized in the Beijing Tiantan Hospital between December 2011 and May 2020 were retrieved. Patients who fulfilled the criteria for diagnosis of GBS and primary SS were included, and their clinical data were analyzed. Among the 785 patients with positive anti-SSA, 52 patients were identified in this study. They were 27 males and 25 females with median age of 59 years old. Besides anti-SSA antibodies, multiple autoantibodies were detected in these patients including antinuclear antibody, anti-Ro52, anti-mitochondrial M2, anti-thyroid peroxidase and anti-thyroglobulin autoantibodies. Preceding infection was reported in 42 patients. Hyporeflexia/areflexia and limbs weakness were the most common manifestation and 35 patients presented cranial nerve injuries. GBS disability score of 3, 4 and 5 was scaled in 28 (53.8%), 15 (28.8%) and 3 (5.8%) patients respectively. Forty-six patients received intravenous immunoglobulin (IVIG) monotherapy, 5 patients were treated by IVIG plus glucocorticoids, and 51 patients improved during hospitalization. The frequency of male gender among the patients with both GBS and primary SS suggests an independent onset of GBS and the co-existence of these autoimmune diseases in patients with multiple autoantibodies. Majority of patients with GBS and primary SS experience benign disease course.
Collapse
Affiliation(s)
- Xiaoyu Cao
- Department of Rheumatology and Immunology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Juan Guo
- Department of Rheumatology and Immunology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yaran Yang
- Department of Rheumatology and Immunology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhibo Yu
- Department of Rheumatology and Immunology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hua Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
| | - Wei Zhou
- Department of Rheumatology and Immunology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
| |
Collapse
|
6
|
Barsottini OGP, Moraes MPMD, Fraiman PHA, Marussi VHR, Souza AWSD, Braga Neto P, Spitz M. Sjogren's syndrome: a neurological perspective. ARQUIVOS DE NEURO-PSIQUIATRIA 2023; 81:1077-1083. [PMID: 38157875 PMCID: PMC10756846 DOI: 10.1055/s-0043-1777105] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 10/20/2023] [Indexed: 01/03/2024]
Abstract
Sjogren's syndrome (SS) is a complex autoimmune disease characterized by lymphocytic infiltration of salivary and lacrimal glands, resulting in sicca symptoms. Additionally, SS presents with neurological manifestations that significantly impact the nervous system. This review aims to provide a comprehensive overview of the neurological aspects of SSj, covering both the peripheral and central nervous system involvement, while emphasizing diagnosis, treatment, and prognosis.
Collapse
Affiliation(s)
- Orlando Grazianni Povoas Barsottini
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Neurologia e Neurocirurgia, Setor de Neurologia Geral e Ataxias, São Paulo SP, Brazil.
| | - Marianna Pinheiro Moraes de Moraes
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Neurologia e Neurocirurgia, Setor de Neurologia Geral e Ataxias, São Paulo SP, Brazil.
| | - Pedro Henrique Almeida Fraiman
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Neurologia e Neurocirurgia, Setor de Neurologia Geral e Ataxias, São Paulo SP, Brazil.
| | | | - Alexandre Wagner Silva de Souza
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Medicina, Divisão de Reumatologia, São Paulo SP, Brazil.
- Sociedade Brasileira de Reumatologia, Comissão de Vasculites, São Paulo SP, Brazil.
| | - Pedro Braga Neto
- Universidade Federal do Ceará, Departamento de Medicina Clínica, Divisão de Neurologia, Fortaleza CE, Brazil.
- Universidade do Estado do Ceará, Centro de Ciências da Saúde, Fortaleza CE, Brazil.
| | - Mariana Spitz
- Universidade do Estado do Rio de Janeiro, Serviço de Neurologia, Rio de Janeiro RJ, Brazil.
| |
Collapse
|