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Pellegrini M, Pulicari F, Kuhn E, Scribante A, Spadari F. Minor Salivary Gland Surgery and Histopathological Scoring System: A Systematic Review. Int J Clin Pract 2022; 2022:1-12. [DOI: 10.1155/2022/7437321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/14/2023] Open
Abstract
Sjögren’s syndrome is a systemic autoimmune disease characterized by chronic inflammation of the exocrine glands with an associated functional deficit. The clinical picture is characterized by symptoms such as dry eyes (xerophthalmia) and dry mouth (xerostomia). The disease is defined as primary if no other autoimmune diseases are associated, otherwise, it is defined as secondary. A systematic review was made using the databases PubMed (MEDLINE), Scopus, and keywords “biopsy,” “classification,” “clinical pathology,” “salivary glands,” and “Sjogren’s syndrome.” The diagnosis of Sjögren’s syndrome is based on a combination of clinical, serologic, instrumental, and histological features. In addition to ocular tests, a biopsy of the minor salivary glands represents one of the most relevant examinations for the diagnosis. In fact, the evaluation of specific histopathological features represents one of the most important criteria proposed in the last international consensus of 2016, which developed the most recent classification criteria for Sjögren’s syndrome. Knowledge of classification criteria, minor salivary gland biopsy techniques, and histopathological features are essential for the clinician to evaluate the pathology report and make a diagnosis of Sjögren’s syndrome. The aim of this review is to describe the classification criteria of the disease proposed to date, the main biopsy techniques used to analyze the minor salivary glands, and finally, the histopathological diagnostic scoring systems currently applied.
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Affiliation(s)
- Matteo Pellegrini
- Section of Dentistry, Department of Clinical, Surgical Diagnostic and Pediatric Sciences, University of Pavia, Pavia 27100, Italy
| | - Federica Pulicari
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Maxillo-Facial and Odontostomatology Unit, Milan 20122, Italy
- University of Milan, Department of Biomedical, Surgical and Dental Sciences, Via Della Commenda 10, Milan 20122, Italy
| | - Elisabetta Kuhn
- University of Milan, Department of Biomedical, Surgical and Dental Sciences, Via Della Commenda 10, Milan 20122, Italy
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Pathology Unit, Milan 20122, Italy
| | - Andrea Scribante
- Section of Dentistry, Department of Clinical, Surgical Diagnostic and Pediatric Sciences, University of Pavia, Pavia 27100, Italy
| | - Francesco Spadari
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Maxillo-Facial and Odontostomatology Unit, Milan 20122, Italy
- University of Milan, Department of Biomedical, Surgical and Dental Sciences, Via Della Commenda 10, Milan 20122, Italy
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Gordon AJ, Patel A, Zhou F, Liu C, Saxena A, Rackoff P, Givi B. Minor Salivary Gland Biopsy in Diagnosis of Sjögren’s Syndrome. OTO Open 2022; 6:2473974X221116107. [PMID: 35909442 PMCID: PMC9326841 DOI: 10.1177/2473974x221116107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 07/03/2022] [Indexed: 11/15/2022] Open
Abstract
Objective Previous studies have questioned the safety and efficacy of minor salivary gland biopsy in the diagnosis of Sjögren’s syndrome, citing complications and difficulty of pathologic evaluation. This study aims to determine the rate of biopsy specimen adequacy and the risk of complications after minor salivary gland biopsy. Study Design Case series. Setting Single tertiary care center. Methods We reviewed the records of all patients who underwent minor salivary gland biopsy at our institution from October 1, 2016, to September 1, 2021. Demographics, comorbidities, symptoms, and serologic results were recorded. The primary outcome was adequacy of the tissue sample. Complications of the procedure were recorded. Biopsies with at least one focus of ≥50 lymphocytes per 4-mm2 sample were considered positive. Results We identified 110 patients who underwent minor salivary gland biopsy. Ninety-three (85%) were female, and the median age was 49.1 years (range, 18.7-80.5). Seventy-seven procedures (70%) were performed in the office setting, and 33 (30%) were performed in the operating room. Nearly all biopsy samples (n = 108, 98%) were adequate, and 33 (31%) were interpreted as positive. Four patients (4%) experienced temporary lip numbness, which resolved with conservative management. No permanent complications were reported after lip biopsy. Nineteen (58%) patients with positive biopsy results had no Sjögren’s-specific antibodies. Most patients with positive biopsy results (n = 20, 61%) subsequently started immunomodulatory therapy. Conclusion Minor salivary gland biopsy can be performed safely and effectively in both the office and the operating room. This procedure provides clinically meaningful information and can be reasonably recommended in patients suspected to have Sjögren’s syndrome.
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Affiliation(s)
- Alex J. Gordon
- Department of Otolaryngology–Head and Neck Surgery, NYU Langone Health, New York, New York, USA
- Alex J. Gordon, Department of Otolaryngology–Head and Neck Surgery, NYU Langone Health, 550 First Ave, New York, NY 10016, USA.
| | - Aneek Patel
- Department of Otolaryngology–Head and Neck Surgery, NYU Langone Health, New York, New York, USA
| | - Fang Zhou
- Department of Pathology, NYU Langone Health, New York, New York, USA
| | - Cheng Liu
- Department of Pathology, NYU Langone Health, New York, New York, USA
| | - Amit Saxena
- Division of Rheumatology, Department of Medicine, NYU Langone Health, New York, New York, USA
| | - Paula Rackoff
- Division of Rheumatology, Department of Medicine, NYU Langone Health, New York, New York, USA
| | - Babak Givi
- Department of Otolaryngology–Head and Neck Surgery, NYU Langone Health, New York, New York, USA
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Salivary Calcium Level in Patients with Sjogren's Syndrome. JOURNAL OF RESEARCH IN DENTAL AND MAXILLOFACIAL SCIENCES 2022. [DOI: 10.52547/jrdms.7.2.77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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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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Zhou QQ, Zhang W, Yu YS, Li HY, Wei L, Li XS, He ZZ, Zhang H. Comparative Study between ZOOMit and Conventional Intravoxel Incoherent Motion MRI for Assessing Parotid Gland Abnormalities in Patients with Early- or Mid-Stage Sjögren’s Syndrome. Korean J Radiol 2022; 23:455-465. [PMID: 35289149 PMCID: PMC8961020 DOI: 10.3348/kjr.2021.0695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 12/11/2021] [Accepted: 12/27/2021] [Indexed: 11/25/2022] Open
Abstract
Objective To compare the reproducibility and performance of quantitative metrics between ZOOMit and conventional intravoxel incoherent motion (IVIM) magnetic resonance imaging (MRI) in the diagnosis of early- and mid-stage Sjögren’s syndrome (SS). Materials and Methods Twenty-two patients (mean age ± standard deviation, 52.0 ± 10.8 years; male:female, 2:20) with early- or mid-stage SS and 20 healthy controls (46.9 ± 14.6 years; male:female, 7:13) were prospectively enrolled in our study. ZOOMit IVIM and conventional IVIM MRI were performed simultaneously in all individuals using a 3T scanner. Quantitative IVIM parameters - including tissue diffusivity (D), pseudodiffusion coefficient (D*), and perfusion fraction (f) - inter- and intra-observer reproducibility in measuring these parameters, and their ability to distinguish patients with SS from healthy individuals were assessed and compared between ZOOMit IVIM and conventional IVIM methods, appropriately. MR gland nodular grade (MRG) was also examined. Results Inter- and intra-observer reproducibility was better with ZOOMit imaging than with conventional IVIM imaging (ZOOMit vs. conventional, intraclass correlation coefficient of 0.897–0.941 vs. 0.667–0.782 for inter-observer reproducibility and 0.891–0.968 vs. 0.814–0.853 for intra-observer reproducibility). Significant differences in ZOOMit f, ZOOMit D*, conventional D*, and MRG between patients with SS and healthy individuals (all p < 0.05) were observed. ZOOMit D* outperformed conventional D* in diagnosing early- and mid-stage SS (area under receiver operating curve, 0.867 and 0.658, respectively; p = 0.002). The combination of ZOOMit D*, MRG, and ZOOMit f as a new diagnostic index for SS, increased diagnostic area under the curve to 0.961, which was higher than that of any single parameter (all p < 0.01). Conclusion Considering its better reproducibility and performance, ZOOMit IVIM may be preferred over conventional IVIM MRI, and may subsequently improve the ability to diagnose early- and mid-stage SS.
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Affiliation(s)
- Qing-Qing Zhou
- Department of Radiology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China
| | - Wei Zhang
- Department of Immunology and Rheumatology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China
| | - Yu-Sheng Yu
- Department of Radiology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China
| | - Hong-Yan Li
- Department of Immunology and Rheumatology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China
| | - Liang Wei
- Department of Radiology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China
| | - Xue-Song Li
- Department of Radiology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China
| | - Zhen-Zhen He
- Department of Radiology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China
| | - Hong Zhang
- Department of Radiology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China
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Vivas ÁJ, Bautista-Vargas M, Portacio S, Garcés-Palacio A, Urbano MA, Agualimpia A, Ruiz-Ordoñez I, Nieto-Aristizábal I, Tobón GJ. Reproducibility of minor salivary gland biopsy reports in Sjögren's syndrome and its correlation with disease biomarkers. Clin Rheumatol 2021; 40:2285-2292. [PMID: 33411139 DOI: 10.1007/s10067-020-05532-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/17/2020] [Accepted: 12/01/2020] [Indexed: 12/01/2022]
Abstract
INTRODUCTION/OBJECTIVE Sjögren's syndrome (SS) is a systemic autoimmune disease that is challenging to diagnose. Although minor salivary gland biopsy (MSGB) is a useful ancillary study, different factors make its interpretation difficult. Also, the significance of distinct histopathological findings is unknown. We aimed to determine the concordance between pathologists and rheumatologists in interpreting the MSGB results, as well as the correlation between MSGB findings, paraclinical features, and SS diagnosis. METHODS This descriptive retrospective study reviewed medical charts from 998 individuals from a single center where MSGBs had been performed. Rheumatologists interpreted biopsy reports from pathologists, and interobserver variability was calculated. Logistic regression using immunological parameters and histological findings was performed. RESULTS We included 998 patients with a median age of 55 years (45-64 years); the majority of patients were females (n = 934, 93.6%). Chisholm and Mason's scoring system was the most frequently used scale (55.1%). There was a good correlation between pathologists and rheumatologists for diagnosing SS using MSGB findings (Cohen's kappa 0.91). We observed a strong association between interstitial plasmocytes and SS (OR 24, 95% CI 9.09-64.94, p = 0). CONCLUSION The MSGB is an essential tool for the diagnosis of SS. Although different factors may negatively affect its reproducibility, histological findings, such as interstitial plasmocytes, may predict the risk of developing SS. Key Points • We provide information based on 998 patients with suspected SS diagnosis. • Chisholm and Mason's scale is the most frequently used compared to Greenspan's and Tarpley's scales. • There is good correlation between pathologists and rheumatologists for the diagnosis of SS using MSGB.
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Affiliation(s)
- Álvaro J Vivas
- GIRAT: Grupo de Investigación en Reumatología, Autoinmunidad y Medicina Traslacional, Fundación Valle Del Lili and Universidad Icesi, Cra 98 Nro.18-49, Cali, 760032, Colombia
- Medical School, Universidad Icesi, Calle 18 No. 122-135, Cali, Colombia
| | - Mario Bautista-Vargas
- GIRAT: Grupo de Investigación en Reumatología, Autoinmunidad y Medicina Traslacional, Fundación Valle Del Lili and Universidad Icesi, Cra 98 Nro.18-49, Cali, 760032, Colombia
- Unit of Rheumatology, Medical School, Universidad Icesi, Calle 18 No. 122-135, Cali, Colombia
| | | | | | | | - Andrés Agualimpia
- GIRAT: Grupo de Investigación en Reumatología, Autoinmunidad y Medicina Traslacional, Fundación Valle Del Lili and Universidad Icesi, Cra 98 Nro.18-49, Cali, 760032, Colombia
- Unit of Rheumatology, Fundación Valle del Lili, Cra 98 No. 18-49, Cali, 760032, Colombia
| | - Ingrid Ruiz-Ordoñez
- GIRAT: Grupo de Investigación en Reumatología, Autoinmunidad y Medicina Traslacional, Fundación Valle Del Lili and Universidad Icesi, Cra 98 Nro.18-49, Cali, 760032, Colombia
- Fundación Valle del Lili, Centro de Investigaciones Clínicas, Cra 98 No. 18-49, Cali, 760032, Colombia
| | - Ivana Nieto-Aristizábal
- GIRAT: Grupo de Investigación en Reumatología, Autoinmunidad y Medicina Traslacional, Fundación Valle Del Lili and Universidad Icesi, Cra 98 Nro.18-49, Cali, 760032, Colombia
- Fundación Valle del Lili, Centro de Investigaciones Clínicas, Cra 98 No. 18-49, Cali, 760032, Colombia
| | - Gabriel J Tobón
- GIRAT: Grupo de Investigación en Reumatología, Autoinmunidad y Medicina Traslacional, Fundación Valle Del Lili and Universidad Icesi, Cra 98 Nro.18-49, Cali, 760032, Colombia.
- Unit of Rheumatology, Fundación Valle del Lili, Cra 98 No. 18-49, Cali, 760032, Colombia.
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Wang B, Chen S, Zheng Q, Li Y, Zhang X, Xuan J, Liu Y, Shi G. Early diagnosis and treatment for Sjögren's syndrome: current challenges, redefined disease stages and future prospects. J Autoimmun 2020; 117:102590. [PMID: 33310686 DOI: 10.1016/j.jaut.2020.102590] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/24/2020] [Accepted: 11/30/2020] [Indexed: 02/06/2023]
Abstract
There are some challenges and unmet needs in the early diagnosis and management of Sjögren's syndrome (SjS) such as prominent glandular dysfunction at diagnosis and long diagnostic delay. Those challenges are partly attributed to the lack of a good knowledge of the early stages of SjS, which is a major obstacle to delivering appropriate care to SjS patients. Findings from both clinical and experimental studies suggest the plausibility of a redefined SjS course consisting of 4 stages, which includes initiation stage, preclinical stage, asymptomatic SjS stage and overt SjS stage. More studies focusing on the pathological processes and changes during the early stages of SjS are needed. To enable early diagnosis and treatment for SjS, more useful biomarkers of the early stages of SjS need to be identified, and individuals at high risk of SjS development need to be identified. Appropriate screening can be performed to facilitate the early diagnosis of SjS among those high-risk individuals.
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Affiliation(s)
- Bin Wang
- Department of Rheumatology and Clinical Immunology, The First Affiliated Hospital of Xiamen University, Xiamen, 361003, China
| | - Shiju Chen
- Department of Rheumatology and Clinical Immunology, The First Affiliated Hospital of Xiamen University, Xiamen, 361003, China
| | - Qing Zheng
- Department of Rheumatology and Clinical Immunology, The First Affiliated Hospital of Xiamen University, Xiamen, 361003, China
| | - Yan Li
- Department of Rheumatology and Clinical Immunology, The First Affiliated Hospital of Xiamen University, Xiamen, 361003, China
| | - Xinwei Zhang
- Department of Rheumatology and Clinical Immunology, The First Affiliated Hospital of Xiamen University, Xiamen, 361003, China
| | - Jingxiu Xuan
- Department of Rheumatology and Clinical Immunology, The First Affiliated Hospital of Xiamen University, Xiamen, 361003, China
| | - Yuan Liu
- Department of Rheumatology and Clinical Immunology, The First Affiliated Hospital of Xiamen University, Xiamen, 361003, China.
| | - Guixiu Shi
- Department of Rheumatology and Clinical Immunology, The First Affiliated Hospital of Xiamen University, Xiamen, 361003, China; Xiamen Key Laboratory of Rheumatology and Clinical Immunology, Xiamen, 361003, China.
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Bautista-Vargas M, Vivas AJ, Tobón GJ. Minor salivary gland biopsy: Its role in the classification and prognosis of Sjögren's syndrome. Autoimmun Rev 2020; 19:102690. [PMID: 33099041 DOI: 10.1016/j.autrev.2020.102690] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 05/25/2020] [Indexed: 12/16/2022]
Abstract
Sjögren's syndrome (SS) is an autoimmune disorder characterized by mononuclear cell infiltration in the exocrine glands, which leads to sicca syndrome (xerostomia and xerophthalmia). The etiology of SS is unknown, but multiple environmental factors (infectious, hormonal and stress-related), as well as genetic factors, may play a role in its pathogenesis. The diagnosis of SS is complex considering its clinical and paraclinical parameters may not be very specific. The minor salivary gland biopsy (MSGB) has undoubtedly become crucial for classifying and determining the prognosis of SS. The three main different classification systems for its interpretation have been described by Chisholm and Mason, Greenspan and Daniels, and Tarpley. However, this invasive procedure has variable sensitivity and specificity as well as low reproducibility. The use of additional methods, such as skin biopsy, imaging techniques, and serum/salivary biomarkers, may be combined with current methods to develop a bioscore that could increase diagnostic performance. In this review, we summarized the main pathological findings in SS and the prognosis of patients with SS according to the biopsy results.
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Affiliation(s)
- Mario Bautista-Vargas
- GIRAT: Grupo de Investigación en Reumatología, Autoinmunidad y Medicina Traslacional, Fundación Valle Del Lili and Universidad Icesi, Cali, Colombia
| | - Alvaro J Vivas
- GIRAT: Grupo de Investigación en Reumatología, Autoinmunidad y Medicina Traslacional, Fundación Valle Del Lili and Universidad Icesi, Cali, Colombia
| | - Gabriel J Tobón
- GIRAT: Grupo de Investigación en Reumatología, Autoinmunidad y Medicina Traslacional, Fundación Valle Del Lili and Universidad Icesi, Cali, Colombia.
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Monsalve DM, Anaya JM. With Minor Salivary Gland Biopsy in Sjögren Syndrome, Is a Negative Result Possible? J Rheumatol 2020; 47:310-312. [PMID: 32115432 DOI: 10.3899/jrheum.190743] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Diana M Monsalve
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario
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Abd-Allah NM, Hassan AA, Omar G, Hamdy M, Abdelaziz STA, Abd El Hamid WM, Moussa RA. Evaluation of patients with dry eye for the presence of primary or secondary Sjӧgren's syndrome. Clin Ophthalmol 2019; 13:1787-1797. [PMID: 31571817 PMCID: PMC6750845 DOI: 10.2147/opth.s217433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 08/16/2019] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To assess the frequency of Sjӧgren's syndrome (SS), either primary or secondary to rheumatic disease, in a cohort of patients with aqueous-deficient dry eye and to determine the most accurate objective test for diagnosis of SS. METHODS A total of 111 patients with dry eye were recruited from Minia University's Ophthalmology Outpatient Clinic (69 patients) and Rheumatology Outpatient Clinic (42 patients). The patients were screened for aqueous tear-deficient dry eye by abnormal test results of Schirmer test I (<10 mm) and tear-film break-up time (<10 seconds) in at least one eye. The diagnosis of SS was made according to the 2012 American College of Rheumatology criteria. A complete work up for SS was performed, including clinical examination, serological tests, ocular tests, and labial salivary-gland biopsy (LSGB). RESULTS Of the 111 patients, 58 had aqueous-deficient dry eye: 23 in the ophthalmology clinic cohort (group I) and 35 in the rheumatology clinic cohort (group II). Three patients had pSS, and its frequency was 13% in group I and 5.2% among all studied patients. The ocular staining score is the most diagnostic ocular test (sensitivity 100% and specificity 90.9%). Anti-SSA/Ro antibody is the most accurate serological method (sensitivity 33.3% and specificity 100%). LSGB histopathology is the most diagnostic method for SS, with sensitivity, specificity, and positive and negative predictive values of 100%. CONCLUSION SS was detected with reasonable frequency among dry-eye patients, particularly pSS. Screening of dry eye for SS can select SS patients early in the disease course.
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Affiliation(s)
- Nashwa M Abd-Allah
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Amal Aly Hassan
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Gihan Omar
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Mona Hamdy
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Minia University, Minia, Egypt
| | | | | | - Rabab A Moussa
- Pathology Department, Faculty of Medicine, Minia University, Minia, Egypt
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