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Lee AYS, Rischmueller M. The diagnosis and misdiagnosis of Sjögren disease. Intern Med J 2024; 54:833-835. [PMID: 38757225 DOI: 10.1111/imj.16395] [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: 02/21/2024] [Accepted: 03/19/2024] [Indexed: 05/18/2024]
Abstract
Although one of the most common systemic autoimmune disorders, Sjögren disease (SjD) may be overlooked in patients presenting with non-specific symptoms or no complaints of sicca symptoms. SjD is not a condition to be missed as patients could present with serious extra-glandular manifestations, including lymphomas. In this article, we discuss the diagnostic pitfalls of this disorder and encourage physicians to consider carefully the 'non-textbook' presentations.
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Affiliation(s)
- Adrian Y S Lee
- Centre for Immunology & Allergy Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia
- Department of Clinical Immunology & Allergy, Westmead Hospital, Sydney, New South Wales, Australia
- Department of Immunopathology, Institute of Clinical Pathology and Medical Research, NSW Health Pathology, Sydney, New South Wales, Australia
| | - Maureen Rischmueller
- Department of Rheumatology, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
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2
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Beydon M, McCoy S, Nguyen Y, Sumida T, Mariette X, Seror R. Epidemiology of Sjögren syndrome. Nat Rev Rheumatol 2024; 20:158-169. [PMID: 38110617 DOI: 10.1038/s41584-023-01057-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2023] [Indexed: 12/20/2023]
Abstract
Sjögren syndrome is a phenotypically varied autoimmune disorder that can occur alone in primary Sjögren syndrome or in association with other connective tissue diseases (CTDs), including rheumatoid arthritis, systemic lupus erythematosus (SLE) and systemic sclerosis (SSc). The estimation of the prevalence and incidence of Sjögren syndrome varies depending on diagnostic criteria and study design, making it difficult to estimate geographical and temporal trends. Nonetheless, disease phenotype is influenced by geographical origin, which is a risk factor for systemic activity. Whether mortality in primary Sjögren syndrome is increased compared with that of the general population is not yet known, but extra-glandular manifestations, in particular lymphomas, are clear risk factors for mortality. In CTDs associated with Sjögren syndrome, lymphoma risk seems higher than that of patients with CTD alone, and there is potentially lower disease activity in SLE with Sjögren syndrome and in SSc with Sjögren syndrome than in SLE or SSc alone.
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Affiliation(s)
- Maxime Beydon
- Department of Rheumatology, Bicêtre AP-HP Hôpital, Université Paris-Saclay, Paris, France
| | - Sara McCoy
- Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Yann Nguyen
- Department of Rheumatology, Bicêtre AP-HP Hôpital, Université Paris-Saclay, Paris, France
- Center for Immunology of Viral Infections and Auto-Immune Diseases, INSERM U1184, Université Paris Saclay, Le Kremlin-Bicêtre, France
| | - Takayuki Sumida
- Department of Internal Medicine, University of Tsukuba, Tsukuba, Japan
| | - Xavier Mariette
- Department of Rheumatology, Bicêtre AP-HP Hôpital, Université Paris-Saclay, Paris, France
- Center for Immunology of Viral Infections and Auto-Immune Diseases, INSERM U1184, Université Paris Saclay, Le Kremlin-Bicêtre, France
| | - Raphaèle Seror
- Department of Rheumatology, Bicêtre AP-HP Hôpital, Université Paris-Saclay, Paris, France.
- Center for Immunology of Viral Infections and Auto-Immune Diseases, INSERM U1184, Université Paris Saclay, Le Kremlin-Bicêtre, France.
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3
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Wu L, Wang Q, Gao QC, Shi GX, Li J, Fan FR, Wu J, He PF, Yu Q. Potential mechanisms and drug prediction of Rheumatoid Arthritis and primary Sjögren's Syndrome: A public databases-based study. PLoS One 2024; 19:e0298447. [PMID: 38359008 PMCID: PMC10868835 DOI: 10.1371/journal.pone.0298447] [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: 08/01/2023] [Accepted: 01/23/2024] [Indexed: 02/17/2024] Open
Abstract
Rheumatoid arthritis (RA) and primary Sjögren's syndrome (pSS) are the most common systemic autoimmune diseases, and they are increasingly being recognized as occurring in the same patient population. These two diseases share several clinical features and laboratory parameters, but the exact mechanism of their co-pathogenesis remains unclear. The intention of this study was to investigate the common molecular mechanisms involved in RA and pSS using integrated bioinformatic analysis. RNA-seq data for RA and pSS were picked up from the Gene Expression Omnibus (GEO) database. Co-expression genes linked with RA and pSS were recognized using weighted gene co-expression network analysis (WGCNA) and differentially expressed gene (DEG) analysis. Then, we screened two public disease-gene interaction databases (GeneCards and Comparative Toxicogenomics Database) for common targets associated with RA and pSS. The DGIdb database was used to predict therapeutic drugs for RA and pSS. The Human microRNA Disease Database (HMDD) was used to screen out the common microRNAs associated with RA and pSS. Finally, a common miRNA-gene network was created using Cytoscape. Four hub genes (CXCL10, GZMA, ITGA4, and PSMB9) were obtained from the intersection of common genes from WGCNA, differential gene analysis and public databases. Twenty-four drugs corresponding to hub gene targets were predicted in the DGIdb database. Among the 24 drugs, five drugs had already been reported for the treatment of RA and pSS. Other drugs, such as bortezomib, carfilzomib, oprozomib, cyclosporine and zidovudine, may be ideal drugs for the future treatment of RA patients with pSS. According to the miRNA-gene network, hsa-mir-21 may play a significant role in the mechanisms shared by RA and pSS. In conclusion, we identified commom targets as potential biomarkers in RA and pSS from publicly available databases and predicted potential drugs based on the targets. A new understanding of the molecular mechanisms associated with RA and pSS is provided according to the miRNA-gene network.
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Affiliation(s)
- Li Wu
- School of Basic Medical Sciences, Shanxi Medical University, Taiyuan, China
- Department of Anesthesiology, Shanxi Provincial People’s Hospital (Fifth Hospital) of Shanxi Medical University, Taiyuan, China
| | - Qi Wang
- School of Basic Medical Sciences, Shanxi Medical University, Taiyuan, China
- Shanxi Key Laboratory of Big Data for Clinical Decision Research, Taiyuan, China
- School of Management, Shanxi Medical University, Taiyuan, China
| | - Qi-chao Gao
- School of Basic Medical Sciences, Shanxi Medical University, Taiyuan, China
| | - Gao-xiang Shi
- School of Basic Medical Sciences, Shanxi Medical University, Taiyuan, China
- Department of Anaesthesia, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Jing Li
- Department of Anesthesiology, Shanxi Provincial People’s Hospital (Fifth Hospital) of Shanxi Medical University, Taiyuan, China
| | - Fu-rong Fan
- Academy of Medical Sciences, Shanxi Medical University, Taiyuan, China
| | - Jing Wu
- Academy of Medical Sciences, Shanxi Medical University, Taiyuan, China
| | - Pei-Feng He
- Shanxi Key Laboratory of Big Data for Clinical Decision Research, Taiyuan, China
- School of Management, Shanxi Medical University, Taiyuan, China
| | - Qi Yu
- Shanxi Key Laboratory of Big Data for Clinical Decision Research, Taiyuan, China
- School of Management, Shanxi Medical University, Taiyuan, China
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Xu S, Zhu C, Jiang J, Cheng H, Wang P, Hong J, Yang S, Li Z, Wang X. Non-invasive diagnosis of primary Sjögren's syndrome using ultrasonography and transcriptome biomarkers. Clin Immunol 2023; 255:109739. [PMID: 37586671 DOI: 10.1016/j.clim.2023.109739] [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: 05/06/2023] [Revised: 08/03/2023] [Accepted: 08/11/2023] [Indexed: 08/18/2023]
Abstract
Diagnosing primary Sjögren's syndrome (pSS) is difficult due to clinical heterogeneity and the absence of non-invasive specific biomarkers. To develop non-invasive pSS diagnosis methods that integrate classic clinical indexes, major salivary gland ultrasonography (SGUS), and gene expression profiles shared by labial gland and peripheral blood, we conducted a study on a cohort of 358 subjects. We identified differentially expressed genes (DEGs) in glands and blood that were enriched in defense response to virus and type I interferon production pathways. Four upregulated DEGs common in glands and blood were identified as hub genes based on the protein-protein interaction networks. A random forest model was trained using features, including SGUS, anti-SSA/Ro60, keratoconjunctivitis sicca tests, and gene expression levels of MX1 and RSAD2. The model achieved comparable pSS diagnosis accuracy to the golden standard method based on labial gland biopsy. Our findings implicate this novel model as a promising diagnosis technique of pSS.
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Affiliation(s)
- Shihao Xu
- Department of Ultrasonography, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China.
| | - Chengwei Zhu
- Department of Ultrasonography, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Jiachun Jiang
- Department of Ultrasonography, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Hui Cheng
- Department of Rheumatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Ping Wang
- Department of Rheumatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Jingwei Hong
- Department of Rheumatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Shiping Yang
- Department of Ultrasonography, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Zhongshan Li
- Institute of Genomic Medicine, Wenzhou Medical University, Wenzhou 325000, China.
| | - Xiaobing Wang
- Department of Rheumatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China; Department of Rheumatology and Immunology, Shanghai Changzheng Hospital, Second Affiliated Hospital of Naval Medical University, Shanghai 200001, China.
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Chau K, Raksadawan Y, Allison K, Ice JA, Scofield RH, Chepelev I, Harley ITW. Pervasive Sharing of Causal Genetic Risk Factors Contributes to Clinical and Molecular Overlap between Sjögren's Disease and Systemic Lupus Erythematosus. Int J Mol Sci 2023; 24:14449. [PMID: 37833897 PMCID: PMC10572278 DOI: 10.3390/ijms241914449] [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: 07/07/2023] [Revised: 09/01/2023] [Accepted: 09/05/2023] [Indexed: 10/15/2023] Open
Abstract
SjD (Sjögren's Disease) and SLE (Systemic Lupus Erythematosus) are similar diseases. There is extensive overlap between the two in terms of both clinical features and pathobiologic mechanisms. Shared genetic risk is a potential explanation of this overlap. In this study, we evaluated whether these diseases share causal genetic risk factors. We compared the causal genetic risk for SLE and SjD using three complementary approaches. First, we examined the published GWAS results for these two diseases by analyzing the predicted causal gene protein-protein interaction networks of both diseases. Since this method does not account for overlapping risk intervals, we examined whether such intervals also overlap. Third, we used two-sample Mendelian randomization (two sample MR) using GWAS summary statistics to determine whether risk variants for SLE are causal for SjD and vice versa. We found that both the putative causal genes and the genomic risk intervals for SLE and SjD overlap 28- and 130-times more than expected by chance (p < 1.1 × 10-24 and p < 1.1 × 10-41, respectively). Further, two sample MR analysis confirmed that alone or in aggregate, SLE is likely causal for SjD and vice versa. [SjD variants predicting SLE: OR = 2.56; 95% CI (1.98-3.30); p < 1.4 × 10-13, inverse-variance weighted; SLE variants predicting SjD: OR = 1.36; 95% CI (1.26-1.47); p < 1.6 × 10-11, inverse-variance weighted]. Notably, some variants have disparate impact in terms of effect size across disease states. Overlapping causal genetic risk factors were found for both diseases using complementary approaches. These observations support the hypothesis that shared genetic factors drive the clinical and pathobiologic overlap between these diseases. Our study has implications for both differential diagnosis and future genetic studies of these two conditions.
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Affiliation(s)
- Karen Chau
- Division of Rheumatology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Yanint Raksadawan
- Internal Medicine Residency Program, Louis A. Weiss Memorial Hospital, Chicago, IL 60640, USA
| | - Kristen Allison
- Division of Rheumatology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - John A. Ice
- Research Service, Oklahoma City US Department of Veterans Affairs Medical Center, Oklahoma City, OK 73104, USA
| | - Robert Hal Scofield
- Research Service, Oklahoma City US Department of Veterans Affairs Medical Center, Oklahoma City, OK 73104, USA
- Medicine Service, Oklahoma City US Department of Veterans Affairs Medical Center, Oklahoma City, OK 73104, USA
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
- Arthritis & Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK 73104, USA
| | - Iouri Chepelev
- Research Service, Cincinnati US Department of Veterans Affairs Medical Center, Cincinnati, OH 45220, USA
| | - Isaac T. W. Harley
- Division of Rheumatology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA
- Rheumatology Section, Medicine Service, Eastern Colorado Healthcare System, US Department of Veterans Affairs Medical Center, Aurora, CO 80045, USA
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Fox RI, Fox CM, McCoy SS. Emerging treatment for Sjögren's disease: a review of recent phase II and III trials. Expert Opin Emerg Drugs 2023:1-14. [PMID: 37127914 DOI: 10.1080/14728214.2023.2209720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
INTRODUCTION Sjögren's Disease, SjD, is a systemic autoimmune disorder characterized by reduced function of the salivary and lacrimal glands. Patients suffer from dryness, fatigue, and pain and may present with or without extra-glandular organ involvement. Symptoms limit SjD patients' quality of life and are the most difficult to improve with therapy. SjD patients are heterogeneous and clustering them into biologically similar subgroups might improve the efficacy of therapies. The need for therapies that address both the symptoms and extra glandular organ involvement of SjD presents an unmet opportunity that has recently attracted a growing interest in the pharmaceutical industry. AREAS COVERED The goal of this report is to review recent phase II/III studies in SjD. To accomplish our goal, we performed a literature search for phase II/III studies and abstracts recently presented at conferences. EXPERT OPINION This review allows updates the reader on the multitude of recent phase II/III clinical trials. We speculate on how subtypes of SjD will drive future therapeutic targeting and inform pathogenesis.
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Affiliation(s)
- Robert I Fox
- Scripps Memorial Hospital and Research Foundation, San Diego, CA, United States
| | - Carla M Fox
- Scripps Memorial Hospital and Research Foundation, San Diego, CA, United States
| | - Sara S McCoy
- University of Wisconsin-Madison Ringgold standard institution, Madison, United States
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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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Differential diagnosis of systemic lupus erythematosus and Sjögren's syndrome using machine learning and multi-omics data. Comput Biol Med 2023; 152:106373. [PMID: 36462367 DOI: 10.1016/j.compbiomed.2022.106373] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 10/20/2022] [Accepted: 11/27/2022] [Indexed: 11/30/2022]
Abstract
Systemic lupus erythematosus and primary Sjogren's syndrome are complex systemic autoimmune diseases that are often misdiagnosed. In this article, we demonstrate the potential of machine learning to perform differential diagnosis of these similar pathologies using gene expression and methylation data from 651 individuals. Furthermore, we analyzed the impact of the heterogeneity of these diseases on the performance of the predictive models, discovering that patients assigned to a specific molecular cluster are misclassified more often and affect to the overall performance of the predictive models. In addition, we found that the samples characterized by a high interferon activity are the ones predicted with more accuracy, followed by the samples with high inflammatory activity. Finally, we identified a group of biomarkers that improve the predictions compared to using the whole data and we validated them with external studies from other tissues and technological platforms.
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Punnanitinont A, Kasperek EM, Kiripolsky J, Zhu C, Miecznikowski JC, Kramer JM. TLR7 agonism accelerates disease in a mouse model of primary Sjögren's syndrome and drives expansion of T-bet + B cells. Front Immunol 2022; 13:1034336. [PMID: 36591307 PMCID: PMC9799719 DOI: 10.3389/fimmu.2022.1034336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
Primary Sjögren's syndrome (pSS) is a systemic autoimmune disease characterized by chronic inflammation of exocrine tissue, resulting in loss of tears and saliva. Patients also experience many extra-glandular disease manifestations. Treatment for pSS is palliative, and there are currently no treatments available that target disease etiology. Previous studies in our lab demonstrated that MyD88 is crucial for pSS pathogenesis in the NOD.B10Sn-H2b (NOD.B10) pSS mouse model, although the way in which MyD88-dependent pathways become activated in disease remains unknown. Based on its importance in other autoimmune diseases, we hypothesized that TLR7 activation accelerates pSS pathogenesis. We administered the TLR7 agonist Imiquimod (Imq) or sham treatment to pre-disease NOD.B10 females for 6 weeks. Parallel experiments were performed in age and sex-matched C57BL/10 controls. Imq-treated pSS animals exhibited cervical lymphadenopathy, splenomegaly, and expansion of TLR7-expressing B cells. Robust lymphocytic infiltration of exocrine tissues, kidney and lung was observed in pSS mice following treatment with Imq. TLR7 agonism also induced salivary hypofunction in pSS mice, which is a hallmark of disease. Anti-nuclear autoantibodies, including Ro (SSA) and La (SSB) were increased in pSS mice following Imq administration. Cervical lymph nodes from Imq-treated NOD.B10 animals demonstrated an increase in the percentage of activated/memory CD4+ T cells. Finally, T-bet+ B cells were expanded in the spleens of Imq-treated pSS mice. Thus, activation of TLR7 accelerates local and systemic disease and promotes expansion of T-bet-expressing B cells in pSS.
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Affiliation(s)
- Achamaporn Punnanitinont
- Department of Oral Biology, School of Dental Medicine, The University at Buffalo, State University of New York, Buffalo, NY, United States
| | - Eileen M. Kasperek
- Department of Oral Biology, School of Dental Medicine, The University at Buffalo, State University of New York, Buffalo, NY, United States
| | - Jeremy Kiripolsky
- Department of Oral Biology, School of Dental Medicine, The University at Buffalo, State University of New York, Buffalo, NY, United States
| | - Chengsong Zhu
- Department of Immunology, Microarray & Immune Phenotyping Core Facility, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Jeffrey C. Miecznikowski
- Department of Biostatistics, School of Public Health and Health Professions, The University at Buffalo, State University of New York, Buffalo, NY, United States
| | - Jill M. Kramer
- Department of Oral Biology, School of Dental Medicine, The University at Buffalo, State University of New York, Buffalo, NY, United States,*Correspondence: Jill M. Kramer,
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Tear Proteomics Approach to Distinguishing Primary from Secondary Sjögren's Syndrome for Dry Eye Patients with Long-Term Instillation of Eyedrops. Int J Mol Sci 2022; 23:ijms232315239. [PMID: 36499565 PMCID: PMC9737549 DOI: 10.3390/ijms232315239] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/28/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
The diagnosis and monitoring of Sjögren syndrome (SS) is often difficult, requiring a multidisciplinary approach with invasive procedures. Our aim is to elucidate the tear protein alterations of dry eye disease (DED) with primary SS (pSS) and secondary SS (sSS) with the long-term instillation of eyedrops. We collected clinical demographics and tear fluid (TF) samples from DED patients with no autoimmune diseases (non-SS-DED), pSS-DED, and sSS-DED patients, followed by TF screening with tandem mass tagging-labeling gel-free proteomics assay. Bioinformatic analysis via Ingenuity Pathway Analysis was used to identify functional pathways and interacting networks. Validation of candidate proteins with enzyme-linked immunosorbent assay on the tear samples was done. The top functional pathways of the two comparisons (sSS-DED vs. pSS-DED and sSS-DED vs. non-SS-DED) were both associated with inflammation and stress-related signaling. After constructing an interaction network model with the selected candidate proteins, five proteins were identified. A Disintegrin and Metalloproteinase domain-containing protein 10 (ADAM10) was found to be an important candidate biomarker in all groups, followed by epidermal growth factor (EGF) in TF. This study revealed novel DED markers, ADAM10 and EGF, in differentiating between primary and secondary SS patients from tears by in-depth proteomic analysis.
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11
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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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Hsu B, Chen Y, Lin C, Tang K. The association between hydroxychloroquine use and future development of systemic lupus erythematosus in patients with primary Sjögren's syndrome. Int J Rheum Dis 2022; 25:1424-1430. [DOI: 10.1111/1756-185x.14437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/26/2022] [Accepted: 08/31/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Bo‐Chueh Hsu
- Division of Allergy, Immunology and Rheumatology Taichung Veterans General Hospital Puli Branch Nantou Taiwan
| | - Yi‐Hsing Chen
- Division of Allergy, Immunology and Rheumatology Taichung Veterans General Hospital Taichung Taiwan
- School of Medicine National Yang Ming Chiao Tung University Taipei Taiwan
- College of Medicine National Chung Hsing University Taichung Taiwan
| | - Ching‐Heng Lin
- Department of Medical Research Taichung Veterans General Hospital Taichung Taiwan
| | - Kuo‐Tung Tang
- Division of Allergy, Immunology and Rheumatology Taichung Veterans General Hospital Taichung Taiwan
- School of Medicine National Yang Ming Chiao Tung University Taipei Taiwan
- Ph.D. Program in Translational Medicine National Chung Hsing University Taichung Taiwan
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13
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Yu K, Ying GS, Vivino FB, Gonzales JA, Massaro-Giordano M, Bunya VY. Preliminary Screening Questionnaire for Sjögren's Syndrome in the Rheumatology Setting. J Clin Rheumatol 2022; 28:e456-e461. [PMID: 34262002 PMCID: PMC9110110 DOI: 10.1097/rhu.0000000000001760] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Sjögren's syndrome (SS) is frequently undetected or misdiagnosed as other rheumatologic diseases. We aimed to develop an SS screening questionnaire for the rheumatology practice. METHODS We developed the Sjögren's Syndrome Screening Questionnaire (SSSQ) via secondary analysis of data from 974 participants referred by rheumatologists to the Sjögren's International Collaborative Clinical Alliance (SICCA) study. Participants answered 88 questions regarding symptoms, medical history, and demographics. They underwent ocular, dental, and serologic tests and were classified as SS or non-SS using the 2016 American College of Rheumatology/European League Against Rheumatism classification criteria. We conducted univariate and multivariate logistic regression to identify questions most discriminative of SS, from which we derived an individual's likelihood of SS ("SSSQ score"). RESULTS Five questions were significantly discriminative of SS in the multivariate analysis (p < 0.05): (1) Can you eat a cracker without drinking a fluid/liquid? (no: odds ratio [OR], 1.39; 95% confidence interval [CI], 1.06-1.82]); (2) How would you describe your dental and oral health in general? (fair/poor: OR, 1.68; 95% CI, 1.04-2.75); (3) During the last week, have you experienced tearing? (none of the time: OR, 2.26; 95% CI, 1.23-4.34); (4) Are you able to produce tears? (no: OR, 1.62; 95% CI, 1.12-2.37); and (5) Do you currently smoke cigarettes? (no: OR, 2.83; 95% CI, 1.69-4.91). SSSQ score ≥7 (possible range, 0-11) distinguishes SS from non-SS patients with 64% sensitivity and 58% specificity (area under receiver operating characteristic curve, 0.65). CONCLUSIONS The SSSQ is a simple 5-item questionnaire designed to screen for SS in clinical practice, with a potential impact to reduce delays in diagnosis.
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Affiliation(s)
- Kimberley Yu
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gui-Shuang Ying
- Department of Ophthalmology, Scheie Eye Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Frederick B. Vivino
- Department of Rheumatology, Penn Presbyterian Medical Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - John A. Gonzales
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA
| | - Mina Massaro-Giordano
- Department of Ophthalmology, Scheie Eye Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Vatinee Y. Bunya
- Department of Ophthalmology, Scheie Eye Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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14
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Sandhya P, Kabeerdoss J, Christudoss P, Arulraj R, Mandal SK, Janardana R, Chebbi PP, Ganesan MP, Mahasampath G, Danda D. Salivary free light chains and salivary immunoglobulins as potential non-invasive biomarkers in primary Sjögren's syndrome. Int J Rheum Dis 2021; 25:61-69. [PMID: 34791797 DOI: 10.1111/1756-185x.14242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/29/2021] [Accepted: 10/25/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND B cells contribute significantly to the pathogenesis of primary Sjögren's syndrome (pSS). Free light chains (FLCs) are generated during the production of immunoglobulins (Igs) and are surrogates of B cell activity. We hypothesized that salivary FLCs and salivary Igs could represent salivary gland inflammation and therefore, serve as biomarkers in pSS. METHODS Patients >18 years old fulfilling the American College of Rheumatology / European League Against Rheumatism (EULAR) 2016 criteria for pSS and age-matched healthy and disease controls (sicca non-pSS, rheumatoid arthritis, systemic lupus erythematosus) were recruited for this cross-sectional study. FLCs in saliva and serum were measured by immunoturbidimetry. Serum and salivary Igs were measured by nephelometry and enzyme-linked immunosorbent assay, respectively. Area under the receiver operator characteristic curve was determined. The factors influencing the serum and salivary FLCs in pSS were determined using backward linear regression. RESULTS A total of 78 patients with pSS, 76 healthy controls and 62 disease controls were recruited. Median EULAR SS disease activity index (interquartile range) was 1 (3.75). Serum FLCκ and FLCλ, salivary FLCλ, serum and salivary IgG, salivary IgM was significantly higher in the pSS group compared to the controls. Areas under the curve for salivary FLCλ, serum FLCκ, serum and salivary IgG were 0.75, 0.72, 0.78 and 0.77, respectively. Regression analysis showed that salivary FLCκ, salivary FLCλ and salivary IgG were associated with positive salivary gland histopathology. Use of immunosuppressants and glucocorticoids was associated with lower values of salivary parameters. CONCLUSION Salivary FLCλ and salivary IgG were significantly different between pSS and control groups and could be potential non-invasive biomarkers in pSS. These findings should be confirmed in larger longitudinal studies.
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Affiliation(s)
- Pulukool Sandhya
- Department of Clinical Immunology & Rheumatology, Christian Medical College and Hospital Vellore, Vellore, India
| | - Jayakanthan Kabeerdoss
- Department of Clinical Immunology & Rheumatology, Christian Medical College and Hospital Vellore, Vellore, India
| | - Pamela Christudoss
- Department of Clinical Biochemistry, Christian Medical College and Hospital Vellore, Vellore, India
| | - Roy Arulraj
- Department of Clinical Immunology & Rheumatology, Christian Medical College and Hospital Vellore, Vellore, India
| | - Santosh Kumar Mandal
- Department of Clinical Immunology & Rheumatology, Christian Medical College and Hospital Vellore, Vellore, India
| | - Ramya Janardana
- Department of Clinical Immunology & Rheumatology, Christian Medical College and Hospital Vellore, Vellore, India
| | - Pramod Prahlad Chebbi
- Department of Clinical Immunology & Rheumatology, Christian Medical College and Hospital Vellore, Vellore, India
| | | | - Gowri Mahasampath
- Department of Biostatistics, Christian Medical College and Hospital Vellore, Vellore, India
| | - Debashish Danda
- Department of Clinical Immunology & Rheumatology, Christian Medical College and Hospital Vellore, Vellore, India
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15
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Lee YJ. Is the anti-centromere antibody a marker for a distinct subset of polyautoimmunity in Sjögren's syndrome? Korean J Intern Med 2021; 36:1323-1326. [PMID: 34742176 PMCID: PMC8588969 DOI: 10.3904/kjim.2021.467] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 10/18/2021] [Indexed: 11/27/2022] Open
Affiliation(s)
- Yun Jong Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
- Correspondence to Yun Jong Lee, M.D. Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 13620, Korea Tel: +82-31-787-7049 Fax: +82-31-787-4050 E-mail:
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16
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Radu AF, Bungau SG. Management of Rheumatoid Arthritis: An Overview. Cells 2021; 10:2857. [PMID: 34831081 PMCID: PMC8616326 DOI: 10.3390/cells10112857] [Citation(s) in RCA: 238] [Impact Index Per Article: 79.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 10/16/2021] [Accepted: 10/22/2021] [Indexed: 02/06/2023] Open
Abstract
Rheumatoid arthritis (RA) is a multifactorial autoimmune disease of unknown etiology, primarily affecting the joints, then extra-articular manifestations can occur. Due to its complexity, which is based on an incompletely elucidated pathophysiological mechanism, good RA management requires a multidisciplinary approach. The clinical status of RA patients has improved in recent years due to medical advances in diagnosis and treatment, that have made it possible to reduce disease activity and prevent systemic complications. The most promising results were obtained by developing disease-modifying anti-rheumatic drugs (DMARDs), the class to which conventional synthetic, biologic, and targeted synthetic drugs belong. Furthermore, ongoing drug development has led to obtaining molecules with improved efficacy and safety profiles, but further research is needed until RA turns into a curable pathology. In the present work, we offer a comprehensive perspective on the management of RA, by centralizing the existing data provided by significant literature, emphasizing the importance of an early and accurate diagnosis associated with optimal personalized treatment in order to achieve better outcomes for RA patients. In addition, this study suggests future research perspectives in the treatment of RA that could lead to higher efficacy and safety profiles and lower financial costs.
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Affiliation(s)
- Andrei-Flavius Radu
- Doctoral School of Biological and Biomedical Sciences, University of Oradea, 410087 Oradea, Romania
| | - Simona Gabriela Bungau
- Doctoral School of Biological and Biomedical Sciences, University of Oradea, 410087 Oradea, Romania
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania
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17
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Quartuccio L, De Marchi G, Longhino S, Manfrè V, Rizzo MT, Gandolfo S, Tommasini A, De Vita S, Fox R. Shared Pathogenetic Features Between Common Variable Immunodeficiency and Sjögren's Syndrome: Clues for a Personalized Medicine. Front Immunol 2021; 12:703780. [PMID: 34322134 PMCID: PMC8311857 DOI: 10.3389/fimmu.2021.703780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 06/22/2021] [Indexed: 11/17/2022] Open
Abstract
Common variable immunodeficiency disorders (CVID) are a group of rare diseases of the immune system and the most common symptomatic primary antibody deficiency in adults. The “variable” aspect of CVID refers to the approximately half of the patients who develop non-infective complications, mainly autoimmune features, in particular organ specific autoimmune diseases including thyroiditis, and cytopenias. Among these associated conditions, the incidence of lymphoma, including mucosal associated lymphoid tissue (MALT) type, is increased. Although these associated autoimmune disorders in CVID are generally attributed to Systemic Lupus Erythematosus (SLE), we propose that Sjogren’s syndrome (SS) is perhaps a better candidate for the associated disease. SS is an autoimmune disorder characterized by the lymphocytic infiltrates of lacrimal and salivary glands, leading to dryness of the eyes and mouth. Thus, it is a lymphocyte aggressive disorder, in contrast to SLE where pathology is generally attributed to auto-antibody and complement activation. Although systemic lupus erythematosus (SLE) shares these features with SS, a much higher frequency of MALT lymphoma distinguishes SS from SLE. Also, the higher frequency of germ line encoded paraproteins such as the monoclonal rheumatoid factor found in SS patients would be more consistent with the failure of B-cell VDJ switching found in CVID; and in contrast to the hypermutation that characterizes SLE autoantibodies. Thus, we suggest that SS may fit as a better “autoimmune” association with CVID. Examining the common underlying biologic mechanisms that promote lymphoid infiltration by dysregulated lymphocytes and lymphoma in CVID may provide new avenues for treatment in both the diseases. Since the diagnosis of SLE or rheumatoid arthritis is usually based on specific autoantibodies, the associated autoimmune features of CVID patients may not be recognized in the absence of autoantibodies.
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Affiliation(s)
- Luca Quartuccio
- Rheumatology Clinic, ASU FC, Udine, Italy.,Department of Medicine, University of Udine, Udine, Italy
| | | | - Simone Longhino
- Rheumatology Clinic, ASU FC, Udine, Italy.,Department of Medicine, University of Udine, Udine, Italy
| | - Valeria Manfrè
- Rheumatology Clinic, ASU FC, Udine, Italy.,Department of Medicine, University of Udine, Udine, Italy
| | - Maria Teresa Rizzo
- Rheumatology Clinic, ASU FC, Udine, Italy.,Department of Medicine, University of Udine, Udine, Italy
| | | | - Alberto Tommasini
- Pediatric Immunology, IRCCS Burlo Garofolo, Trieste, Italy.,Department of Medical Sciences, University of Trieste, Trieste, Italy
| | - Salvatore De Vita
- Rheumatology Clinic, ASU FC, Udine, Italy.,Department of Medicine, University of Udine, Udine, Italy
| | - Robert Fox
- Rheumatology Clinic, Scripps Memorial Hospital and Research Foundation, La Jolla, CA, United States
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18
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Viegas-Costa LC, Friesen R, Flores-Mir C, McGaw T. Diagnostic performance of serology against histologic assessment to diagnose Sjogren's syndrome: a systematic review. Clin Rheumatol 2021; 40:4817-4828. [PMID: 34142295 DOI: 10.1007/s10067-021-05813-5] [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: 02/18/2021] [Revised: 05/20/2021] [Accepted: 06/06/2021] [Indexed: 10/21/2022]
Abstract
The objective of this review was to assess and evaluate whether the published diagnostic accuracy studies provide evidence to sustain the current diagnostic guidelines put forth by ACR/EULAR used for patients with suspected Sjögren's syndrome (SS). Literature databases, including Medline, Embase, and EBM Reviews, were searched for relevant studies on the correlation between ACR/EULAR criteria, particularly those with a direct comparison between their accuracy in diagnosing Sjögren's syndrome. We followed Cochrane, QUADAS-2, and STARD guidelines and the four-phase flow diagram by the PRISMA Statement. Reports in several languages, but only human studies were considered. Three studies assessed the accuracy of the current diagnostic tests, and these did not present adequate designs that would allow a well-supported conclusion with a high level of certainty. Due to significant clinical and methodological heterogeneity, a meta-analysis was not performed. A qualitative review of the papers was undertaken. Neither the comparative nor the non-comparative study designs permit conclusive recommendations regarding an alternative diagnostic pathway for SS. Well-designed studies of the diagnostic accuracy of SS tests are needed to validate current guidelines or to suggest changes to the current guidelines.
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Affiliation(s)
- Luiz Claudio Viegas-Costa
- Department of Dentistry - Division of Oral Medicine, Oral Pathology and Radiology & Division of Orthodontics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Reid Friesen
- Department of Dentistry - Division of Oral Medicine, Oral Pathology and Radiology & Division of Orthodontics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Carlos Flores-Mir
- Department of Dentistry - Division of Oral Medicine, Oral Pathology and Radiology & Division of Orthodontics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Timothy McGaw
- Department of Dentistry - Division of Oral Medicine, Oral Pathology and Radiology & Division of Orthodontics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada. .,Edmonton Clinic Health Academy, Room 5-357, 11405 87 Avenue NW, Edmonton, AB, Canada.
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19
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Ohlsson M, Hellmark T, Bengtsson AA, Theander E, Turesson C, Klint C, Wingren C, Ekstrand AI. Proteomic Data Analysis for Differential Profiling of the Autoimmune Diseases SLE, RA, SS, and ANCA-Associated Vasculitis. J Proteome Res 2020; 20:1252-1260. [PMID: 33356304 PMCID: PMC7872503 DOI: 10.1021/acs.jproteome.0c00657] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
![]()
Early
and correct diagnosis of inflammatory rheumatic diseases
(IRD) poses a clinical challenge due to the multifaceted nature of
symptoms, which also may change over time. The aim of this study was
to perform protein expression profiling of four systemic IRDs, systemic
lupus erythematosus (SLE), ANCA-associated systemic vasculitis (SV),
rheumatoid arthritis (RA), and Sjögren’s syndrome (SS),
and healthy controls to identify candidate biomarker signatures for
differential classification. A total of 316 serum samples collected
from patients with SLE, RA, SS, or SV and from healthy controls were
analyzed using 394-plex recombinant antibody microarrays. Differential
protein expression profiling was examined using Wilcoxon signed rank
test, and condensed biomarker panels were identified using advanced
bioinformatics and state-of-the art classification algorithms to pinpoint
signatures reflecting each disease (raw data set available at https://figshare.com/s/3bd3848a28ef6e7ae9a9.). In this study, we were able to classify the included individual
IRDs with high accuracy, as demonstrated by the ROC area under the
curve (ROC AUC) values ranging between 0.96 and 0.80. In addition,
the groups of IRDs could be separated from healthy controls at an
ROC AUC value of 0.94. Disease-specific candidate biomarker signatures
and general autoimmune signature were identified, including several
deregulated analytes. This study supports the rationale of using multiplexed
affinity-based technologies to reflect the biological complexity of
autoimmune diseases. A multiplexed approach for decoding multifactorial
complex diseases, such as autoimmune diseases, will play a significant
role for future diagnostic purposes, essential to prevent severe organ-
and tissue-related damage.
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Affiliation(s)
- Mattias Ohlsson
- Computational Biology & Biological Physics, Department of Astronomy and Theoretical Physics, Lund University, Sölvegatan 14A, Lund SE-221 00, Sweden.,Center for Applied Intelligent Systems Research (CAISR), Halmstad University, Halmstad SE-301 18, Sweden
| | - Thomas Hellmark
- Department of Clinical Sciences Lund, Nephrology, Skåne University Hospital Lund, Lund University, Lund SE-221 85, Sweden
| | - Anders A Bengtsson
- Rheumatology, Department of Clinical Sciences, Lund, Lund University, Lund SE-221 00, Sweden.,Department of Rheumatology, Skåne University Hospital, Lund and Malmö SE-214 28, Sweden
| | - Elke Theander
- Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Malmö SE-221 00, Sweden
| | - Carl Turesson
- Department of Rheumatology, Skåne University Hospital, Lund and Malmö SE-214 28, Sweden.,Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Malmö SE-221 00, Sweden
| | | | - Christer Wingren
- Department of Immunotechnology, Lund University, Medicon Village, Scheelevägen 2, Lund SE-223 81, Sweden
| | - Anna Isinger Ekstrand
- Department of Immunotechnology, Lund University, Medicon Village, Scheelevägen 2, Lund SE-223 81, Sweden
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20
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Chen X, Jiang S, Zhou Z, Xu X, Ying S, Du L, Qiu K, Xu Y, Wu J, Wang X. Increased expression of interleukin-21-inducible genes in minor salivary glands are associated with primary Sjögren’s syndrome disease characteristics. Rheumatology (Oxford) 2020; 60:2979-2989. [DOI: 10.1093/rheumatology/keaa695] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 09/24/2020] [Indexed: 01/31/2023] Open
Abstract
Abstract
Objective
To determine the upregulation of IL-21-inducible genes in minor salivary glands (MSGs) in 28 primary SS (pSS) patients and 12 non-pSS subjects and correlate it with disease characteristics.
Methods
RNA sequencing was utilized to compare IL-21-inducible genes expression in the MSGs between pSS and non-pSS subjects. The subgroups were characterized according to the IL-21 score calculated by seven IL-21-inducible genes. Furthermore, the disease characteristics and transcripts implicated in hypoxia and interferon signalling were assessed in two pSS subgroups.
Results
We observed that the expression of the IL-21-inducible genes (IL-21, IL-21R, JAK3, STAT1, HLA-B, CCR7 and CXCL10), the so-called IL-21 signature genes, was significantly increased in pSS patients. The upregulation of JAK3 expression may be induced by hypomethylation of the JAK3 promoter in pSS patients and putatively associated with POU2F2. The patients with increased IL-21 signature gene expression showed an increased EULAR Sjögren’s Syndrome Disease Activity Index score and increased enrichment of B cells, memory B cells, CD4+ T cells and CD8+ T cells. Furthermore, the IL-21 scores in the anti-SSA+, SSB+, ANA+ and high IgG samples were higher than those in the respective antibody-negative samples and normal IgG. In addition, we found both hypoxia and IFN-relevant genes showed strong correlation with IL-21 signature gene expression, indicating their interaction in pSS.
Conclusion
IL-21 signature gene was associated with typical disease characteristics in pSS, which provides insight into the contribution of the IL-21 signalling pathway to the pathogenesis of the disease and might provide a novel treatment strategy for this subtype of pSS.
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Affiliation(s)
- Xiaomin Chen
- Institute of Genomic Medicine, Wenzhou Medical University, Wenzhou, China
| | - Shan Jiang
- Institute of Genomic Medicine, Wenzhou Medical University, Wenzhou, China
| | - Zihao Zhou
- Institute of Genomic Medicine, Wenzhou Medical University, Wenzhou, China
| | - Xin Xu
- Institute of Genomic Medicine, Wenzhou Medical University, Wenzhou, China
| | - Senhong Ying
- Institute of Genomic Medicine, Wenzhou Medical University, Wenzhou, China
| | - Lifeng Du
- Institute of Genomic Medicine, Wenzhou Medical University, Wenzhou, China
| | - Kairui Qiu
- Institute of Genomic Medicine, Wenzhou Medical University, Wenzhou, China
| | - Yesha Xu
- Institute of Genomic Medicine, Wenzhou Medical University, Wenzhou, China
| | - Jinyu Wu
- Institute of Genomic Medicine, Wenzhou Medical University, Wenzhou, China
| | - Xiaobing Wang
- Department of Rheumatology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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21
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Abstract
BACKGROUND AND OBJECTIVE Primary Sjögren syndrome (pSS) is a systemic autoimmune rheumatic disease that particularly affects exocrine glands. Dry eye is one of the most important features of this syndrome, and a recent study reported reduced deoxyribonuclease I (DNase I) activity in the tear of patients with dry eye. We therefore postulated that patients with pSS might have antibodies targeting DNAse I. METHODS We have evaluated in a cross-sectional study 85 patients with pSS (2002 American-European Consensus Group Criteria), 50 rheumatoid arthritis (RA) patients (1987 American College of Rheumatology Criteria) without sicca symptoms, and 88 healthy volunteers. IgG anti-DNase I was detected by enzyme-linked immunosorbent assay using as antigen bovine pancreas enzyme and confirmed by immunoblotting. RESULTS Age and sex were alike in the 3 groups (p > 0.05). Anti-DNase I was detected in 43.5% of the pSS patients. In contrast, this reactivity was absent in all RA patients (p = 0.0001). Additional comparison of pSS patients with (n = 37) or without (n = 48) anti-DNase I showed that the former group had higher IgG serum levels (2293.2 ± 666.2 vs 1483.9 ± 384.6 mg/dL, p = 0.0001) and greater rate of non-drug-induced leukopenia (43% vs 19%, p = 0.02). A multivariate logistic regression analysis identified that only IgG levels were independently associated with anti-DNase I. CONCLUSIONS We describe a high frequency of anti-DNase I antibodies in pSS patients associated with higher serum IgG levels. The lack of this reactivity in RA patients without sicca symptoms suggests that this antibody may be helpful in the differential diagnosis of these diseases.
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22
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McCoy SS, Sampene E, Baer AN. Association of Sjögren's Syndrome With Reduced Lifetime Sex Hormone Exposure: A Case-Control Study. Arthritis Care Res (Hoboken) 2020; 72:1315-1322. [PMID: 31233285 DOI: 10.1002/acr.24014] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 06/18/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To test whether cumulative estrogen exposure, as determined by age at menarche, age at menopause, female hormone use, hysterectomy, and parity, have an effect on the development of primary Sjögren's syndrome (SS). METHODS We performed a case-control study of 2,680 women from the Sjögren's International Collaborative Clinical Alliance registry, including 1,320 registrants with primary SS and 1,360 with sicca symptoms but no key features of primary SS (sicca controls). The composite estrogen score (CES) was calculated by point assignment for early menarche (age ≤10 years), high parity (>3 pregnancies), hysterectomy, female hormone use, and late menopause (age ≥53 years). Cumulative menstrual cycling (CMC) was calculated as years menstruating minus time pregnant. RESULTS Using a regression model that adjusted for age, recruitment site, ethnicity, education, employment status, and smoking, we observed a progressive inverse trend between primary SS and CES. The odds ratio (OR) and 95% confidence interval (95% CI) were as follows for the sicca control group: CES 1, OR 0.81 (95% CI 0.67-0.99); CES 2, OR 0.74 (95% CI 0.57-0.97); CES 3, OR 0.50 (95% CI 0.30-0.86). This trend was corroborated by analysis of CMC. At the highest level of CMC within the postmenopausal group there was a 24% reduction in cumulative sex hormone exposure among primary SS participants relative to controls. CONCLUSION Women with primary SS have lower estrogen exposure and CMC compared to sicca controls. Increasing estrogen exposure was negatively associated with development of primary SS. Further longitudinal studies of sex hormone exposure in primary SS are needed to confirm these findings.
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Affiliation(s)
- Sara S McCoy
- University of Wisconsin School of Medicine and Public Health, Madison
| | - Emmanuel Sampene
- University of Wisconsin School of Medicine and Public Health, Madison
| | - Alan N Baer
- Johns Hopkins University School of Medicine, Baltimore, Maryland
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23
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Khan H, Ullah H, Khattak S, Aschner M, Aguilar CN, Halimi SMA, Cauli O, Shah SMM. Therapeutic potential of alkaloids in autoimmune diseases: Promising candidates for clinical trials. Phytother Res 2020; 35:50-62. [PMID: 32667693 DOI: 10.1002/ptr.6763] [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] [Received: 02/19/2020] [Revised: 04/23/2020] [Accepted: 05/16/2020] [Indexed: 02/05/2023]
Abstract
Clinical investigations have characterized numerous disorders like autoimmune diseases, affecting the population at a rate of approximately 8-10%. These disorders are characterized by T-cell and auto-antibodies responses to self-molecules by immune system reactivity. Several therapeutic options have been adopted in clinics to combat such diseases, however, most of them are recurring. Thus, the discovery of new effective agents for the treatment of autoimmune diseases is paramount. In this context, natural products might be a useful alternative to the current therapies. Plant alkaloids with their substantial therapeutic history can be particularly interesting candidates for the alleviation of autoimmune ailments. This review encompasses various alkaloids with significant effects against autoimmune diseases in preclinical trials. These results suggest further clinical assessment with respect to autoimmune illnesses. Furthermore, the application of modern technologies such as nanoformulation could be also helpful in the design of more effective therapies and thus further studies are needed to decipher their therapeutic efficacy as well as potential limitations.
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Affiliation(s)
- Haroon Khan
- Abdul Wali khan university Mardan, Abdul Wali khan university Mardan, Department of Pharmacy, Abdul Wali Khan university Mardan, Pakistan, Mardan, Pakistan, 23200, Pakistan
| | - Hammad Ullah
- Department of Pharmacy, University of Naples Federico II, Naples, Italy
| | - Sumaira Khattak
- Abdul Wali khan university Mardan, Abdul Wali khan university Mardan, Department of Pharmacy, Abdul Wali Khan university Mardan, Pakistan, Mardan, Pakistan, 23200, Pakistan
| | - Michael Aschner
- Department of Molecular Pharmacology, Albert Einstein College of Medicine, New York, New York, USA
| | - Cristobal N Aguilar
- School of Chemistry, Universidad Autónoma de Coahuila Saltillo, Saltillo, Mexico
| | - Syed M A Halimi
- Department of Pharmacy, University of Peshawar, Peshawar, Pakistan
| | - Omar Cauli
- Department of Nursing, University of Valencia, Valencia, Spain
| | - Syed M M Shah
- Department of Pharmacy, University of Swabi Pakistan, Swabi, Pakistan
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Scofield RH, Sharma R, Pezant N, Kelly JA, Radfar L, Lewis DM, Kaufman CE, Cioli S, Harris J, Grundahl K, Rhodus NL, Wallace DJ, Weisman MH, Venuturupalli S, Brennan MT, Koelsch KA, Lessard CJ, Montgomery CG, Sivils KL, Rasmussen A. American Indians Have a Higher Risk of Sjögren's Syndrome and More Disease Activity Than European Americans and African Americans. Arthritis Care Res (Hoboken) 2020; 72:1049-1056. [PMID: 31199565 DOI: 10.1002/acr.24003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 06/11/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To describe the clinical and serologic manifestations of Sjögren's syndrome (SS) in ethnic groups of the US. METHODS This was a cross-sectional study of 648 patients with primary SS: 20 African American (AA), 164 American Indian (AI), 426 European American (EA), and 38 patients of other races evaluated in a multidisciplinary Sjögren's International Collaborative Clinical Alliance research clinic. RESULTS AA subjects comprised 3.1% of the SS cohort, much lower than the percentage of AA in the state of Oklahoma (P = 3.01 × E - 05), the US (P = 2.24E - 13), or a systemic lupus erythematosus (SLE) cohort at the same institution (P = 4.26 × 10E - 27). In contrast, the percentage of AI in the SS cohort (25.3%) was much higher than expected (P = 3.17E - 09 versus SLE cohort, P = 6.36 - 26 versus Oklahoma, and P = 8.14E - 96 versus US population). The SS classification criteria were similar between AA and EA, but subjects of AI ancestry had lower rates of abnormal tear and salivary flow, as well as anti-Ro/SSA and anti-La/SSB antibodies. Paradoxically, AI had higher levels of disease activity (mean ± SD European League Against Rheumatism Sjögren's Syndrome Disease Activity Index score 3.77 ± 4.78) in comparison to EA (2.90 ± 4.12; P = 0.011) and more extraglandular manifestations affecting mainly the articular and glandular domains. Meanwhile, AA patients were characterized by higher rates of hypergammaglobulinemia (odds ratio [OR] 1.39 [95% confidence interval (95% CI) 1.39-8.65]; P = 0.01), elevated erythrocyte sedimentation rate (ESR) (OR 3.95 [95% CI 1.46-9.95]; P = 0.009), and parotid enlargement (OR 4.40 [95% CI 1.49-13.07]; P = 0.02). CONCLUSION AI are affected at high rates with SS but present with few classical features, potentially preventing timely diagnosis. In contrast to SLE, SS is infrequent and not more severe among AA, but the triad of hypergammaglobulinemia, increased ESR, and parotid enlargement warrants extra vigilance for lymphomagenesis.
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Affiliation(s)
- R Hal Scofield
- Oklahoma Medical Research Foundation, University of Oklahoma Health Sciences Center, and Department of Veterans Affairs Medical Center, Oklahoma City
| | - Rohan Sharma
- University of Arkansas for Medical Sciences, Little Rock
| | | | | | - Lida Radfar
- University of Oklahoma College of Dentistry, Oklahoma City
| | - David M Lewis
- University of Oklahoma College of Dentistry, Oklahoma City
| | - C Erick Kaufman
- University of Oklahoma Health Sciences Center, Oklahoma City
| | - Sarah Cioli
- Oklahoma Medical Research Foundation, Oklahoma City
| | - Judy Harris
- Oklahoma Medical Research Foundation, Oklahoma City
| | | | | | | | | | | | | | - Kristi A Koelsch
- Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center, Oklahoma City
| | | | | | | | - Astrid Rasmussen
- Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, and Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Kondo K, Kaneko T, Horie N. Primary Sjögren's syndrome with multiple calcifications in parotid glands. Clin Case Rep 2019; 7:2239-2241. [PMID: 31788287 PMCID: PMC6878060 DOI: 10.1002/ccr3.2161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 02/08/2019] [Accepted: 02/13/2019] [Indexed: 11/30/2022] Open
Abstract
Dispersed calcifications in bilateral parotid glands may strongly suggest Sjögren's syndrome (SS), since the occurrence of bilateral calcifications in other salivary gland diseases is rare. This association between parotid calcifications and SS would thus represent highly useful information for the diagnosis of SS.
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Affiliation(s)
- Keisuke Kondo
- Department of Oral and Maxillofacial Surgery, Saitama Medical CenterSaitama Medical UniversitySaitamaJapan
| | - Takahiro Kaneko
- Department of Oral and Maxillofacial Surgery, Saitama Medical CenterSaitama Medical UniversitySaitamaJapan
| | - Norio Horie
- Department of Oral and Maxillofacial Surgery, Saitama Medical CenterSaitama Medical UniversitySaitamaJapan
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Endreffy I, Bjørklund G, Bartha A, Chirumbolo S, Dadar M, Fényi Á. Plasma α-L-fucosidase-1 in patients with Sjögren's syndrome and other rheumatic disorders. Int J Rheum Dis 2019; 22:1762-1767. [PMID: 31419081 DOI: 10.1111/1756-185x.13639] [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: 11/12/2018] [Revised: 05/02/2019] [Accepted: 05/23/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Human α-fucosidase (EC 3.2.1.51) is a hydrolase the importance of which has been increasing in the latest years. However, data about its plasma level in children with autoimmune disorders, particularly Sjögren's syndrome (SS), are lacking. In this study, the plasma activity of L-α-fucosidase-1 (α-L-FUCA-1) was assayed in hospitalized children and adults and its association with SS and other rheumatic disorders further evaluated. METHODS In total 73 Hungarian hospitalized patients, 32 children (2.5-10 years) and 41 adults (32-68 years), were enrolled in the study and underwent plasma assay of α-L-FUCA1 activity. Linear regression, Durbin-Watson (DW), and Pearson tests were evaluated to investigate the relationship between α-L-FUCA-1 plasma levels and autoimmune manifestations. RESULTS α-L-FUCA-1 correlated with SS both in children (2-sided t test, P = 0.0023) and in adults (2-sided t test, P = 0.00035). Linear regressions showed that in other rheumatic disorders, α-L-FUCA1 did not show any differential distribution related to the particular pathology (r = 0.2042, P = 0.1531, DW test = 2.2139 positive), while this trend was radically opposite for patients with SS (r = 0.1462, P = 0.0032, DW test = 1.3664, negative). CONCLUSIONS Alterations in plasma level of α-L-FUCA-1 were significantly associated with SS. This preliminary result should encourage further research on α-L-FUCA-1 as a possible differential serological marker of SS.
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Affiliation(s)
- Ildikó Endreffy
- Department of Pediatrics, Jósa András County Hospital, Nyíregyháza, Hungary
| | - Geir Bjørklund
- Council for Nutritional and Environmental Medicine, Mo i Rana, Norway
| | - Attila Bartha
- Department of Rheumatology, Jósa András County Hospital, Nyíregyháza, Hungary
| | - Salvatore Chirumbolo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Maryam Dadar
- Razi Vaccine and Serum Research Institute, Agricultural Research, Education and Extension Organization (AREEO), Karaj, Iran
| | - Ágnes Fényi
- Department of Otolaryngology, Head and Neck Surgery, Semmelweis University, Budapest, Hungary
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Sandhya P, Janardana R, Sudarsanam T, Mahasampath G, Prakash JAJ, Danda D. Determinants of diagnosis and disease course in primary Sjögren's syndrome: Results from datamining of electronic health records. Int J Rheum Dis 2019; 22:1768-1774. [DOI: 10.1111/1756-185x.13641] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 04/03/2019] [Accepted: 05/02/2019] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - Thambu Sudarsanam
- Department of Medicine Christian Medical College and Hospital Vellore Tamil Nadu India
| | - Gowri Mahasampath
- Department of Biostatistics Christian Medical College and Hospital Vellore Tamil Nadu India
| | - John Antony Jude Prakash
- Department of Clinical Microbiology Christian Medical College and Hospital Vellore Tamil Nadu India
| | - Debashish Danda
- Department of Clinical Immunology and Rheumatology Christian Medical College and Hospital Vellore Tamil Nadu India
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Pasoto SG, Adriano de Oliveira Martins V, Bonfa E. Sjögren's syndrome and systemic lupus erythematosus: links and risks. Open Access Rheumatol 2019; 11:33-45. [PMID: 30774485 PMCID: PMC6357904 DOI: 10.2147/oarrr.s167783] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Systemic lupus erythematosus (SLE) and Sjögren’s syndrome (SS) may coexist, and they are chronic complex disorders, with an autoimmune background, multifactorial etiology, multiple circulating autoantibodies, and variable prognosis. The prominent feature of SS is the impairment of the lacrimal and salivary glands leading to sicca symptoms. This disease may be classified as primary Sjögren’s syndrome (pSS), or secondary Sjögren’s syndrome (sSS) since it is often associated to other autoimmune disorders, principally SLE, rheumatoid arthritis, and systemic sclerosis. Systematic reviews and meta-analyses show an sSS prevalence in SLE patients of about 14%–17.8%. Herein, we updated important aspects of the clinical association between SLE and sSS through a narrative review of the PubMed database in the last 5 years (from July 2013 to October 2018) with the terms “Sjogren syndrome and systemic lupus erythematosus”. The following aspects are addressed: the classification criteria for sSS; differences and similarities between SLE and pSS regarding demographic, clinical, and serological characteristics (including new autoantibodies), as well as comorbidities; the etiopathogenic links between SLE and pSS (including genetic and environmental factors, B-cell activation, and autoantibodies); the predictive factors for sSS onset in SLE patients; the ocular and oral involvements due to sSS in SLE; and the main distinctive demographic, clinical, and serological features of SLE with and without associated SS.
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Affiliation(s)
- Sandra Gofinet Pasoto
- Rheumatology Division, Hospital das Clinicas, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Sao Paulo, Brazil, .,Laboratory Division, Hospital das Clinicas, Faculdade de Medicina da Universidade de Sao Paulo (HCFMUSP), Sao Paulo, Sao Paulo, Brazil,
| | | | - Eloisa Bonfa
- Rheumatology Division, Hospital das Clinicas, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Sao Paulo, Brazil,
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Jhorar P, Torre K, Lu J. Cutaneous features and diagnosis of primary Sjögren syndrome: An update and review. J Am Acad Dermatol 2018; 79:736-745. [DOI: 10.1016/j.jaad.2018.05.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 05/02/2018] [Accepted: 05/14/2018] [Indexed: 12/25/2022]
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30
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Bizzaro N, Brusca I, Previtali G, Alessio MG, Daves M, Platzgummer S, Cinquanta L, Paura G, Infantino M, Manfredi M, Faricelli R, Bassetti D, Musso M, Deleonardi G, Trevisan MT, Radice A, Liguori M, Imbastaro T, Pesente F, Fabris M, Tonutti E. The association of solid-phase assays to immunofluorescence increases the diagnostic accuracy for ANA screening in patients with autoimmune rheumatic diseases. Autoimmun Rev 2018; 17:541-547. [PMID: 29631063 DOI: 10.1016/j.autrev.2017.12.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 12/08/2017] [Indexed: 12/11/2022]
Affiliation(s)
- Nicola Bizzaro
- Laboratorio di Patologia Clinica, Ospedale S. Antonio, Tolmezzo, Italy.
| | - Ignazio Brusca
- Patologia Clinica, Ospedale Buccheri La Ferla FBF, Palermo, Italy
| | - Giulia Previtali
- Laboratorio Analisi Chimico Cliniche, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Massimo Daves
- Laboratorio Centrale, Ospedale Civile, Merano, Italy
| | | | - Luigi Cinquanta
- Autoimmunologia e Allergologia Diagnostica di Laboratorio, OORR San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Giusy Paura
- Autoimmunologia e Allergologia Diagnostica di Laboratorio, OORR San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Maria Infantino
- Laboratorio Immunologia Allergologia, Azienda Usl Toscana Centro, Ospedale San Giovanni di Dio, Florence, Italy
| | - Mariangela Manfredi
- Laboratorio Immunologia Allergologia, Azienda Usl Toscana Centro, Ospedale San Giovanni di Dio, Florence, Italy
| | | | | | - Maura Musso
- Laboratorio Analisi, Ospedale S.Croce e Carle, Cuneo, Italy
| | - Gaia Deleonardi
- Laboratorio Unico Metropolitano, Ospedale Maggiore, Bologna, Italy
| | | | - Antonella Radice
- UOC Microbiologia e Virologia, Presidio Ospedaliero San Carlo Borromeo, Milan, Italy
| | - Marco Liguori
- Laboratorio Analisi, Azienda Ospedaliera G. Brotzu, Cagliari, Italy
| | | | - Fiorenza Pesente
- SOC Istituto di Patologia Clinica, Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - Martina Fabris
- SOC Istituto di Patologia Clinica, Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - Elio Tonutti
- SOC Istituto di Patologia Clinica, Azienda Sanitaria Universitaria Integrata, Udine, Italy
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Wu H, Liao J, Li Q, Yang M, Zhao M, Lu Q. Epigenetics as biomarkers in autoimmune diseases. Clin Immunol 2018; 196:34-39. [PMID: 29574040 DOI: 10.1016/j.clim.2018.03.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 03/19/2018] [Accepted: 03/19/2018] [Indexed: 12/21/2022]
Abstract
Autoimmune diseases are immune system disorders in which immune cells cannot distinguish self-antigens from foreign ones. The current criteria for autoimmune disease diagnosis are based on clinical manifestations and laboratory tests. However, none of these markers shows both high sensitivity and specificity. In addition, some autoimmune diseases, for example, systemic lupus erythematosus (SLE), are highly heterogeneous and often exhibit various manifestations. On the other hand, certain autoimmune diseases, such as Sjogren's syndrome versus SLE, share similar symptoms and autoantibodies, which also causes difficulties in diagnosis. Therefore, biomarkers that have both high sensitivity and high specificity for diagnosis, reflect disease activity and predict drug response are necessary. An increasing number of publications have proposed the abnormal epigenetic modifications as biomarkers of autoimmune diseases. Therefore, this review will comprehensively summarize the epigenetic progress in the pathogenesis of autoimmune disorders and unearth potential biomarkers that might be appropriate for disease diagnosis and prediction.
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Affiliation(s)
- Haijing Wu
- Department of Dermatology, Second Xiangya Hospital, Central South University, Hunan Key Laboratory of Medical Epigenomics, Changsha, Hunan, China
| | - Jieyue Liao
- Department of Dermatology, Second Xiangya Hospital, Central South University, Hunan Key Laboratory of Medical Epigenomics, Changsha, Hunan, China
| | - Qianwen Li
- Department of Dermatology, Second Xiangya Hospital, Central South University, Hunan Key Laboratory of Medical Epigenomics, Changsha, Hunan, China
| | - Ming Yang
- Department of Dermatology, Second Xiangya Hospital, Central South University, Hunan Key Laboratory of Medical Epigenomics, Changsha, Hunan, China
| | - Ming Zhao
- Department of Dermatology, Second Xiangya Hospital, Central South University, Hunan Key Laboratory of Medical Epigenomics, Changsha, Hunan, China
| | - Qianjin Lu
- Department of Dermatology, Second Xiangya Hospital, Central South University, Hunan Key Laboratory of Medical Epigenomics, Changsha, Hunan, China.
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Gazeau P, Cornec D, Jousse-Joulin S, Guellec D, Saraux A, Devauchelle-Pensec V. Time-course of ultrasound abnormalities of major salivary glands in suspected Sjögren's syndrome. Joint Bone Spine 2018; 85:227-232. [DOI: 10.1016/j.jbspin.2017.02.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 02/01/2017] [Indexed: 12/12/2022]
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Abstract
Sjögren syndrome (SS) comprises glandular and extraglandular manifestations. Double-blind prospective trials of traditional disease-modifying antirheumatic drugs and biologics have failed because they have not improved benign symptoms, the major cause of lowered quality of life. Rituximab has proven effective in SS patients with associated mixed cryoglobulinemia, parotid gland swelling, lymphocytic interstitial pneumonitis, thrombocytopenia, and other manifestations. There were few of these SS patients in the trials required for FDA approval. Most patients had benign symptoms and did not show benefit, leading to failure of the study. This article examines the reasons for these failures and proposes future directions.
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Maciel G, Crowson CS, Matteson EL, Cornec D. Incidence and Mortality of Physician-Diagnosed Primary Sjögren Syndrome: Time Trends Over a 40-Year Period in a Population-Based US Cohort. Mayo Clin Proc 2017; 92:734-743. [PMID: 28389066 PMCID: PMC5470777 DOI: 10.1016/j.mayocp.2017.01.020] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 01/11/2017] [Accepted: 01/16/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To estimate the incidence and mortality rates, and their evolution over time, of physician-diagnosed primary Sjögren syndrome (pSS) in residents of Olmsted County, Minnesota. PATIENTS AND METHODS Medical records of patients with a diagnosis or suspicion of SS in Olmsted County from January 1, 2006, through December 31, 2015, were reviewed to identify incident cases of pSS (defined by physician diagnosis). These cases were combined with those from a 1976 through 2005 incident cohort (n=111) from the same population. Incidence rates were age and sex adjusted to the 2010 US white population. Survival rates were compared with the expected rates in the population of Minnesota. RESULTS With 61 incident cases of pSS diagnosed in Olmsted County from 2006 through 2015, the total cohort included 172 patients with incident pSS from 1976 through 2015. Of the 172 patients, 151 (88%) were women and 161 (94%) were white, with a mean ± SD age at diagnosis of 58.3±16.7 years. The average age- and sex-adjusted annual incidence for 2006 through 2015 was 5.9 per 100,000 population (95% CI, 4.4-7.4 per 100,000 population), and the overall incidence for the entire period was 5.8 per 100,000 (95% CI, 4.9-6.6 per 100,000). The incidence increased with calendar time over the 40-year period (P=.005). There was no difference in mortality in the pSS cohort compared with expected (standardized mortality ratio, 1.15; 95% CI, 0.86-1.50). CONCLUSION The average annual incidence of pSS in this population-based cohort was 5.8 per 100,000, with a progressive increase over the 40 years of the study. Overall survival of patients with pSS was not different from that of the general population.
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Affiliation(s)
- Gabriel Maciel
- Division of Rheumatology, Mayo Clinic College of Medicine and Science, Rochester, MN; Hospital Maciel, Montevideo, Uruguay
| | - Cynthia S Crowson
- Division of Rheumatology, Mayo Clinic College of Medicine and Science, Rochester, MN; Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Eric L Matteson
- Division of Rheumatology, Mayo Clinic College of Medicine and Science, Rochester, MN; Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science, Rochester, MN.
| | - Divi Cornec
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN; Rheumatology Department, Brest Teaching Hospital, Brest, France
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Tseng CC, Chang SJ, Tsai WC, Ou TT, Wu CC, Sung WY, Hsieh MC, Yen JH. Sex differential association of dermatomyositis with Sjögren syndrome. CMAJ 2017; 189:E187-E193. [PMID: 28246264 DOI: 10.1503/cmaj.160783] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Although dermatomyositis and Sjögren syndrome share serologic autoantibodies and genetic polymorphisms, population data about the incidence of Sjögren syndrome in patients with dermatomyositis is unavailable. We performed a nationwide cohort study to explore the potential relation between dermatomyositis and Sjögren syndrome and, if an association exists, to elucidate whether it varies by sex. METHODS We identified all patients with newly diagnosed dermatomyositis from the Registry of Catastrophic Illness Database in Taiwan between Jan. 1, 1998, and Dec. 31, 2011. Each patient was matched to, at most, 5 control patients from the National Health Insurance Research Database by age, sex and entry date. Cox regression was used to calculate the hazard ratio (HR) and 95% confidence interval (CI) of Sjögren syndrome after adjusting for age, sex, rheumatoid arthritis, systemic lupus erythematosus and systemic sclerosis. RESULTS A total of 1602 patients with dermatomyositis and 7981 control patients were enrolled in the study. There was a positive association of having Sjögren syndrome among patients with dermatomyositis after adjusting for age, sex, rheumatoid arthritis, systemic lupus erythematosus and systemic sclerosis (HR 2.67, 95% CI 2.01-3.54). The association was more pronounced in the male cohort (HR 2.69, 95% CI 1.19-6.09). INTERPRETATION We found a sex differential association of Sjögren syndrome among patients with dermatomyositis independent of age and concomitant autoimmune disease. Further studies are required to determine the clinical importance of this association for both outcomes and therapeutic options.
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Affiliation(s)
- Chia-Chun Tseng
- Department of Internal Medicine (Tseng), Kaohsiung Municipal Ta-Tung Hospital; Department of Kinesiology (Chang), Health and Leisure Studies, National University of Kaohsiung; Division of Rheumatology (Tsai, Ou, Wu, Sung, Yen), Department of Internal Medicine, Kaohsiung Medical University Hospital; Graduate Institute of Medicine (Sung, Yen), College of Medicine, Kaohsiung Medical University; Division of Endocrinology and Metabolism, Department of Internal Medicine (Hsieh), Changhua Christian Hospital, Changhua, Taiwan; Graduate Institute of Integrated Medicine (Hsieh), China Medical University, Taichung, Taiwan
| | - Shun-Jen Chang
- Department of Internal Medicine (Tseng), Kaohsiung Municipal Ta-Tung Hospital; Department of Kinesiology (Chang), Health and Leisure Studies, National University of Kaohsiung; Division of Rheumatology (Tsai, Ou, Wu, Sung, Yen), Department of Internal Medicine, Kaohsiung Medical University Hospital; Graduate Institute of Medicine (Sung, Yen), College of Medicine, Kaohsiung Medical University; Division of Endocrinology and Metabolism, Department of Internal Medicine (Hsieh), Changhua Christian Hospital, Changhua, Taiwan; Graduate Institute of Integrated Medicine (Hsieh), China Medical University, Taichung, Taiwan
| | - Wen-Chan Tsai
- Department of Internal Medicine (Tseng), Kaohsiung Municipal Ta-Tung Hospital; Department of Kinesiology (Chang), Health and Leisure Studies, National University of Kaohsiung; Division of Rheumatology (Tsai, Ou, Wu, Sung, Yen), Department of Internal Medicine, Kaohsiung Medical University Hospital; Graduate Institute of Medicine (Sung, Yen), College of Medicine, Kaohsiung Medical University; Division of Endocrinology and Metabolism, Department of Internal Medicine (Hsieh), Changhua Christian Hospital, Changhua, Taiwan; Graduate Institute of Integrated Medicine (Hsieh), China Medical University, Taichung, Taiwan
| | - Tsan-Teng Ou
- Department of Internal Medicine (Tseng), Kaohsiung Municipal Ta-Tung Hospital; Department of Kinesiology (Chang), Health and Leisure Studies, National University of Kaohsiung; Division of Rheumatology (Tsai, Ou, Wu, Sung, Yen), Department of Internal Medicine, Kaohsiung Medical University Hospital; Graduate Institute of Medicine (Sung, Yen), College of Medicine, Kaohsiung Medical University; Division of Endocrinology and Metabolism, Department of Internal Medicine (Hsieh), Changhua Christian Hospital, Changhua, Taiwan; Graduate Institute of Integrated Medicine (Hsieh), China Medical University, Taichung, Taiwan
| | - Cheng-Chin Wu
- Department of Internal Medicine (Tseng), Kaohsiung Municipal Ta-Tung Hospital; Department of Kinesiology (Chang), Health and Leisure Studies, National University of Kaohsiung; Division of Rheumatology (Tsai, Ou, Wu, Sung, Yen), Department of Internal Medicine, Kaohsiung Medical University Hospital; Graduate Institute of Medicine (Sung, Yen), College of Medicine, Kaohsiung Medical University; Division of Endocrinology and Metabolism, Department of Internal Medicine (Hsieh), Changhua Christian Hospital, Changhua, Taiwan; Graduate Institute of Integrated Medicine (Hsieh), China Medical University, Taichung, Taiwan
| | - Wan-Yu Sung
- Department of Internal Medicine (Tseng), Kaohsiung Municipal Ta-Tung Hospital; Department of Kinesiology (Chang), Health and Leisure Studies, National University of Kaohsiung; Division of Rheumatology (Tsai, Ou, Wu, Sung, Yen), Department of Internal Medicine, Kaohsiung Medical University Hospital; Graduate Institute of Medicine (Sung, Yen), College of Medicine, Kaohsiung Medical University; Division of Endocrinology and Metabolism, Department of Internal Medicine (Hsieh), Changhua Christian Hospital, Changhua, Taiwan; Graduate Institute of Integrated Medicine (Hsieh), China Medical University, Taichung, Taiwan
| | - Ming-Chia Hsieh
- Department of Internal Medicine (Tseng), Kaohsiung Municipal Ta-Tung Hospital; Department of Kinesiology (Chang), Health and Leisure Studies, National University of Kaohsiung; Division of Rheumatology (Tsai, Ou, Wu, Sung, Yen), Department of Internal Medicine, Kaohsiung Medical University Hospital; Graduate Institute of Medicine (Sung, Yen), College of Medicine, Kaohsiung Medical University; Division of Endocrinology and Metabolism, Department of Internal Medicine (Hsieh), Changhua Christian Hospital, Changhua, Taiwan; Graduate Institute of Integrated Medicine (Hsieh), China Medical University, Taichung, Taiwan
| | - Jeng-Hsien Yen
- Department of Internal Medicine (Tseng), Kaohsiung Municipal Ta-Tung Hospital; Department of Kinesiology (Chang), Health and Leisure Studies, National University of Kaohsiung; Division of Rheumatology (Tsai, Ou, Wu, Sung, Yen), Department of Internal Medicine, Kaohsiung Medical University Hospital; Graduate Institute of Medicine (Sung, Yen), College of Medicine, Kaohsiung Medical University; Division of Endocrinology and Metabolism, Department of Internal Medicine (Hsieh), Changhua Christian Hospital, Changhua, Taiwan; Graduate Institute of Integrated Medicine (Hsieh), China Medical University, Taichung, Taiwan
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