1
|
Nguyen R, Gomez-Castillo L, Gonzales JA. Ocular manifestations of juvenile Sjögren's disease. Curr Opin Ophthalmol 2024:00055735-990000000-00180. [PMID: 38923442 DOI: 10.1097/icu.0000000000001069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
PURPOSE OF REVIEW This review aims to enhance understanding of juvenile Sjögren's disease (jSjD) by exploring diagnostic criteria, ocular clinical features, ancillary ophthalmic testing, and management strategies specific to this rare pediatric condition. RECENT FINDINGS Unlike adults, children with jSjD often present with recurrent parotitis and extra-glandular symptoms before developing sicca symptoms. Adult SjD classification criteria do not consider pediatric-specific symptoms and physiological differences. Underutilization of diagnostic tests such as the ocular staining score (OSS) and Schirmer I may result in an incomplete understanding of the prevalence of keratoconjunctivitis sicca in jSjD. SUMMARY Timely referral to an ophthalmologist can address perceived feasibility issues with respect to ocular features in jSjD. Management of keratoconjunctivitis sicca in jSjD includes improving ocular surface lubrication and decreasing inflammation. Recognition of pediatric-specific clinical features and development of universally accepted jSjD classification criteria will allow for better identification of potential participants for future jSjD studies.
Collapse
Affiliation(s)
- Robert Nguyen
- School of Medicine, University of Washington, Seattle, Washington
- Francis I. Proctor Foundation
| | | | - John A Gonzales
- Francis I. Proctor Foundation
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California, USA
| |
Collapse
|
2
|
Hou L, Wang N, Zhao C, Wang X, Du Y. A single-center study of clinical features of pediatric Sjögren's syndrome. Pediatr Rheumatol Online J 2023; 21:119. [PMID: 37833819 PMCID: PMC10571342 DOI: 10.1186/s12969-023-00902-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 09/30/2023] [Indexed: 10/15/2023] Open
Abstract
OBJECTIVE Sjögren's syndrome (SS) is a rare disease with unclear diagnostic criteria among the children and adolescents. The purpose of this study is to describe the clinical features of pediatric Sjögren's syndrome and validate with Japanese diagnostic guidelines criteria of 2018. METHODS We conducted a retrospective analysis of the clinical data of a cohort of 54 patients with pediatric Sjögren's syndrome admitted to our hospital over a total of 10 years from September 2013 to September 2022. RESULTS The ratio of females to males was 49:5 among the 54 children (34 cases of primary SS and 20 cases of secondary SS), the average age of onset of symptoms for the first time was 9.9 years, and the average age at diagnosis was 10.2 years. In terms of subjective symptoms, 7 cases (13.0%) presented with dry mouth and 5 cases (9.3%) reported dry eyes. The positive rates were 9.3% for Schirmer I test, 70.4% for salivary gland function test, and 55.6% for salivary gland ultrasonography. The positive rates were 94.4% for Anti-Ro/SSA antibodies, 66.7% for Anti-La/SSB antibodies, 88.9% for ANA, 59.3% for RF, and the elevation rate of IgG was 63.0%. Among the EULAR Sjögren's syndrome disease activity index (ESSDAI) domains, the biological, constitutional, glandular, cutaneous, and lymphadenopathy domains were most involved. Treatment consisted of glucocorticoids in 88.9% of the patients in our study and hydroxychloroquine in 92.6%. As per the Japanese version of the clinical practice guidance for Sjögren's Syndrome in pediatric patients (2018), 5 cases were identified as Definite SS, 35 cases as Probable SS, and 14 cases as Possible SS. With respect to primary and secondary SS, there was essentially no significant difference between the groups in any of the above aspects. CONCLUSIONS Patients with pediatric SS presented with a wide spectrum of clinical features, a low prevalence of reported symptoms of dry mouth and dry eyes, and various clinical manifestations with multi-system involvement. These are similar to other pediatric study cohorts in terms of epidemiology, auxiliary investigation results, disease activity scores, and treatment. The coincidence between our study and the Japanese version of the clinical practice guidance for Sjögren's Syndrome in pediatric patients (2018) is good for the diagnosis of pediatric SS.
Collapse
Affiliation(s)
- Ling Hou
- Department of Pediatrics, Shengjing Hospital of China Medical University, No.36 of Sanhao Street, Heping District, Shenyang, 110004, China
| | - Ningning Wang
- Department of Pediatrics, Shengjing Hospital of China Medical University, No.36 of Sanhao Street, Heping District, Shenyang, 110004, China
| | - Chengguang Zhao
- Department of Pediatrics, Shengjing Hospital of China Medical University, No.36 of Sanhao Street, Heping District, Shenyang, 110004, China
| | - Xiuli Wang
- Department of Pediatrics, Shengjing Hospital of China Medical University, No.36 of Sanhao Street, Heping District, Shenyang, 110004, China
| | - Yue Du
- Department of Pediatrics, Shengjing Hospital of China Medical University, No.36 of Sanhao Street, Heping District, Shenyang, 110004, China.
| |
Collapse
|
3
|
Bartholomeo A, Aujla S, Eklund M, Kerrigan C, Riemer E, Gilbert M. Pulmonary manifestations of childhood-onset primary Sjogren's syndrome (SS) masquerading as reactive airways disease in a male patient and review of interstitial lung disease associated with SS. Pediatr Rheumatol Online J 2022; 20:101. [PMID: 36384806 PMCID: PMC9670561 DOI: 10.1186/s12969-022-00761-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 10/29/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Sjogren's syndrome (SS) is a rare chronic autoimmune disease involving exocrine glands presenting with sicca syndrome, recurrent parotitis and other extraglandular stigmata. SS is well characterized in the adult population with classification criteria; however, primary SS presenting in childhood is poorly defined and rare in males. Recurrent parotitis is the most common presenting symptom in children with primary SS; however, clinical phenotype in children appears more variable than in adults. The lungs are a common extraglandular location for manifestations of primary SS. However, interstitial lung disease (ILD) is rare in children with primary SS. There are only four published reports of ILD associated with primary SS in female children. Here, we present a very rare case of primary SS in a pediatric male with pulmonary manifestations and review of the literature on ILD in childhood-onset primary SS. CASE PRESENTATION A 14-year-old White male with a history of chronic severe asthma, recurrent parotitis and idiopathic intracranial hypertension was referred to pediatric rheumatology for evaluation of a positive ANA. In early childhood, he was diagnosed with persistent asthma recalcitrant to therapy. At age 8, he developed recurrent episodes of bilateral parotitis despite multiple treatments with sialoendoscopy. At age 14, respiratory symptoms significantly worsened prompting reevaluation. Lab workup was notable for positive ANA and Sjogren's Syndrome A and B antibodies. Pulmonary function tests showed only a mild obstructive process. Computed tomography of chest was significant for small airway disease, and lung biopsy was positive for mild interstitial lymphocytic inflammation presenting a conflicting picture for ILD. The constellation of findings led to the diagnosis of primary SS with associated pulmonary manifestations. He was treated with hydroxychloroquine, mycophenolate mofetil and oral corticosteroids with resolution of symptoms. CONCLUSIONS Primary SS is a rare disease in the pediatric population that is poorly characterized. This case is the very rare presentation of childhood-onset primary SS with pulmonary manifestations in a male patient. ILD associated with primary SS is also very rare with only four pediatric patients reported in the literature. Collaborative effort is needed to develop pediatric specific diagnostic and treatment guidelines in this rare condition.
Collapse
Affiliation(s)
- Adam Bartholomeo
- Department of Pediatrics, Medical University of South Carolina, 135 Rutledge Avenue, MSC 561, Charleston, SC, 29425, USA.
| | - Shean Aujla
- grid.259828.c0000 0001 2189 3475Department of Pediatrics, Medical University of South Carolina, 135 Rutledge Avenue, MSC 561, Charleston, SC 29425 USA ,Division of Pediatric Pulmonology, Allergy and Immunology, 125 Doughty Street, MSC 917, Charleston, SC 29425 USA
| | - Meryle Eklund
- grid.259828.c0000 0001 2189 3475Department of Radiology and Radiological Sciences, Medical University of South Carolina, 96 Jonathan Lucas St, MSC 323, Suite 210 CSB, Charleston, SC 29425 USA
| | - Cheryl Kerrigan
- grid.259828.c0000 0001 2189 3475Department of Pediatrics, Medical University of South Carolina, 135 Rutledge Avenue, MSC 561, Charleston, SC 29425 USA ,Division of Pediatric Pulmonology, Allergy and Immunology, 125 Doughty Street, MSC 917, Charleston, SC 29425 USA
| | - Ellen Riemer
- grid.259828.c0000 0001 2189 3475Department of Pathology and Laboratory Medicine, Medical University of South Carolina, 165 Ashley Avenue, Suite 337, Charleston, SC 29425 USA
| | - Mileka Gilbert
- grid.259828.c0000 0001 2189 3475Department of Pediatrics, Medical University of South Carolina, 135 Rutledge Avenue, MSC 561, Charleston, SC 29425 USA ,grid.259828.c0000 0001 2189 3475Division of Pediatric Rheumatology, Medical University of South Carolina, 125 Doughty Street, MSC 917, Charleston, SC 29425 USA
| |
Collapse
|
4
|
Mapping theme trends and knowledge structure of Sjögren's syndrome (SS), a bibliometric analysis from 2010 to 2021. Clin Rheumatol 2022; 41:2779-2789. [PMID: 35567664 DOI: 10.1007/s10067-022-06196-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 04/21/2022] [Accepted: 05/02/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Sjögren's syndrome is an autoimmune disease with a complicated pathophysiology, and treatment strategies are in desperate need of improvement. In this research, we provide the literature topic trends and knowledge structure connected to Sjögren's syndrome from the perspective of bibliometrics for further research. METHODS We acquired 3753 publications from the PubMed database and 3880 catalogs from the Web of Science Core Collection, with a time limit of 2010 to 2021 and the search term as "Sjögren's syndrome." Using the VOSviewer and bibliographic item co-occurrence matrix generator, we conducted cocited analysis, extracted major MeSH terms, generated matrices and performed biclustering analysis, visual matrix, drawn strategy diagram, and social network analysis. RESULTS Through the clustering of the major MeSH terms, a total of five categories and 10 research topics were identified. Cocitation analysis suggests that diagnosis and clinical manifestations have been the main basis over the past 12 years and also are the mature content in the first quadrant of the strategy map. Ultrasonography, immunosuppressive agents and therapy, mechanism and therapeutic targets, and diagnostic autoantibodies are examples of the third quadrant, which wields great potential to progress. Genetic predisposition and psychology, in the fourth quadrant, need to be developed additionally. The subject keywords near the network's edge, such as "Salivary Glands, Minor/pathology," "Immunosuppressive Agents/therapeutic use," and "Autoantibodies/blood," are all growing research hotspots with much space, according to social network analysis. CONCLUSION Through bibliometric analysis of the literature related to Sjögren's syndrome in the past 12 years, we obtained the knowledge basis, undeveloped topics, and emerging hotspots, which can suggest recommendations for future research. Key Points • We disclosed the topic trends and knowledge structure of Sjögren's syndrome literature over the past 12 years. • Clinical manifestations and diagnosis of Sjögren syndrome are included in mature and comprehensive studies, whereas ultrasonography, immunosuppressants and treatments, mechanisms and therapeutic targets, and diagnostic autoantibodies are studies with high potential for advancement. Additional research in genetics and psychology is needed. • We identified potential future research hotspots, including "Salivary Glands, Minor/pathology," "Immunosuppressive Agents/therapeutic use," and "Autoantibodies/blood."
Collapse
|
5
|
Chafin JB, Bayazid L. Pediatric Salivary Gland Disease. Pediatr Clin North Am 2022; 69:363-380. [PMID: 35337545 DOI: 10.1016/j.pcl.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Salivary gland disease in the pediatric population is rare, yet it encompasses a wide spectrum of disease. It is estimated that 4.3% of salivary gland disease occurs in the pediatric population, with most classified as nonneoplastic. Further extrapolation reveals that 5% of salivary gland neoplastic diseases occur in patients younger than 20 years. Moreover, salivary gland tumors represent 1% of all head and neck tumors across all ages. Regardless, clinicians across all fields should be familiar with the workup of various pediatric salivary gland diseases and appropriate referral to a pediatric otolaryngologist.
Collapse
Affiliation(s)
- James Brett Chafin
- Department of Pediatric Otolaryngology-Head & Neck Surgery, Nemours Children's Health System, 807 Childrens Way 4th Floor, Jacksonville, FL 32207, USA.
| | - Leith Bayazid
- Department of Otolaryngology-Head and Neck Surgery, University of South Florida College of Medicine, 12901 Bruce B. Downs Boulevard, MDC 73, Tampa, FL 33612, USA
| |
Collapse
|
6
|
Pehlivanoglu C, Zerenler Gursoy F, Sozeri B. An unusual cause of immune complex-mediated membranoproliferative glomerulonephritis in a child: Answers. Pediatr Nephrol 2021; 36:2307-2310. [PMID: 33768323 DOI: 10.1007/s00467-021-05015-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 02/11/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Cemile Pehlivanoglu
- Pediatric Nephrology Department, University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, Turkey.
| | - Fatıma Zerenler Gursoy
- Patology Department, University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Betul Sozeri
- Pediatric Rheumatology Department, University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
7
|
Condé K, Guelngar CO, Barry MC, Atakla HG, Mohamed A, Cissé FA. Sjögren's syndrome in children: about 15 cases in Guinea Conakry. Eur J Med Res 2021; 26:66. [PMID: 34215328 PMCID: PMC8252240 DOI: 10.1186/s40001-021-00534-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 06/15/2021] [Indexed: 11/23/2022] Open
Abstract
Objectives Sjögren’s syndrome is rare in children and most often secondary. It frequently affects girls and is characterized by dry eye syndrome, mouth and sometimes systemic involvement. Its diagnosis is difficult to establish in children. We report a series of 15 cases of Sjögren’s syndrome in order to clarify the peculiarities of this condition in children. Patients and methods This retrospective study was carried out over a 2-year period focused on children under 16 years of age who had been followed for Sjögren’s syndrome in the rheumatology and pediatric departments. Patient data were collected and then analyzed by STATA/SE version 11.2 software. Anonymity and respect for ethical rules were the norm. There was no connection between the patients and the researchers. Description of cases The mean age of the patients was 11 years with extremes of 5–15 years. History reveals that a dry mouth was found in more than half of the cases, or in 10 (66.7%) patients. Clinical examination found oral ulceration and periodontitis in equal proportions, 6 (40%). The immunological workup and the biopsy of the accessory salivary glands served as diagnostic evidence in the 15 patients according to the US–European criteria of 2002. Conclusion Sjögren’s syndrome is a rare entity in pediatrics. Its diagnosis is difficult to establish in pediatrics and its severity is linked to the occurrence of late visceral and lymphomatous sicca syndrome. Rapid diagnosis and initiation of a synthetic antimalarial (hydroxychloroquine) increases the hope of a cure.
Collapse
Affiliation(s)
- Kaba Condé
- Rheumatology Department, Ignace Deen University Hospital Center, Conakry, Guinea.,Neurology Department, Ignace Deen National Hospital, Conakry, Guinea
| | | | - Mamadou Ciré Barry
- Pediatric Department, Ignace Deen University Hospital Center, Conakry, Guinea
| | | | - Awada Mohamed
- Rheumatology Department, Ignace Deen University Hospital Center, Conakry, Guinea
| | - Fodé Abass Cissé
- Neurology Department, Ignace Deen National Hospital, Conakry, Guinea
| |
Collapse
|
8
|
Juvenile recurrent parotitis: Review and proposed management algorithm. Int J Pediatr Otorhinolaryngol 2021; 142:110617. [PMID: 33421670 DOI: 10.1016/j.ijporl.2021.110617] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/31/2020] [Accepted: 12/31/2020] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Despite being the second most common salivary disease in childhood, the aetiology and appropriate management of juvenile recurrent parotitis (JRP) remains uncertain. Consequently patients may be misdiagnosed, or even undergo indeterminate or potentially invasive procedures without benefit. This article reviews the current understanding of the epidemiology and pathophysiology of JRP, and to appraise the management options available. METHODS AND RESULTS Medline and Google Scholar databases were searched and peer reviewed journal articles assessed. The epidemiology of JRP remains uncertain, and the clinical presentation of JRP can vary widely in frequency and severity. Diagnosis is still largely based on clinical signs and symptoms including parotid swelling, pain and fever. Investigation typically focuses on the exclusion of other diseases and immunodeficiencies, however there are noted typical radiological findings on both ultrasound and magnetic resonance imaging. The ideal management of this condition still remains unclear, however symptoms typically resolve by puberty. Treatment focuses on minimally invasive procedures such as sialography and sialendoscopy to reduce the frequency and severity of acute episodes. CONCLUSIONS Acute episodes of JRP can occur up to 30 times per year and have a significant impact on the quality of life of an affected child. Consequently a management algorithm is proposed based on the exclusion of other pathology. There is increasing evidence for non-ablative, minimally invasive approaches such as sialography and sialendoscopy to reduce the impact of this disease.
Collapse
|
9
|
Gomez Hernandez MP, Starman EE, Davis AB, Harishchandra Hikkaduwa Withanage M, Zeng E, Lieberman SM, Brogden KA, Lanzel EA. A distinguishing profile of chemokines, cytokines, and biomarkers in the saliva of children with Sjögren's syndrome. Rheumatology (Oxford) 2021; 60:4765-4777. [PMID: 33512494 PMCID: PMC8487313 DOI: 10.1093/rheumatology/keab098] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 01/17/2021] [Indexed: 01/08/2023] Open
Abstract
Objective SS is an autoimmune disease most commonly diagnosed in adults but can occur in children. Our objective was to assess the presence of chemokines, cytokines and biomarkers (CCBMs) in saliva from these children that were associated with lymphocyte and mononuclear cell functions. Methods Saliva was collected from 11 children diagnosed with SS prior to age 18 years and 16 normal healthy children. A total of 105 CCBMs were detected in multiplex microparticle-based immunoassays. ANOVA and t test (0.05 level) were used to detect differences. Ingenuity Pathway Analysis (IPA) was used to assess whether elevated CCBMs were in annotations associated with immune system diseases and select leukocyte activities and functions. Machine learning methods were used to evaluate the predictive power of these CCBMs for SS and were measured by receiver operating characteristic (ROC) curve and area under curve (AUC). Results Of the 105 CCBMs detected, 43 (40.9%) differed in children with SS from those in healthy study controls (P < 0.05) and could differentiate the two groups (P < 0.05). Elevated CCBMs in IPA annotations were associated with autoimmune diseases and with leukocyte chemotaxis, migration, proliferation, and regulation of T cell activation. The best AUC value in ROC analysis was 0.93, indicating that there are small numbers of CCBMs that may be useful for diagnosis of SS. Conclusion While 35 of these 43 CCBMs have been previously reported in SS, 8 CCBMs had not. Additional studies focusing on these CCBMs may provide further insight into disease pathogenesis and may contribute to diagnosis of SS in children.
Collapse
Affiliation(s)
| | - Emily E Starman
- Iowa Institute for Oral Health Research, College of Dentistry, University of Iowa, Iowa City, IA USA
| | - Andrew B Davis
- Department of Otolaryngology, College of Medicine, University of Iowa, Iowa City, IA USA
| | | | - Erliang Zeng
- Division of Biostatistics and Computational Biology, College of Dentistry, University of Iowa, Iowa City, IA USA
| | - Scott M Lieberman
- Stead Family Department of Pediatrics-Division of Rheumatology, Allergy and Immunology, Carver College of Medicine, University of Iowa, Iowa City, IA USA
| | - Kim A Brogden
- Iowa Institute for Oral Health Research, College of Dentistry, University of Iowa, Iowa City, IA USA
| | - Emily A Lanzel
- Department of Oral Pathology, Radiology and Medicine, College of Dentistry, University of Iowa, Iowa City, IA USA
| |
Collapse
|
10
|
Ramos-Casals M, Acar-Denizli N, Vissink A, Brito-Zerón P, Li X, Carubbi F, Priori R, Toplak N, Baldini C, Faugier-Fuentes E, Kruize AA, Mandl T, Tomiita M, Gandolfo S, Hashimoto K, Hernandez-Molina G, Hofauer B, Mendieta-Zerón S, Rasmussen A, Sandhya P, Sene D, Trevisani VFM, Isenberg D, Sundberg E, Pasoto SG, Sebastian A, Suzuki Y, Retamozo S, Xu B, Giacomelli R, Gattamelata A, Bizjak M, Bombardieri S, Loor-Chavez RE, Hinrichs A, Olsson P, Bootsma H, Lieberman SM. Childhood-onset of primary Sjögren's syndrome: phenotypic characterization at diagnosis of 158 children. Rheumatology (Oxford) 2021; 60:4558-4567. [PMID: 33493333 DOI: 10.1093/rheumatology/keab032] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/12/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES To characterize the phenotypic presentation at diagnosis of childhood-onset primary Sjögren syndrome (SjS). METHODS The Big Data Sjögren Project Consortium is an international, multicentre registry using worldwide data-sharing cooperative merging of pre-existing clinical SjS databases from the five continents. For this study, we selected those patients in whom the disease was diagnosed below the age of 19 according to the fulfilment of the 2002/2016 classification criteria. RESULTS Among the 12 083 patients included in the Sjögren Big Data Registry, 158 (1.3%) patients had a childhood-onset diagnosis (136 girls, mean age of 14.2 years): 126 (80%) reported dry mouth, 111 (70%) dry eyes, 52 (33%) parotid enlargement, 118/122 (97%) positive minor salivary gland biopsy and 60/64 (94%) abnormal salivary ultrasound study, 140/155 (90%) positive antinuclear antibody, 138/156 (89%) anti-Ro/La antibodies and 86/142 (68%) positive rheumatoid factor. The systemic ESSDAI domains containing the highest frequencies of active patients included the glandular (47%), articular (26%) and lymphadenopathy (25%) domains. Patients with childhood-onset primary SjS showed the highest mean ESSDAI score and the highest frequencies of systemic disease in 5 (constitutional, lymphadenopathy, glandular, cutaneous and haematological) of the 12 ESSDAI domains, and the lowest frequencies in 4 (articular, pulmonary, peripheral nerve and central nervous system) in comparison with patients with adult-onset disease. CONCLUSIONS Childhood-onset primary SjS involves around 1% of patients with primary SjS, with a clinical phenotype dominated by sicca features, parotid enlargement and systemic disease. Age at diagnosis plays a key role on modulating the phenotypic expression of the disease.
Collapse
Affiliation(s)
- Manuel Ramos-Casals
- Department of Autoimmune Diseases, ICMiD, Hospital Clínic, Barcelona, Spain.,Sjögren Syndrome Research Group (AGAUR), Laboratory of Autoimmune Diseases Josep Font, IDIBAPS-CELLEX, Barcelona, Spain.,Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Nihan Acar-Denizli
- Department of Statistics and Operations Research, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Arjan Vissink
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Pilar Brito-Zerón
- Sjögren Syndrome Research Group (AGAUR), Laboratory of Autoimmune Diseases Josep Font, IDIBAPS-CELLEX, Barcelona, Spain.,Autoimmune Diseases Unit, Department of Medicine, Hospital CIMA- Sanitas, Barcelona, Spain
| | - Xiaomei Li
- Department of Rheumatology and Immunology, Anhui Provincial Hospital, Hefei, China
| | - Francesco Carubbi
- Clinical Unit of Rheumatology, University of l'Aquila, School of Medicine, L'Aquila, Italy
| | - Roberta Priori
- Department of Internal Medicine and Medical Specialties, Rheumatology Clinic, Sapienza University of Rome, Rome, Italy
| | - Nataša Toplak
- University Children's Hospital Ljubljana, University Medical center Ljubljana, Medical faculty of Ljubljana, Slovenia
| | | | | | - Aike A Kruize
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Thomas Mandl
- Department of Rheumatology, Skane University Hospital Malmö, Lund University, Lund, Sweden
| | - Minako Tomiita
- Department of Pediatrics, National Hospital Organization, Shimoshizu National Hospital, Yotsukaido, Japan
| | - Saviana Gandolfo
- Clinic of Rheumatology, Department of Medical and Biological Sciences, University Hospital "Santa Maria della Misericordia", Udine, Italy
| | - Kunio Hashimoto
- Department of Pediatrics (Pediatric Allergy and Rheumatology), Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Gabriela Hernandez-Molina
- Immunology and Rheumatology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, Mexico
| | - Benedikt Hofauer
- Otorhinolaryngology, Head and Neck Surgery, Technical University Munich, Munich, Germany
| | | | - Astrid Rasmussen
- Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - Pulukool Sandhya
- Department of Clinical Immunology & Rheumatology, Christian Medical College & Hospital, Vellore, India
| | - Damien Sene
- Service de Médecine Interne 2, Hôpital Lariboisière, Université Paris VII, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - David Isenberg
- Centre for Rheumatology, Division of Medicine, University College London, London, UK
| | - Erik Sundberg
- Pediatric Rheumatology, Astrid Lindgreńs Children Hospital, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden
| | - Sandra G Pasoto
- Rheumatology Division, Hospital das Clinicas, Faculdade de Medicina da Universidade de Sao Paulo (HCFMUSP), Sao Paulo, Brazil
| | - Agata Sebastian
- Department of Rheumatology and Internal Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Yasunori Suzuki
- Division of Rheumatology, Kanazawa University Hospital, Kanazawa, Japan
| | - Soledad Retamozo
- Sjögren Syndrome Research Group (AGAUR), Laboratory of Autoimmune Diseases Josep Font, IDIBAPS-CELLEX, Barcelona, Spain.,Instituto De Investigaciones En Ciencias De La Salud (INICSA), Universidad Nacional de Córdoba (UNC), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Córdoba, Argentina.,Instituto Universitario de Ciencias Biomédicas de Córdoba (IUCBC), Córdoba, Argentina
| | - Bei Xu
- Department of Rheumatology and Immunology, Anhui Provincial Hospital, Hefei, China
| | - Roberto Giacomelli
- Clinical Unit of Rheumatology, University of l'Aquila, School of Medicine, L'Aquila, Italy
| | - Angelica Gattamelata
- Department of Internal Medicine and Medical Specialties, Rheumatology Clinic, Sapienza University of Rome, Rome, Italy
| | - Masa Bizjak
- University Children's Hospital Ljubljana, University Medical center Ljubljana, Medical faculty of Ljubljana, Slovenia
| | | | | | - Anneline Hinrichs
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Peter Olsson
- Department of Rheumatology, Skane University Hospital Malmö, Lund University, Lund, Sweden
| | - Hendrika Bootsma
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Scott M Lieberman
- Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | | |
Collapse
|
11
|
Adolescent Sjogren's syndrome presenting as psychosis: a case series. Pediatr Rheumatol Online J 2020; 18:15. [PMID: 32046763 PMCID: PMC7014743 DOI: 10.1186/s12969-020-0412-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 02/03/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Neurological involvement has been reported in up to 80% of adults with Primary Sjogren's syndrome (pSS) with psychiatric abnormalities including anxiety, depression, and cognitive dysfunction being common. Psychosis due to pSS has been reported in adult patients but has never been previously reported in the adolescent/pediatric literature. Here we describe for the first time four cases of adolescent Sjogren's syndrome that presented with psychotic symptoms. Rituximab treatment was followed by improvement of psychiatric symptoms in all patients. CASE PRESENTATION 1: 16 year old female without significant past medical history presented to the emergency department with 4 days of abnormal behavior, tremors, insomnia, polyphagia, polyuria, and suicidal ideation. 2: 16 year old female with a 4 year history of severe anxiety, OCD, and tic disorder treated with fluoxetine with partial benefit presented with an abrupt and severe worsening of anxiety, OCD and new auditory hallucinations. 3: 19 year old female without significant past medical history presented with a 3 day history of progressively altered behavior, incoherent speech, insomnia, headache, and tangential thoughts. 4: 17 year old female without significant past medical history presented with new onset suicidal ideation, paranoia, confusion, and emotional lability. CONCLUSION Psychosis is more common in autoimmune disease than previously known. To our knowledge, the four teenage women described above are the first reported patients with adolescent pSS manifesting as psychosis. pSS should be considered in the differential diagnosis of young patients with new psychiatric disorders, even in the absence of sicca symptoms. Psychiatric symptoms improved with rituximab infusions in all 4 of our patients, which suggests rituximab may be an effective treatment option that should be considered early after the diagnosis of pSS-associated psychiatric disturbance.
Collapse
|
12
|
Hammenfors DS, Valim V, Bica BERG, Pasoto SG, Lilleby V, Nieto-González JC, Silva CA, Mossel E, Pereira RMR, Coelho A, Bootsma H, Thatayatikom A, Brun JG, Jonsson MV. Juvenile Sjögren's Syndrome: Clinical Characteristics With Focus on Salivary Gland Ultrasonography. Arthritis Care Res (Hoboken) 2019; 72:78-87. [PMID: 30697959 PMCID: PMC6972604 DOI: 10.1002/acr.23839] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 01/22/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Juvenile Sjögren's syndrome (SS) is a rare, poorly defined, and possibly underdiagnosed condition affecting children and adolescents. The aim of this study was to characterize symptoms and clinical findings of juvenile SS and to explore the clinical application of major salivary gland ultrasonography (SGUS) in patients with juvenile SS. METHODS A cross-sectional multicenter study recruited patients with disease onset until age 18 years (n = 67). Disease characteristics were recorded, and unstimulated whole sialometry and SGUS examination of the parotid and submandibular salivary glands were performed. RESULTS The female:male ratio was 58:9. The mean age at first symptom was 10.2 years and 12.1 years at diagnosis. Ocular and oral symptoms were noted in 42 of 67 patients (63%) and 53 of 66 patients (80%), respectively. The American-European Consensus Group or American College of Rheumatology/European League Against Rheumatism classification criteria for primary SS were fulfilled by 42 of 67 patients (63%). Pathologic SGUS findings were observed in 41 of 67 patients (61%); 26 of 41 SGUS+ patients (63%) fulfilled primary SS criteria. Salivary gland enlargements/parotitis were noted in 37 of 58 patients and were nonsignificantly associated with SGUS+ status (P = 0.066). The mean levels of saliva were 5.6 ml/15 minutes in SGUS- patients compared to 3.3 ml/15 minutes in the SGUS+ patients (P = 0.049). A total of 36 of 41 SGUS+ patients (88%) were anti-Ro/La+ compared to 14 of 26 SGUS- patients (54%) (P = 0.001). In addition, 24 of 39 SGUS+ patients (62%) were positive for rheumatoid factor (RF), whereas only 5 of 25 SGUS- patients (20%) were RF+ (P = 0.001). CONCLUSION Juvenile SS is characterized by a large spectrum of clinical symptoms and findings. Several glandular and extraglandular parameters such as hyposalivation, swollen salivary glands, and autoantibodies are associated with pathologic SGUS findings.
Collapse
Affiliation(s)
| | - Valéria Valim
- Federal University of Espírito Santo, Vitória, Brazil
| | - Blanca E R G Bica
- Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Sandra G Pasoto
- Hospital das Clinicas, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | | | - Clovis A Silva
- Hospital das Clinicas, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Esther Mossel
- University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Rosa M R Pereira
- Hospital das Clinicas, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Aline Coelho
- Federal University of Espírito Santo, Vitória, Brazil
| | - Hendrika Bootsma
- University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | | | - Johan G Brun
- University of Bergen and Haukeland University Hospital, Bergen, Norway
| | | |
Collapse
|
13
|
Izmirly PM, Buyon JP, Wan I, Belmont HM, Sahl S, Salmon JE, Askanase A, Bathon JM, Geraldino-Pardilla L, Ali Y, Ginzler EM, Putterman C, Gordon C, Helmick CG, Parton H. The Incidence and Prevalence of Adult Primary Sjögren's Syndrome in New York County. Arthritis Care Res (Hoboken) 2019; 71:949-960. [PMID: 30044541 PMCID: PMC6347539 DOI: 10.1002/acr.23707] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 07/17/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Extant epidemiologic data of primary Sjögren's syndrome (SS) remains limited, particularly for racial/ethnic populations in the US. The Manhattan Lupus Surveillance Program (MLSP) is a population-based retrospective registry of cases of systemic lupus erythematosus and related diseases, including primary SS in Manhattan, New York. The MLSP was used to provide estimates of the incidence and prevalence of primary SS across major racial/ethnic populations. METHODS MLSP cases were identified from hospitals, rheumatologists, and population databases. Three case definitions were used for primary SS, including physician diagnosis, rheumatologist diagnosis, and modified primary SS criteria. Rates among Manhattan residents were age-adjusted, and capture-recapture analyses were conducted to assess underascertainment of cases. RESULTS By physician diagnosis, age-adjusted overall incidence and prevalence rates of primary SS among adult Manhattan residents were 3.5 and 13.1 per 100,000 person-years, respectively. Capture-recapture adjustment increased incidence and prevalence rates (4.1 and 14.2 per 100,000 person-years, respectively). Based on physician diagnosis, incidence and prevalence rates were approximately 6 times higher among women than men (P < 0.001). Incidence of primary SS was statistically higher among non-Latina Asian women (10.5) and non-Latina white women (6.2) compared with Latina women (3.2). Incidence was also higher among non-Latina Asian women compared with non-Latina black women (3.3). Prevalence of primary SS did not differ by race/ethnicity. Similar trends were observed when more restrictive case definitions were applied. CONCLUSION Data from the MLSP revealed disparities among Manhattan residents in primary SS incidence and prevalence by sex and differences in primary SS incidence by race/ethnicity among women. These data also provided epidemiologic estimates for the major racial/ethnic populations in the US.
Collapse
Affiliation(s)
- Peter M. Izmirly
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY
| | - Jill P. Buyon
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY
| | - Isabella Wan
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY
| | - H. Michael Belmont
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY
| | - Sara Sahl
- Department of Pediatrics, Harbor-University of California Medical Center Los Angeles, CA
| | - Jane E. Salmon
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, Weill Cornell Medical College, New York, NY
| | - Anca Askanase
- Division of Rheumatology, Department of Medicine Columbia University College of Physicians & Surgeons, New York, NY
| | - Joan M. Bathon
- Division of Rheumatology, Department of Medicine Columbia University College of Physicians & Surgeons, New York, NY
| | - Laura Geraldino-Pardilla
- Division of Rheumatology, Department of Medicine Columbia University College of Physicians & Surgeons, New York, NY
| | - Yousaf Ali
- Division of Rheumatology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ellen M. Ginzler
- Division of Rheumatology, Department of Medicine, State University of New York Downstate College of Medicine, Brooklyn, NY
| | - Chaim Putterman
- Division of Rheumatology, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
| | - Caroline Gordon
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Charles G. Helmick
- Arthritis Program, Centers for Disease Control and Prevention, Atlanta, GA
| | - Hilary Parton
- New York City Department of Health and Mental Hygiene, Long Island City, New York
| |
Collapse
|
14
|
Shabana K, Okamoto N, Sugita Y, Shindo K, Murata T, Tamai H, Fujiwara K. The findings of musculoskeletal ultrasonography on primary Sjögren's syndrome patients in childhood with articular manifestations and the impact of anti-cyclic citrullinated peptide antibody. Mod Rheumatol 2018; 29:821-828. [PMID: 30289018 DOI: 10.1080/14397595.2018.1530849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objective: We researched the findings of musculoskeletal ultrasound sonography (MSUS) on primary Sjogren's syndrome in childhood (pSS-C) with articular manifestations. The correlation of rheumatoid factor (RF) and anti-cyclic citrullinated peptide antibody (ACPA) were investigated to evaluate the usefulness of MSUS on their articular prognosis. Method: The objective patients are pSS-C cases who visited our hospital complaining joint pain and/or joint swelling and for whom MSUS was performed. Result: Eight patients included 6 female and 2 male, 5 RF-positive patients and 3 ACPA- positive patients. The mean age of onset was 11.1 ± 3.0 years (352 physical joint findings and 284 MSUS findings. The number of joints found clinical articular manifestations was 58/352 joints, and arthritis detected by MSUS was 30/284 joints). In multivariate analysis, the odds ratio of clinical articular manifestations was significant high in RF-positivity (2.9, 95%CI 1.5-6.2). The odds ratio of arthritis detected by MSUS in ACPA-positivity was significant high (3.7, 95%CI 1.5-11.6), although odds ratio in RF-positivity had no statistical significance and a similar trend was seen in odds ratios of subclinical arthritis (4.9, 95%CI 1.6-18.0). Conclusion: It was indicated that MSUS is useful for pSS-C. ACPA-positive pSS-C patients have arthritis and subclinical arthritis more frequently than ACPA-negative patients.
Collapse
Affiliation(s)
- Kosuke Shabana
- Departments of Pediatrics, Osaka Medical College , Osaka , Japan
| | - Nami Okamoto
- Departments of Pediatrics, Osaka Medical College , Osaka , Japan
| | - Yuko Sugita
- Departments of Pediatrics, Osaka Medical College , Osaka , Japan
| | - Keisuke Shindo
- Departments of Pediatrics, Osaka Medical College , Osaka , Japan
| | - Takuji Murata
- Departments of Pediatrics, Osaka Medical College , Osaka , Japan
| | - Hiroshi Tamai
- Departments of Pediatrics, Osaka Medical College , Osaka , Japan
| | - Kenta Fujiwara
- Departments of Orthopedics, Osaka Medical College , Osaka , Japan
| |
Collapse
|
15
|
Jonsson R, Brokstad KA, Jonsson MV, Delaleu N, Skarstein K. Current concepts on Sjögren's syndrome - classification criteria and biomarkers. Eur J Oral Sci 2018; 126 Suppl 1:37-48. [PMID: 30178554 PMCID: PMC6586012 DOI: 10.1111/eos.12536] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2018] [Indexed: 12/13/2022]
Abstract
Sjögren's syndrome is a lymphoproliferative disease with autoimmune features characterized by mononuclear cell infiltration of exocrine glands, notably the lacrimal and salivary glands. These lymphoid infiltrations lead to dryness of the eyes (keratoconjunctivitis sicca), dryness of the mouth (xerostomia), and, frequently, dryness of other surfaces connected to exocrine glands. Sjögren's syndrome is associated with the production of autoantibodies because B-cell activation is a consistent immunoregulatory abnormality. The spectrum of the disease extends from an organ-specific autoimmune disorder to a systemic process and is also associated with an increased risk of B-cell lymphoma. Current treatments are mainly symptomatic. As a result of the diverse presentation of the syndrome, a major challenge remains to improve diagnosis and therapy. For this purpose an international set of classification criteria for primary Sjögren's syndrome has recently been developed and validated and seems well suited for enrolment in clinical trials. Salivary gland biopsies have been examined and histopathology standards have been developed, to be used in clinical trials and patient stratification. Finally, ultrasonography and saliva meet the need of non-invasive imaging and sampling methods for discovery and validation of disease biomarkers in Sjögren's syndrome.
Collapse
Affiliation(s)
- Roland Jonsson
- Broegelmann Research LaboratoryDepartment of Clinical ScienceUniversity of BergenBergenNorway
- Department of RheumatologyHaukeland University HospitalBergenNorway
| | - Karl A. Brokstad
- Broegelmann Research LaboratoryDepartment of Clinical ScienceUniversity of BergenBergenNorway
| | - Malin V. Jonsson
- Department of Clinical Dentistry – Section for Oral and Maxillofacial RadiologyUniversity of BergenBergenNorway
| | - Nicolas Delaleu
- Broegelmann Research LaboratoryDepartment of Clinical ScienceUniversity of BergenBergenNorway
- 2C SysBioMedContraSwitzerland
| | - Kathrine Skarstein
- Gade Laboratory for PathologyDepartment of Clinical MedicineUniversity of BergenBergenNorway
- Department of PathologyHaukeland University HospitalBergenNorway
| |
Collapse
|
16
|
Clinical and immunological parameters of Sjögren's syndrome. Autoimmun Rev 2018; 17:1053-1064. [DOI: 10.1016/j.autrev.2018.05.005] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 05/13/2018] [Indexed: 02/08/2023]
|
17
|
Extranodal marginal zone B cell lymphoma: An unexpected complication in children with Sjögren's syndrome. ACTA ACUST UNITED AC 2018; 14:227-229. [DOI: 10.1016/j.reuma.2017.01.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 12/21/2016] [Accepted: 01/26/2017] [Indexed: 12/15/2022]
|
18
|
Jonsson MV, Baldini C. Major Salivary Gland Ultrasonography in the Diagnosis of Sjögren’s Syndrome. Rheum Dis Clin North Am 2016; 42:501-17. [DOI: 10.1016/j.rdc.2016.03.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
19
|
Matsui Y, Takenouchi T, Narabayashi A, Ohara K, Nakahara T, Takahashi T. Childhood Sjögren syndrome presenting as acute brainstem encephalitis. Brain Dev 2016; 38:158-62. [PMID: 26006751 DOI: 10.1016/j.braindev.2015.05.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 04/27/2015] [Accepted: 05/11/2015] [Indexed: 11/17/2022]
Abstract
Sjögren syndrome is an autoimmune disease characterized by dry mouth and eyes, known as sicca symptoms. The exact spectrum of neurological involvement, especially of the central nervous system, in childhood Sjögren syndrome has not been well defined. We report a girl who presented with acute febrile brainstem encephalitis. In retrospect, she had exhibited a preceding history of recurrent conjunctivitis and strong halitosis that could be considered as sicca symptoms. The histopathology results of a minor salivary biopsy, the presence of anti-SSA/Ro antibody, and keratoconjunctivitis confirmed the diagnosis of Sjögren syndrome. Commonly observed features in previously reported patients with childhood Sjögren syndrome and central nervous system complications have included fever at the time of neurologic presentation, cerebrospinal fluid pleocytosis, abnormal neuroimaging, and positivity for several specific antibodies. In children presenting with unknown acute febrile encephalopathy, Sjögren syndrome should be included in the differential diagnosis, especially when sicca symptoms are present.
Collapse
Affiliation(s)
- Yoriko Matsui
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Toshiki Takenouchi
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan.
| | | | - Kentaro Ohara
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Tadaki Nakahara
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Takao Takahashi
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| |
Collapse
|
20
|
Moy MM, Mandel L. Identifying Primary Sjögren Syndrome in Children: Case Report. J Oral Maxillofac Surg 2014; 72:2485-90. [DOI: 10.1016/j.joms.2014.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 07/01/2014] [Indexed: 11/16/2022]
|
21
|
Iro H, Zenk J. Salivary gland diseases in children. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2014; 13:Doc06. [PMID: 25587366 PMCID: PMC4273167 DOI: 10.3205/cto000109] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Salivary gland diseases in children are rare, apart from viral-induced diseases. Nevertheless, it is essential for the otolaryngologist to recognize these uncommon findings in children and adolescents and to diagnose and initiate the proper treatment. The present work provides an overview of the entire spectrum of congenital and acquired diseases of the salivary glands in childhood and adolescence. The current literature was reviewed and the results discussed and summarized. Besides congenital diseases of the salivary glands in children, the main etiologies of viral and bacterial infections, autoimmune diseases and tumors of the salivary glands were considered. In addition to the known facts, new developments in diagnostics, imaging and therapy, including sialendoscopy in obstructive diseases and chronic recurrent juvenile sialadenitis were taken into account. In addition, systemic causes of salivary gland swelling and the treatment of sialorrhoea were discussed. Although salivary gland diseases in children are usually included in the pathology of the adult, they differ in their incidence and sometimes in their symptoms. Clinical diagnostics and especially the surgical treatment are influenced by a stringent indications and a less invasive strategy. Due to the rarity of tumors of the salivary glands in children, it is recommended to treat them in a specialized center with greater surgical experience. Altogether the knowledge of the differential diagnoses in salivary gland diseases in children is important for otolaryngologists, to indicate the proper therapeutic approach.
Collapse
Affiliation(s)
- Heinrich Iro
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Erlangen, University of Erlangen-Nuremberg, Germany
| | - Johannes Zenk
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Erlangen, University of Erlangen-Nuremberg, Germany
| |
Collapse
|
22
|
Gommerman JL, Browning JL, Ware CF. The Lymphotoxin Network: orchestrating a type I interferon response to optimize adaptive immunity. Cytokine Growth Factor Rev 2014; 25:139-45. [PMID: 24698108 DOI: 10.1016/j.cytogfr.2014.02.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Accepted: 02/24/2014] [Indexed: 12/13/2022]
Abstract
The Lymphotoxin (LT) pathway is best known for its role in orchestrating the development and homeostasis of lymph nodes and Peyer's patches through the regulation of homeostatic chemokines. More recently an appreciation of the LTβR pathway in the production of Type I interferons (IFN-I) during homeostasis and infection has emerged. LTβR signaling is essential in differentiating stromal cells and macrophages in lymphoid organs to rapidly produce IFN-I in response to virus infections independently of the conventional TLR signaling systems. In addition, LTβR signaling is required to produce homeostatic levels of IFN-I from dendritic cells in order to effectively cross-prime a CD8+ T cell response to protein antigen. Importantly, pharmacological inhibition of LTβR signaling in mice has a profound positive impact on a number of autoimmune disease models, although it remains unclear if this efficacy is linked to IFN-I production during chronic inflammation. In this review, we will provide a brief overview of how the "Lymphotoxin Network" is linked to the IFN-I response and its impact on the immune system.
Collapse
Affiliation(s)
| | - Jeffrey L Browning
- Department of Microbiology and Section of Rheumatology, Boston University School of Medicine, Boston, MA 02118, USA
| | - Carl F Ware
- Infectious and Inflammatory Disease Center, Sanford-Burnham Medical Research Institute, La Jolla, CA 92037, USA.
| |
Collapse
|