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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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Fidalgo M, Faria R, Carvalho C, Carvalheiras G, Mendonça D, Farinha F, da Silva BM, Vasconcelos C. Multiple autoimmune syndrome: Clinical, immunological and genotypic characterization. Eur J Intern Med 2023; 116:119-130. [PMID: 37385917 DOI: 10.1016/j.ejim.2023.06.020] [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] [Received: 02/27/2023] [Revised: 06/17/2023] [Accepted: 06/20/2023] [Indexed: 07/01/2023]
Abstract
INTRODUCTION The existence of subphenotypes common to several autoimmune diseases (AIDs) suggests a shared physiopathology - autoimmune tautology. Multiple Autoimmune Syndrome (MAS) - the coexistence of three or more AIDs in one person-, best illustrates that polyautoimmunity is more than a coincidence. OBJECTIVES Characterize and compare the monoautoimmune and MAS patients. Understand if clustering of AIDs leads to differences in disease severity, autoantibodies expression or genetic polymorphisms that could be markers for polyautoimmunity. METHODS Currently adult patients were selected from unit cohort. MAS was assumed when ≥3 AIDs were present. 343 patients were included after exclusion criteria: having two AIDs or undetermined diagnosis. Clinical and immunological data were collected from medical files. HLA-DRB1 was genotyped by PCR-SSP methodology and PTPN22(rs2476601) polymorphisms by TaqMan Real Time PCR. Data were analysed using Chi-Square, Fisher's exact tests and logistic regression. Odds ratios (OR) and 95% confidence intervals were calculated. RESULTS In comparison with control population: ELEVATED FREQUENCIES: HLA-DRB1*03 in study cohort (OR=3.68,p<0.001) and in monoautoimmune SLE (OR=2.79,p<0.001) and SjS (OR=8.27,p<0.001); HLA-DRB1*15 in monoautoimmune SjS (OR=2.39,p = 0.011); HLA-DRB1*16 in MAS SLE (OR=2.67,p = 0.031); PTPN22_T in all groups except monoautoimmune SjS and triple positive systemic MAS. DIMINISHED FREQUENCIES HLA-DRB1*11 in study cohort (OR=0.57,p = 0.013), in MAS SLE (OR=0.39,p = 0.031) and monoautoimmune SjS (OR=0.10,p = 0.005); HLA-DRB1*13 in study cohort (OR=0.52,p = 0.001) and in monoautoimmune SLE (OR=0.53,p = 0.009) and SjS (OR=0.38,p = 0.031); HLA-DRB1*14 in study cohort (OR=0.32,p = 0.013) and monoautoimmune SLE (OR=0.21,p = 0.021); SLE group: HLA-DRB1*07 frequency was higher in monoautoimmune patients (OR=0.43,p = 0.023). MAS patients had significantly more NPSLE (OR=2.99,p<0.001), subacute cutaneous lesions (OR=2.30,p = 0.037), muscle&tendon (OR=2.00,p = 0.045), and haematological (OR=3.18,p = 0.006) involvement and Raynaud's (OR=2.94,p<0.001). SjS group: MAS patients had more frequently cryoglobulins (OR=2.96,p = 0.030), low complement (OR=2.43,p = 0.030) and Raynaud's (OR=4.38,p<0.001); monoautoimmune patients had more parotid enlargement (OR=0.12,p<0.001). APS group: MAS patients had more non-thrombotic manifestations (OR=4.69,p = 0.020) and Raynaud's (OR=9.12,p<0.001). Triple positive systemic MAS (SLE+SjS+APS) had more frequently severe kidney involvement (OR=11.67,p = 0.021) and CNS thrombosis (OR=4.44,p = 0.009). Anti-U1RNP increased frequency was transversally attributable to MAS. CONCLUSIONS The coexistence of AIDs contributes to a more severe disease course. We confirmed previously established genetic risk and protection factors and suggest a new protective one - HLA-DRB1*14. HLA-DRB1*07 and anti-U1RNP could be markers for mono and polyautoimmunity, respectively; HLA-DRB1*13 could be a predictor for vascular risk in patients with multiple AIDs. PTPN22(rs2476601) polymorphism could be associated with less severe disease.
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Affiliation(s)
- Mariana Fidalgo
- Internal Medicine Resident, Clinical Internship at Unidade de Imunologia Clínica (2), Portugal.
| | - Raquel Faria
- Unidade de Imunologia Clínica, Centro Hospitalar do Porto, Portugal; Unit for Multidisciplinary Research in Biomedicine, Portugal
| | - Cláudia Carvalho
- Unit for Multidisciplinary Research in Biomedicine, Portugal; Laboratório de Imunogenética, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Portugal
| | | | - Denisa Mendonça
- Departamento de Estudos de Populações, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Portugal; EpiUnit, Instituto de Saúde Pública, Universidade do Porto, Portugal
| | - Fátima Farinha
- Unidade de Imunologia Clínica, Centro Hospitalar do Porto, Portugal; Unit for Multidisciplinary Research in Biomedicine, Portugal
| | - Berta Martins da Silva
- Unit for Multidisciplinary Research in Biomedicine, Portugal; Laboratório de Imunogenética, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Portugal
| | - Carlos Vasconcelos
- Unidade de Imunologia Clínica, Centro Hospitalar do Porto, Portugal; Unit for Multidisciplinary Research in Biomedicine, Portugal
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Gianordoli APE, Laguardia RVRB, Santos MCFS, Jorge FC, da Silva Salomão A, Caser LC, Moulaz IR, Serrano ÉV, Miyamoto ST, Machado KLLL, Valim V. Prevalence of Sjögren's syndrome according to 2016 ACR-EULAR classification criteria in patients with systemic lupus erythematosus. Adv Rheumatol 2023; 63:11. [PMID: 36918938 DOI: 10.1186/s42358-022-00280-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 11/19/2022] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Diagnosis of SS is a complex task, as no symptom or test is unique to this syndrome. The American-European Consensus Group (AECG 2002) and the American-European classification criteria of 2016 (ACR/EULAR 2016) emerged through a search for consensus. This study aims to assess the prevalence of Sjögren's Syndrome (SS) in patients with Systemic Lupus Erythematosus (SLE), according to AECG 2002 and ACR-EULAR 2016 classifications, as well as clinical and histopathological features in this overlap. To date, there is no study that has evaluated SS in SLE, using the two current criteria. METHODS This cross-sectional study evaluated 237 SLE patients at the outpatient rheumatology clinic between 2016 and 2018. Patients were submitted to a dryness questionnaire, whole unstimulated salivary flow (WUSF), "Ocular Staining Score" (OSS), Schirmer's test I (ST-I), and labial salivary gland biopsy (LSGB). RESULTS After verifying inclusion and exclusion criteria, a total of 117 patients were evaluated, with predominance of females (94%) and mixed ethnicity (49.6%). The prevalence of SS was 23% according to AECG 2002 and 35% to ACR-EULAR 2016. Kappa agreement between AECG 2002 and ACR-EULAR 2016 were 0.7 (p < 0.0001). After logistic regression, predictors for SS were: anti/Ro (OR = 17.86, p < 0.05), focal lymphocytic sialadenitis (OR = 3.69, p < 0.05), OSS ≥ 5 (OR = 7.50, p < 0.05), ST I positive (OR = 2.67, p < 0.05), and WUSF ≤ 0.1 mL/min (OR = 4.13, p < 0.05). CONCLUSION The prevalence of SS in SLE was 23% (AECG 2002) and 35% (ACR-EULAR 2016). The presence of glandular dysfunction, focal lymphocytic sialadenitis, and anti/Ro were predictors of SS in SLE. The greatest advantage of the new ACR-EULAR 2016 criteria is to enable an early diagnosis and identify the overlapping of these two diseases. ACR-EULAR 2016 criteria is not yet validated for secondary SS and this study is a pioneer in investigating prevalence based on the new criteria.
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Affiliation(s)
- Ana Paula Espíndula Gianordoli
- Rheumatology Division, University Hospital Cassiano Antônio Moraes of Federal University of Espírito Santo (HUCAM-UFES/EBSERH), Mal. Campos Avenue, n° 1355, Santos Dumont, Vitória, ES, 29041-295, Brazil
| | | | - Maria Carmen F S Santos
- Pathology Department, Science Health Centre, University Hospital (HUCAM-UFES/EBSERH), Federal University of Espirito Santo, Vitória, Brazil
| | | | | | | | | | - Érica Vieira Serrano
- Rheumatology Division, University Hospital Cassiano Antônio Moraes of Federal University of Espírito Santo (HUCAM-UFES/EBSERH), Mal. Campos Avenue, n° 1355, Santos Dumont, Vitória, ES, 29041-295, Brazil
| | | | - Ketty Lysie Libardi Lira Machado
- Rheumatology Division, University Hospital Cassiano Antônio Moraes of Federal University of Espírito Santo (HUCAM-UFES/EBSERH), Mal. Campos Avenue, n° 1355, Santos Dumont, Vitória, ES, 29041-295, Brazil
| | - Valéria Valim
- Rheumatology Division, University Hospital Cassiano Antônio Moraes of Federal University of Espírito Santo (HUCAM-UFES/EBSERH), Mal. Campos Avenue, n° 1355, Santos Dumont, Vitória, ES, 29041-295, Brazil.
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Felten R, Meyer A, Gottenberg JE. Non-primary Sjogren's Syndrome: Secondary or associated? Joint Bone Spine 2023; 90:105502. [PMID: 36464213 DOI: 10.1016/j.jbspin.2022.105502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2022] [Indexed: 12/03/2022]
Affiliation(s)
- Renaud Felten
- Service de rhumatologie, centre national de référence des maladies autoimmunes et systémiques rares (CNR RESO), laboratoire d'immunopathologie et de chimie thérapeutique, institut de biologie moléculaire et cellulaire (IBMC), CNRS UPR3572, hôpital de Hautepierre, 1, avenue Molière, BP 83049, 67098 Strasbourg Cedex, France
| | - Alain Meyer
- Service d'exploration fonctionnelle musculaire, service de rhumatologie, centre national de référence des maladies autoimmunes et systémiques rares (CNR RESO), hôpital de Hautepierre, 1, avenue Molière, BP 83049, 67098 Strasbourg cedex, France
| | - Jacques-Eric Gottenberg
- Service de rhumatologie, centre national de référence des maladies autoimmunes et systémiques rares (CNR RESO), laboratoire d'immunopathologie et de chimie thérapeutique, institut de biologie moléculaire et cellulaire (IBMC), CNRS UPR3572, hôpital de Hautepierre, 1, avenue Molière, BP 83049, 67098 Strasbourg Cedex, France.
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Hammam N, Elzohri MH, Elsonbaty A, Eldaly ZH, Hammam O, Tarik D, Ibrahim HM, Gheita TA. Diagnostic value of salivary gland ultrasonography for secondary Sjögren syndrome in patients with systemic lupus erythematosus. Lupus 2022; 31:1045-1053. [PMID: 35514317 DOI: 10.1177/09612033221100154] [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: 11/15/2022]
Abstract
BACKGROUND Salivary gland ultrasound (SGUS) is a reliable technique for assessing the salivary glands in patients with primary Sjögren's syndrome (SS); however, the role of SGUS for diagnosis of secondary SS (sSS) in patients with systemic lupus erythematosus (SLE) was not examined. OBJECTIVE To assess the diagnostic value of SGUS for sSS in patients with SLE, and to investigate the relationship between SGUS findings with clinical and laboratory characteristics of patients with SLE. PATIENTS AND METHODS This cross-sectional study included 49 patients with SLE. The diagnosis of sSS was confirmed according to the 2016 ACR/EULAR criteria. Salivary gland US was performed for all patients and graded using a validated Hočevar scoring system. A complete clinical and laboratory workup for SLE was assessed. Schirmer's test and the ocular staining were performed. RESULTS Of the 49 patients with a mean age of 30.2 ± 9.6 years, 98% were female. 19 (38.8%) had sSS. SGUS changes consistent with sSS (≥17) were found in 29 (59.2%) of the patients. Patients with higher SGUS score had more sicca findings as well as positive anti-Ro, anti-La antibodies, and poorer psychological stress (p < 0.05). The SGUS (≥17) showed a sensitivity of 84.2% and a specificity of 56.7% for sSS diagnosis, with an area under the curve of 0.77 (95% CI: 0.63, 0.91). CONCLUSION We propose salivary gland ultrasound as a non-invasive method in the diagnostic workup for sSS in patients with SLE. Further studies to confirm the diagnostic value of SGUS in a larger sample of patients with sSS will be necessary.
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Affiliation(s)
- Nevin Hammam
- Rheumatology Department, 68797Assiut University Hospitals, Assiut, Egypt
| | - Mona H Elzohri
- Faculty of Medicine, Department of Internal Medicine, Rheumatology and Clinical Immunology unit, 68797Assiut University, Assiut, Egypt
| | - Amira Elsonbaty
- Rheumatology Department, 68797Assiut University Hospitals, Assiut, Egypt
| | - Zeiad H Eldaly
- Department of Ophthalmology, 68797Assiut University, Assiut, Egypt
| | - Osman Hammam
- Assiut University Hospitals, 68797Assiut University, Assiut Egypt
| | - Dalia Tarik
- Clinical Pathology Department, 68797Assiut University Hospitals, Assiut, Egypt
| | - Hamdy M Ibrahim
- Department of Diagnostic Radiology, Faculty of Medicine, 68797Assiut University, Assiut, Egypt
| | - Tamer A Gheita
- Rheumatology Department, Faculty of Medicine, 63527Cairo University, Cairo, Egypt
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Abstract
OBJECTIVES To investigate dry eye disease (DED) in patients affected by systemic lupus erythematosus (SLE). METHODS We conducted a systematic search of the literature on PubMed, EMBASE and the Cochrane Library databases from conception to 30 April 2020 for studies related to dry eye, secondary Sjögren's syndrome (sSS) and SLE. Original full-text articles with the number of patients diagnosed with SLE of over 15 were included. The risk of bias was evaluated with a validated critical appraisal tool which assessed study quality based on confounding factors, selection bias, bias related to measurement and bias related to data analysis. Data were extracted and pooled to evaluate the overall prevalence of DED with the random-effect model and sSS with the fixed effect model. RESULTS A total of 29 studies were included and 18 273 participants were involved. The pooled data showed that the overall prevalence of DED was 16% (95% CI 10% to 21%, p<0.001) in patients of SLE. Dry eye symptoms and abnormal Schirmer's test were found in 26% (95% CI 20% to 32%, p<0.001) and 24% (95% CI 14% to 34%, p<0.001) of patients with SLE, respectively. 12% (95% CI 9% to 15%, p<0.001) of patients also met the criteria of sSS. The OR of DED in patients with SLE was 4.26 (95% CI 3.47 to 5.05, p<0.001) compared with healthy controls. The meta-regression analysis showed that the sample size (p=0.004) and study location (p=0.022) could be the source of heterogeneity. CONCLUSIONS DED and sSS are both common in patients with SLE.
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Affiliation(s)
- Lixiang Wang
- Department of Ophthalmology, Sichuan University West China Hospital, Chengdu, Sichuan Province, China
| | - Yan Xie
- Department of Rheumatology and Immunology, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Yingping Deng
- Department of Ophthalmology, Sichuan University West China Hospital, Chengdu, Sichuan Province, China
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The other connective tissue disease-associated interstitial lung diseases: Sjogren's syndrome, mixed connective tissue disease, and systemic lupus erythematosus. Curr Opin Pulm Med 2021; 27:388-395. [PMID: 34127620 DOI: 10.1097/mcp.0000000000000791] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW We review the clinical manifestations of three less common connective tissue disease (CTD)-associated interstitial lung diseases (ILDs): Sjogren's syndrome (SjS), mixed CTD (MCTD), and systemic lupus erythematosus (SLE). RECENT FINDINGS SjS is classically associated with lymphocytic interstitial pneumonia and cystic lung disease, but the most common type of ILD in Sjogren's patients is nonspecific interstitial pneumonia. ILD is prevalent in MCTD and associated with worse survival. SLE-associated ILD, while rare, is more common in those with CTD overlap syndromes. Regardless of underlying cause, a subset of patients with fibrotic CTD-associated ILD develop a progressive course for which antifibrotic agents and lung transplantation should be considered. SUMMARY An understanding of the characteristics of ILD in SjS, MCTD, and SLE is important for the pulmonary specialist. Future research should identify risk factors for progression and develop additional treatment modalities for both CTD-related autoimmune features and progressive ILD.
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McDonald J, Vega-Fernandez P, Ting T. Findings and feasibility of major salivary gland ultrasound in childhood-onset systemic lupus erythematosus: a pilot study. Pediatr Rheumatol Online J 2021; 19:73. [PMID: 34001167 PMCID: PMC8130521 DOI: 10.1186/s12969-021-00561-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 05/05/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Childhood-onset systemic lupus erythematosus (cSLE) is a complex autoimmune disorder with multi-organ manifestations and can be associated with other rheumatic diseases including Sjögren's syndrome (SS). Salivary gland ultrasound (SGUS) represents a noninvasive tool to screen for salivary gland disease in rheumatic disease patients. The aims of this cross-sectional study were to determine feasibility of major SGUS in a clinic setting and to identify characteristics in a cohort of cSLE patients (without confirmed SS) that may be associated with salivary gland abnormalities consistent with secondary SS. METHODS Patients with SLE onset prior to age 18 were recruited. Patients completed questionnaires rating symptoms and underwent major SGUS examination. Disease and demographic differences were compared between cSLE patients with abnormal SGUS vs. cSLE patients with normal SGUS using t-tests and Fisher's exact tests. RESULTS Thirty-one cSLE patients were recruited, 84% were female, 55% were Caucasian. The average disease duration among all patients was 5 years. Average time to complete the SGUS examination and scoring protocol was 7 min. 35% of SGUS scores were abnormal and significantly associated with IgG level at diagnosis, and anti-Ro and anti-La antibodies. CONCLUSIONS This is one of the first studies to our knowledge that assesses major SGUS in a cohort of patients with cSLE without prior diagnoses of SS. The SGUS protocol was feasible to perform by rheumatologists in a clinic setting. Although the sample size was small, SGUS abnormalities were identified in one-third of patients. IgG level at diagnosis and anti-Ro and anti-La antibodies may be associated with SGUS abnormalities.
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Affiliation(s)
- Joseph McDonald
- Division of Pediatric Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | - Patricia Vega-Fernandez
- grid.239573.90000 0000 9025 8099Division of Pediatric Rheumatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA
| | - Tracy Ting
- grid.239573.90000 0000 9025 8099Division of Pediatric Rheumatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA
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Price E, Allen A, Rauz S, Tappuni A, Sutcliffe N, Bombardieri M, Carty S, Ciurtin C, Crampton B, Duncalfe L, Fisher B, Glennon P, Hackett KL, Larkin G, Ng WF, Ramanan AV, Rassam S, Walsh SB, Bowman S. The management of Sjögren's syndrome: British Society for Rheumatology guideline scope. Rheumatology (Oxford) 2021; 60:2122-2127. [PMID: 33331922 DOI: 10.1093/rheumatology/keaa870] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 12/01/2020] [Accepted: 12/01/2020] [Indexed: 11/13/2022] Open
Abstract
The guideline will be developed using the methods and processes outlined in Creating Clinical Guidelines: Our Protocol [1]. This development process to produce guidance, advice and recommendations for practice has National Institute for Health and Care Excellence (NICE) accreditation.
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Affiliation(s)
| | | | - Saaeha Rauz
- Academic Unit of Ophthalmology, Birmingham and Midland, Eye Centre, University of Birmingham, Birmingham
| | | | - Nurhan Sutcliffe
- Department of Rheumatology, Mile End Hospital, Barts and The London School of Medicine and Dentistry, Queen Mary University of London
| | - Michele Bombardieri
- William Harvey Research Institute, Centre for Experimental Medicine and Rheumatology, London
| | - Sara Carty
- Rheumatology , Great Western Hospital, Swindon
| | - Coziana Ciurtin
- Department of Rheumatology, University College London Hospitals NHS Trust, London
| | | | - Lisa Duncalfe
- Rheumatology, New Queen Elizabeth Hospital Birmingham
| | - Benjamin Fisher
- Rheumatology Research Group, Centre for Translational Inflammation Research, University of Birmingham Research Laboratories, Queen Elizabeth Hospital, Birmingham
| | | | - Katie L Hackett
- Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne
| | - Genevieve Larkin
- Ophthalmology, King's College Hospital NHS Foundation Trust, London
| | - Wan-Fai Ng
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne
| | - Athimalaipet V Ramanan
- Paediatric Rheumatology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol
| | - Saad Rassam
- Haemato-Oncology, Maidstone and Tunbridge Wells NHS Trust, Maidstone
| | - Stephen B Walsh
- Centre for Nephrology, University College London, UCL Hampstead Campus, Royal Free Hospital, London
| | - Simon Bowman
- Rheumatology Department, Selly Oak Hospital, University Hospital Birmingham, Birmingham, UK
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Ogata K, Matsumura-Kawashima M, Moriyama M, Kawado T, Nakamura S. Dental pulp-derived stem cell-conditioned media attenuates secondary Sjögren's syndrome via suppression of inflammatory cytokines in the submandibular glands. Regen Ther 2021; 16:73-80. [PMID: 33659580 PMCID: PMC7878993 DOI: 10.1016/j.reth.2021.01.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 01/01/2021] [Accepted: 01/16/2021] [Indexed: 12/24/2022] Open
Abstract
Introduction Sjögren's syndrome (SS) is a chronic inflammatory autoimmune disease, which affects the exocrine glands. Its primary symptoms are decreased moisture in the mouth and eyes. Therapies are limited to treatment with steroids, which has unpleasant side effects, so new treatments would be beneficial. One possibility might be stem cells, such as bone marrow mesenchymal stem cells (BMMSCs) or dental pulp-derived stem cells (DPSCs); these have been reported to exert immunomodulatory effects on activated lymphoid cells. This study aimed to evaluate the effects of conditioned media from DPSCs (DPSC-CM) or BMMSCs (BMMSC-CM) on salivary functions in SS. Methods Cytokine array analysis was performed to assess the types of cytokines present in the media. DPSC-CM or BMMSC-CM was administered in an SS mouse model. Histological analysis of the salivary glands was performed, and gene expression levels of inflammatory and anti-inflammatory cytokines in the submandibular glands (SMGs) were evaluated. Results DPSC-CM contained more anti-inflammatory factors than BMMSC-CM. The mice that were given DPSC-CM had a lower number of inflammation sites in the SMGs than those in the other experimental groups, and their salivary flow rate increased. The expression levels of interleukin (IL)-10 and transforming growth factor-β1 increased in the DPSC-CM group, while those of Il-4, Il-6, and Il-17a decreased. The mice that received DPSC-CM showed a significantly increased percentage of regulatory T cells and a significantly decreased percentage of type T helper 17 cells compared to other groups. Conclusions These results indicate that DPSC-CM could be an effective therapy for SS-induced hyposalivation, since it decreases the number of inflammatory cytokines and regulates the local inflammatory microenvironment in the SMGs.
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Management of Severe Refractory Systemic Lupus Erythematosus: Real-World Experience and Literature Review. Clin Rev Allergy Immunol 2020; 60:17-30. [PMID: 33159635 DOI: 10.1007/s12016-020-08817-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2020] [Indexed: 12/11/2022]
Abstract
Systemic lupus erythematosus (SLE) is a highly heterogeneous disease affecting multiple organs and is characterized by an aberrant immune response. Although the mortality of SLE has decreased significantly since the application of glucocorticoids, severe or refractory SLE can potentially cause irreversible organ damage and contribute to the disease morbidity and mortality. Early recognition of severe SLE or life-threatening conditions is of great challenge to clinicians since the onset symptoms can be rapid and aggressive, involving the visceral organs of the neuropsychiatric, gastrointestinal, hematologic, renal, pulmonary, and cardiovascular systems, etc. Additionally, SLE patients with specific comorbidities and detrimental complications could lead to a clinical dilemma and contribute to poor prognosis. Prompt and adequate treatment for severe refractory SLE is crucial for a better prognosis. However, as evidence from well-designed randomized controlled trials is limited, this review aims to provide real-world evidence based on cohort studies from Peking Union Medical College Hospital, the national tertiary referral center in China, together with the literature, on clinical characteristics, risks and prognostic factors, and treatment strategies for severe and/or refractory SLE.
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Benli M, Batool F, Stutz C, Petit C, Jung S, Huck O. Orofacial manifestations and dental management of systemic lupus erythematosus: A review. Oral Dis 2020; 27:151-167. [PMID: 31886584 DOI: 10.1111/odi.13271] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 12/14/2019] [Accepted: 12/24/2019] [Indexed: 12/14/2022]
Abstract
Systemic lupus erythematosus (SLE) is an autoimmune multisystem disease with numerous clinical manifestations. There is no consensus about the ideal oral management for this group of patients to date. This review aimed to describe the broad spectrum of orofacial and clinical manifestations and their therapeutic approaches. Studies concerning orofacial manifestations of SLE and dental treatment modalities were selected by a literature search (1978-2019) using Google Scholar, PubMed/MEDLINE electronic databases. The initial search strategy provided a total of 129 articles, and of these, 30 were included for qualitative synthesis. The reviewed studies revealed that SLE patients are more at risk of compromised oral and dental health exhibiting increased risk of periodontal diseases and temporomandibular joint disorders. The use of systemic drugs especially immunosuppressive and anticoagulants in SLE patients may also influence their oral management. Results emphasize the need to carry out, at an early stage of the disease, an appropriate oral management of these patients to improve oral health-related quality of life and to prevent the need of more invasive therapeutics. A multidisciplinary approach is needed for dental and medical management of such patients.
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Affiliation(s)
- Merve Benli
- Department of Prosthodontics, Faculty of Dentistry, Istanbul University, Istanbul, Turkey
| | - Fareeha Batool
- INSERM, UMR 1260 'Osteoarticular and Dental Regenerative Nanomedicine', Faculté de Médecine, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France.,Faculté de Chirurgie Dentaire, Université de Strasbourg, Strasbourg, France
| | - Céline Stutz
- INSERM, UMR 1260 'Osteoarticular and Dental Regenerative Nanomedicine', Faculté de Médecine, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France
| | - Catherine Petit
- INSERM, UMR 1260 'Osteoarticular and Dental Regenerative Nanomedicine', Faculté de Médecine, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France.,Faculté de Chirurgie Dentaire, Université de Strasbourg, Strasbourg, France.,Pôle de Médecine et de Chirurgie Bucco-Dentaires, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Sophie Jung
- Faculté de Chirurgie Dentaire, Université de Strasbourg, Strasbourg, France.,Pôle de Médecine et de Chirurgie Bucco-Dentaires, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,CNRS UPR 3572 "Immunologie, Immunopathologie et Chimie Thérapeutique (I2CT)", Institut de Biologie Moléculaire et Cellulaire (IBMC), Strasbourg, France
| | - Olivier Huck
- INSERM, UMR 1260 'Osteoarticular and Dental Regenerative Nanomedicine', Faculté de Médecine, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France.,Faculté de Chirurgie Dentaire, Université de Strasbourg, Strasbourg, France.,Pôle de Médecine et de Chirurgie Bucco-Dentaires, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
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Ruacho G, Kvarnström M, Zickert A, Oke V, Rönnelid J, Eketjäll S, Elvin K, Gunnarsson I, Svenungsson E. Sjögren Syndrome in Systemic Lupus Erythematosus: A Subset Characterized by a Systemic Inflammatory State. J Rheumatol 2019; 47:865-875. [PMID: 31523050 DOI: 10.3899/jrheum.190250] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE An often-neglected subset of patients with systemic lupus erythematosus (SLE) is those with secondary Sjögren syndrome (SLE-sSS). Further, primary SS overlaps and can be difficult to delineate from SLE. To shed light on the SLE-sSS subset, we investigated a large and well-characterized SLE cohort, comparing patients with SLE-sSS and SLE patients without SS (SLE-nonsSS) and controls. METHODS We included 504 consecutive patients with SLE, fulfilling the 1982 revised American College of Rheumatology criteria, and 319 controls from the general population, matched for age and sex to the first 319 patients. SLE-sSS was defined according to the American-European Consensus Criteria (AECC). A thorough clinical examination, including subjective and objective quantifications of sicca symptoms, was performed in all participants. Autoantibodies and 20 selected cytokines were measured by luminex and multiplex analysis, respectively. RESULTS SLE-sSS, as defined by AECC, occurred in 23% of the patients with SLE. In comparison to SLE-nonsSS, the SLE-sSS group was older and more frequently female. Leukopenia and peripheral neuropathy were more frequent and nephritis less frequent. Circulating levels of 6/20 investigated proinflammatory cytokines [tumor necrosis factor-α, interleukin (IL) 6, monocyte chemoattractant protein 4, macrophage inflammatory protein 1β, IL-12/IL-23p40, and interferon γ-induced protein 10], total IgG, anti-SSA/Ro52, anti-SSA/Ro60, anti-SSB/La antibodies, and rheumatoid factor (IgM and IgA) were higher in the SLE-sSS group (p < 0.05 for all comparisons). CONCLUSION The frequency of SLE-sSS increased with age and affected roughly one-quarter of all patients with SLE. Despite less internal organ involvement, a systemic inflammatory state with high levels of proinflammatory cytokines is present in the SLE-sSS subgroup. This is a novel observation that may affect future understanding and treatment of the SLE-sSS subset.
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Affiliation(s)
- Guillermo Ruacho
- From the Department of Medicine Solna, Division of Rheumatology, Karolinska Institutet, Stockholm; Karolinska University Hospital, Stockholm; Karolinska Institutet/AstraZeneca Integrated Cardio Metabolic Centre (KI-AZ ICMC), Stockholm; Department of Medicine Solna, Division of Immunology and Allergy, Karolinska Institutet, Stockholm; Center for Clinical Research, Uppsala University, Sörmland; Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala; Cardiovascular, Renal and Metabolism, Innovative Medicines and Early Development (IMED) Biotech Unit, AstraZeneca, Huddinge, Sweden.,G. Ruacho, DMD, Department of Medicine Solna, Division of Rheumatology, Karolinska Institutet, and Center for Clinical Research, Uppsala University; M. Kvarnström, MD, PhD, Department of Medicine Solna, Division of Rheumatology, Karolinska Institutet, and Karolinska University Hospital; A. Zickert, MD, PhD, Department of Medicine Solna, Division of Rheumatology, Karolinska Institutet, and Karolinska University Hospital; V. Oke, MD, PhD, Department of Medicine Solna, Division of Rheumatology, Karolinska Institutet, and Karolinska University Hospital; J. Rönnelid, MD, PhD, Department of Immunology, Genetics and Pathology, Uppsala University; S. Eketjäll, PhD, Cardiovascular, Renal and Metabolism, IMED Biotech Unit, AstraZeneca, and KI-AZ ICMC; K. Elvin, MD, PhD, Department of Medicine Solna, Division of Immunology and Allergy, Karolinska Institutet and Karolinska University Hospital; I. Gunnarsson, MD, PhD, Department of Medicine Solna, Division of Rheumatology, Karolinska Institutet, and Karolinska University Hospital; E. Svenungsson, MD, PhD, Department of Medicine Solna, Division of Rheumatology, Karolinska Institutet, and Karolinska University Hospital
| | - Marika Kvarnström
- From the Department of Medicine Solna, Division of Rheumatology, Karolinska Institutet, Stockholm; Karolinska University Hospital, Stockholm; Karolinska Institutet/AstraZeneca Integrated Cardio Metabolic Centre (KI-AZ ICMC), Stockholm; Department of Medicine Solna, Division of Immunology and Allergy, Karolinska Institutet, Stockholm; Center for Clinical Research, Uppsala University, Sörmland; Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala; Cardiovascular, Renal and Metabolism, Innovative Medicines and Early Development (IMED) Biotech Unit, AstraZeneca, Huddinge, Sweden.,G. Ruacho, DMD, Department of Medicine Solna, Division of Rheumatology, Karolinska Institutet, and Center for Clinical Research, Uppsala University; M. Kvarnström, MD, PhD, Department of Medicine Solna, Division of Rheumatology, Karolinska Institutet, and Karolinska University Hospital; A. Zickert, MD, PhD, Department of Medicine Solna, Division of Rheumatology, Karolinska Institutet, and Karolinska University Hospital; V. Oke, MD, PhD, Department of Medicine Solna, Division of Rheumatology, Karolinska Institutet, and Karolinska University Hospital; J. Rönnelid, MD, PhD, Department of Immunology, Genetics and Pathology, Uppsala University; S. Eketjäll, PhD, Cardiovascular, Renal and Metabolism, IMED Biotech Unit, AstraZeneca, and KI-AZ ICMC; K. Elvin, MD, PhD, Department of Medicine Solna, Division of Immunology and Allergy, Karolinska Institutet and Karolinska University Hospital; I. Gunnarsson, MD, PhD, Department of Medicine Solna, Division of Rheumatology, Karolinska Institutet, and Karolinska University Hospital; E. Svenungsson, MD, PhD, Department of Medicine Solna, Division of Rheumatology, Karolinska Institutet, and Karolinska University Hospital
| | - Agneta Zickert
- From the Department of Medicine Solna, Division of Rheumatology, Karolinska Institutet, Stockholm; Karolinska University Hospital, Stockholm; Karolinska Institutet/AstraZeneca Integrated Cardio Metabolic Centre (KI-AZ ICMC), Stockholm; Department of Medicine Solna, Division of Immunology and Allergy, Karolinska Institutet, Stockholm; Center for Clinical Research, Uppsala University, Sörmland; Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala; Cardiovascular, Renal and Metabolism, Innovative Medicines and Early Development (IMED) Biotech Unit, AstraZeneca, Huddinge, Sweden.,G. Ruacho, DMD, Department of Medicine Solna, Division of Rheumatology, Karolinska Institutet, and Center for Clinical Research, Uppsala University; M. Kvarnström, MD, PhD, Department of Medicine Solna, Division of Rheumatology, Karolinska Institutet, and Karolinska University Hospital; A. Zickert, MD, PhD, Department of Medicine Solna, Division of Rheumatology, Karolinska Institutet, and Karolinska University Hospital; V. Oke, MD, PhD, Department of Medicine Solna, Division of Rheumatology, Karolinska Institutet, and Karolinska University Hospital; J. Rönnelid, MD, PhD, Department of Immunology, Genetics and Pathology, Uppsala University; S. Eketjäll, PhD, Cardiovascular, Renal and Metabolism, IMED Biotech Unit, AstraZeneca, and KI-AZ ICMC; K. Elvin, MD, PhD, Department of Medicine Solna, Division of Immunology and Allergy, Karolinska Institutet and Karolinska University Hospital; I. Gunnarsson, MD, PhD, Department of Medicine Solna, Division of Rheumatology, Karolinska Institutet, and Karolinska University Hospital; E. Svenungsson, MD, PhD, Department of Medicine Solna, Division of Rheumatology, Karolinska Institutet, and Karolinska University Hospital
| | - Vilija Oke
- From the Department of Medicine Solna, Division of Rheumatology, Karolinska Institutet, Stockholm; Karolinska University Hospital, Stockholm; Karolinska Institutet/AstraZeneca Integrated Cardio Metabolic Centre (KI-AZ ICMC), Stockholm; Department of Medicine Solna, Division of Immunology and Allergy, Karolinska Institutet, Stockholm; Center for Clinical Research, Uppsala University, Sörmland; Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala; Cardiovascular, Renal and Metabolism, Innovative Medicines and Early Development (IMED) Biotech Unit, AstraZeneca, Huddinge, Sweden.,G. Ruacho, DMD, Department of Medicine Solna, Division of Rheumatology, Karolinska Institutet, and Center for Clinical Research, Uppsala University; M. Kvarnström, MD, PhD, Department of Medicine Solna, Division of Rheumatology, Karolinska Institutet, and Karolinska University Hospital; A. Zickert, MD, PhD, Department of Medicine Solna, Division of Rheumatology, Karolinska Institutet, and Karolinska University Hospital; V. Oke, MD, PhD, Department of Medicine Solna, Division of Rheumatology, Karolinska Institutet, and Karolinska University Hospital; J. Rönnelid, MD, PhD, Department of Immunology, Genetics and Pathology, Uppsala University; S. Eketjäll, PhD, Cardiovascular, Renal and Metabolism, IMED Biotech Unit, AstraZeneca, and KI-AZ ICMC; K. Elvin, MD, PhD, Department of Medicine Solna, Division of Immunology and Allergy, Karolinska Institutet and Karolinska University Hospital; I. Gunnarsson, MD, PhD, Department of Medicine Solna, Division of Rheumatology, Karolinska Institutet, and Karolinska University Hospital; E. Svenungsson, MD, PhD, Department of Medicine Solna, Division of Rheumatology, Karolinska Institutet, and Karolinska University Hospital
| | - Johan Rönnelid
- From the Department of Medicine Solna, Division of Rheumatology, Karolinska Institutet, Stockholm; Karolinska University Hospital, Stockholm; Karolinska Institutet/AstraZeneca Integrated Cardio Metabolic Centre (KI-AZ ICMC), Stockholm; Department of Medicine Solna, Division of Immunology and Allergy, Karolinska Institutet, Stockholm; Center for Clinical Research, Uppsala University, Sörmland; Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala; Cardiovascular, Renal and Metabolism, Innovative Medicines and Early Development (IMED) Biotech Unit, AstraZeneca, Huddinge, Sweden.,G. Ruacho, DMD, Department of Medicine Solna, Division of Rheumatology, Karolinska Institutet, and Center for Clinical Research, Uppsala University; M. Kvarnström, MD, PhD, Department of Medicine Solna, Division of Rheumatology, Karolinska Institutet, and Karolinska University Hospital; A. Zickert, MD, PhD, Department of Medicine Solna, Division of Rheumatology, Karolinska Institutet, and Karolinska University Hospital; V. Oke, MD, PhD, Department of Medicine Solna, Division of Rheumatology, Karolinska Institutet, and Karolinska University Hospital; J. Rönnelid, MD, PhD, Department of Immunology, Genetics and Pathology, Uppsala University; S. Eketjäll, PhD, Cardiovascular, Renal and Metabolism, IMED Biotech Unit, AstraZeneca, and KI-AZ ICMC; K. Elvin, MD, PhD, Department of Medicine Solna, Division of Immunology and Allergy, Karolinska Institutet and Karolinska University Hospital; I. Gunnarsson, MD, PhD, Department of Medicine Solna, Division of Rheumatology, Karolinska Institutet, and Karolinska University Hospital; E. Svenungsson, MD, PhD, Department of Medicine Solna, Division of Rheumatology, Karolinska Institutet, and Karolinska University Hospital
| | - Susanna Eketjäll
- From the Department of Medicine Solna, Division of Rheumatology, Karolinska Institutet, Stockholm; Karolinska University Hospital, Stockholm; Karolinska Institutet/AstraZeneca Integrated Cardio Metabolic Centre (KI-AZ ICMC), Stockholm; Department of Medicine Solna, Division of Immunology and Allergy, Karolinska Institutet, Stockholm; Center for Clinical Research, Uppsala University, Sörmland; Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala; Cardiovascular, Renal and Metabolism, Innovative Medicines and Early Development (IMED) Biotech Unit, AstraZeneca, Huddinge, Sweden.,G. Ruacho, DMD, Department of Medicine Solna, Division of Rheumatology, Karolinska Institutet, and Center for Clinical Research, Uppsala University; M. Kvarnström, MD, PhD, Department of Medicine Solna, Division of Rheumatology, Karolinska Institutet, and Karolinska University Hospital; A. Zickert, MD, PhD, Department of Medicine Solna, Division of Rheumatology, Karolinska Institutet, and Karolinska University Hospital; V. Oke, MD, PhD, Department of Medicine Solna, Division of Rheumatology, Karolinska Institutet, and Karolinska University Hospital; J. Rönnelid, MD, PhD, Department of Immunology, Genetics and Pathology, Uppsala University; S. Eketjäll, PhD, Cardiovascular, Renal and Metabolism, IMED Biotech Unit, AstraZeneca, and KI-AZ ICMC; K. Elvin, MD, PhD, Department of Medicine Solna, Division of Immunology and Allergy, Karolinska Institutet and Karolinska University Hospital; I. Gunnarsson, MD, PhD, Department of Medicine Solna, Division of Rheumatology, Karolinska Institutet, and Karolinska University Hospital; E. Svenungsson, MD, PhD, Department of Medicine Solna, Division of Rheumatology, Karolinska Institutet, and Karolinska University Hospital
| | - Kerstin Elvin
- From the Department of Medicine Solna, Division of Rheumatology, Karolinska Institutet, Stockholm; Karolinska University Hospital, Stockholm; Karolinska Institutet/AstraZeneca Integrated Cardio Metabolic Centre (KI-AZ ICMC), Stockholm; Department of Medicine Solna, Division of Immunology and Allergy, Karolinska Institutet, Stockholm; Center for Clinical Research, Uppsala University, Sörmland; Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala; Cardiovascular, Renal and Metabolism, Innovative Medicines and Early Development (IMED) Biotech Unit, AstraZeneca, Huddinge, Sweden.,G. Ruacho, DMD, Department of Medicine Solna, Division of Rheumatology, Karolinska Institutet, and Center for Clinical Research, Uppsala University; M. Kvarnström, MD, PhD, Department of Medicine Solna, Division of Rheumatology, Karolinska Institutet, and Karolinska University Hospital; A. Zickert, MD, PhD, Department of Medicine Solna, Division of Rheumatology, Karolinska Institutet, and Karolinska University Hospital; V. Oke, MD, PhD, Department of Medicine Solna, Division of Rheumatology, Karolinska Institutet, and Karolinska University Hospital; J. Rönnelid, MD, PhD, Department of Immunology, Genetics and Pathology, Uppsala University; S. Eketjäll, PhD, Cardiovascular, Renal and Metabolism, IMED Biotech Unit, AstraZeneca, and KI-AZ ICMC; K. Elvin, MD, PhD, Department of Medicine Solna, Division of Immunology and Allergy, Karolinska Institutet and Karolinska University Hospital; I. Gunnarsson, MD, PhD, Department of Medicine Solna, Division of Rheumatology, Karolinska Institutet, and Karolinska University Hospital; E. Svenungsson, MD, PhD, Department of Medicine Solna, Division of Rheumatology, Karolinska Institutet, and Karolinska University Hospital
| | - Iva Gunnarsson
- From the Department of Medicine Solna, Division of Rheumatology, Karolinska Institutet, Stockholm; Karolinska University Hospital, Stockholm; Karolinska Institutet/AstraZeneca Integrated Cardio Metabolic Centre (KI-AZ ICMC), Stockholm; Department of Medicine Solna, Division of Immunology and Allergy, Karolinska Institutet, Stockholm; Center for Clinical Research, Uppsala University, Sörmland; Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala; Cardiovascular, Renal and Metabolism, Innovative Medicines and Early Development (IMED) Biotech Unit, AstraZeneca, Huddinge, Sweden.,G. Ruacho, DMD, Department of Medicine Solna, Division of Rheumatology, Karolinska Institutet, and Center for Clinical Research, Uppsala University; M. Kvarnström, MD, PhD, Department of Medicine Solna, Division of Rheumatology, Karolinska Institutet, and Karolinska University Hospital; A. Zickert, MD, PhD, Department of Medicine Solna, Division of Rheumatology, Karolinska Institutet, and Karolinska University Hospital; V. Oke, MD, PhD, Department of Medicine Solna, Division of Rheumatology, Karolinska Institutet, and Karolinska University Hospital; J. Rönnelid, MD, PhD, Department of Immunology, Genetics and Pathology, Uppsala University; S. Eketjäll, PhD, Cardiovascular, Renal and Metabolism, IMED Biotech Unit, AstraZeneca, and KI-AZ ICMC; K. Elvin, MD, PhD, Department of Medicine Solna, Division of Immunology and Allergy, Karolinska Institutet and Karolinska University Hospital; I. Gunnarsson, MD, PhD, Department of Medicine Solna, Division of Rheumatology, Karolinska Institutet, and Karolinska University Hospital; E. Svenungsson, MD, PhD, Department of Medicine Solna, Division of Rheumatology, Karolinska Institutet, and Karolinska University Hospital
| | - Elisabet Svenungsson
- From the Department of Medicine Solna, Division of Rheumatology, Karolinska Institutet, Stockholm; Karolinska University Hospital, Stockholm; Karolinska Institutet/AstraZeneca Integrated Cardio Metabolic Centre (KI-AZ ICMC), Stockholm; Department of Medicine Solna, Division of Immunology and Allergy, Karolinska Institutet, Stockholm; Center for Clinical Research, Uppsala University, Sörmland; Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala; Cardiovascular, Renal and Metabolism, Innovative Medicines and Early Development (IMED) Biotech Unit, AstraZeneca, Huddinge, Sweden. .,G. Ruacho, DMD, Department of Medicine Solna, Division of Rheumatology, Karolinska Institutet, and Center for Clinical Research, Uppsala University; M. Kvarnström, MD, PhD, Department of Medicine Solna, Division of Rheumatology, Karolinska Institutet, and Karolinska University Hospital; A. Zickert, MD, PhD, Department of Medicine Solna, Division of Rheumatology, Karolinska Institutet, and Karolinska University Hospital; V. Oke, MD, PhD, Department of Medicine Solna, Division of Rheumatology, Karolinska Institutet, and Karolinska University Hospital; J. Rönnelid, MD, PhD, Department of Immunology, Genetics and Pathology, Uppsala University; S. Eketjäll, PhD, Cardiovascular, Renal and Metabolism, IMED Biotech Unit, AstraZeneca, and KI-AZ ICMC; K. Elvin, MD, PhD, Department of Medicine Solna, Division of Immunology and Allergy, Karolinska Institutet and Karolinska University Hospital; I. Gunnarsson, MD, PhD, Department of Medicine Solna, Division of Rheumatology, Karolinska Institutet, and Karolinska University Hospital; E. Svenungsson, MD, PhD, Department of Medicine Solna, Division of Rheumatology, Karolinska Institutet, and Karolinska University Hospital.
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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: 44] [Impact Index Per Article: 8.8] [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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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]
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Primary Sjögren's syndrome with diffuse cystic lung changes developed systemic lupus erythematosus: a case report and literature review. Oncotarget 2017; 8:35473-35479. [PMID: 28415674 PMCID: PMC5471070 DOI: 10.18632/oncotarget.16010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 03/02/2017] [Indexed: 11/25/2022] Open
Abstract
Sjögren's syndrome (SS) is a chronic inflammatory autoimmune disease that can occur as a unique existence (primary Sjögren's syndrome) or merge with other systemic diseases like systemic lupus erythematosus (SLE), rheumatoid arthritis or systemic sclerosis (secondary Sjögren's syndrome). Data on the two diseases occurrence order are inadequate. Primary Sjögren's syndrome (pSS) may relatively uncommonly lead to diffuse cystic lung changes. We represent a female who was diagnosed pSS with diffuse cystic lung alterations developed SLE two years later. SS was diagnosed on account of the existence of dryness of eye and mouth, Schirmer's test, biopsy of the minor salivary glands of her lip, positive anti-SSA and anti-SSB antibody in the serum. Chest computed tomography image showed bilateral diffuse cystic changes with a wide variation in cyst size and distribution. SLE was finally diagnosed based on bilateral lower limb skin rash, gonarthritis and omarthritis, low level of complement, antinuclear antibody 1:640 and positive antibodies to double-stranded DNA. Improvement was achieved with therapy of corticosteroids, hydroxychloroquine and antibiotics. This report provides us clinical, diagnosis and treatment perception of SS-onset SLE as patient presenting diffuse cystic lung changes.
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Gao N, Li MT, Li YH, Zhang SH, Dai RP, Zhang SZ, Zhao LD, Wang L, Zhang FC, Zhao Y, Zeng XF. Retinal vasculopathy in patients with systemic lupus erythematosus. Lupus 2017; 26:1182-1189. [PMID: 28355986 DOI: 10.1177/0961203317698050] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A retrospective case control study was conducted in the Peking Union Medical College Hospital. Medical records were reviewed for demographic data, clinical features, laboratory results, systemic lupus erythematosus (SLE) disease activity evaluations, and ophthalmic examinations to investigate the clinical characteristics and significance of retinal vasculopathy (RV) in Chinese patients with systemic lupus erythematosus. The prevalence of RV was approximately 0.66% (35/5298) in SLE patients. A total of 60 eyes were involved. The ocular presentations included decrease of visual acuity (48/60, 80%), visual field loss (7/60, 11.7%), and diplopia (3/60, 5%). Ophthalmic fundoscopic examination revealed cotton-wool spots (30/60, 50%), retinal vascular attenuation (31/60, 51.6%), and hemorrhages (41/60, 68.3%). Retinal angiogram showed that 72.7% (16/22) eyes had vaso-occlusion. The ophthalmic episodes could occur at any stage of SLE duration, with a median of 12 months (0-168 months) following SLE onset. Twenty-one (35%) eyes did not recover, or even worsened, during hospital stay. RV was found to be significantly associated with neuropsychiatric lesions (51.4% vs. 21.3%, p = .005) and hematological disturbance (62.9% vs. 34.3%, p = .005). SLE patients with RV had significantly higher SLE disease activity index scores than controls (19.9 ± 0.9 vs. 10.2 ± 0.7, p < .001). An inverse association of anti-SSA antibody with RV was detected (34.3% vs. 67.1%, p = .001). Nervous system disturbance (odds ratio (OR) = 4.340, 95% confidence interval (CI) 1.438, 13.094, p = .009) and leukocytopenia (OR = 6.385, 95% CI 1.916, 21.278, p = .003) were independent risk factors, while anti-SSA antibody positivity (OR = 0.249, 95% CI 0.087, 0.710, p = .009) was a protective factor for RV in SLE patients. In certain cases, RV is a threatening condition for SLE patients presenting with clinical ocular manifestations. Ophthalmo-fundoscopic detection is recommended as soon as SLE is diagnosed.
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Affiliation(s)
- N Gao
- 1 Department of Rheumatology, Peking Union Medical College Hospital, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - M T Li
- 1 Department of Rheumatology, Peking Union Medical College Hospital, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Y H Li
- 2 Department of Rheumatology, No.323 PLA Hospital, Xi'an, China
| | - S H Zhang
- 3 Department of Ophthalmology, Peking Union Medical College Hospital, Beijing, China
| | - R P Dai
- 3 Department of Ophthalmology, Peking Union Medical College Hospital, Beijing, China
| | - S Z Zhang
- 1 Department of Rheumatology, Peking Union Medical College Hospital, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - L D Zhao
- 1 Department of Rheumatology, Peking Union Medical College Hospital, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - L Wang
- 1 Department of Rheumatology, Peking Union Medical College Hospital, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - F C Zhang
- 1 Department of Rheumatology, Peking Union Medical College Hospital, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Y Zhao
- 1 Department of Rheumatology, Peking Union Medical College Hospital, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - X F Zeng
- 1 Department of Rheumatology, Peking Union Medical College Hospital, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
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18
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Okada A, Yoshida T, Takemura K, Ishigaki K, Shimizu A, Takano H. Successful Detection of Renal Involvement in Sjögren's Syndrome Secondary to Systemic Lupus Erythematosus by Renal Biopsy. Intern Med 2015; 54:1265-71. [PMID: 25986268 DOI: 10.2169/internalmedicine.54.3525] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
An 80-year-old man presented with a mildly decreased renal function and increased anti-double-stranded-DNA (anti-dsDNA) antibody levels, and met the diagnostic criteria of the American College of Rheumatology for systemic lupus erythematosus (SLE). However, the incremental increase in creatinine levels and the mild proteinuria were inconsistent with lupus nephritis. We performed a renal biopsy, which revealed interstitial nephritis and minor glomerular abnormalities. Further examinations determined that the renal lesion was due to Sjögren's syndrome secondary to SLE. Following treatment with oral prednisolone, the patient's renal function improved as his anti-dsDNA antibody levels decreased. This case report indicates that renal biopsy should be considered even in elderly individuals when it may assist in the diagnosis, treatment, and prognosis of the patient.
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Affiliation(s)
- Akira Okada
- Department of Nephrology, Tokyo Teishin Hospital, 2. Divison of Nephrology and Endocrinology, The University of Tokyo Graduate School of Medicine, Japan
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19
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Fangtham M, Magder LS, Petri MA. Oral candidiasis in systemic lupus erythematosus. Lupus 2014; 23:684-90. [PMID: 24598219 DOI: 10.1177/0961203314525247] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Accepted: 01/27/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVES We assessed the frequency of oral candidiasis and the association between demographic variables, disease-related variables, corticosteroid treatment, other treatments and the occurrence of oral candidiasis in the Hopkins Lupus Cohort. METHODS In this large prospective cohort study of 2258 patients with systemic lupus erythematosus (SLE), demographic and clinical associates of oral candidiasis were estimated by univariate, multivariate and within-person regression models. RESULTS There were 53,548 cohort visits. Oral candidiasis was diagnosed at 675 visits (1.25%) in 325 (14%) of the patients. In the multivariate analyses, oral candidiasis was associated with African-American ethnicity, SELENA-SLEDAI disease activity, high white blood cell count, a history of bacterial infection, prednisone use and immunosuppressive use. The urine protein by urine dip stick was higher in SLE patients with oral candidiasis. Considering only patients who had candidiasis at some visits in a 'within-person' analysis, candidiasis was more frequent in visits with higher SELENA-SLEDAI disease activity, high white blood cell count, proteinuria by urine dip stick, a history of bacterial infection and prednisone use. The use of hydroxychloroquine was associated with a lower risk of oral candidiasis, but was not statistically significant (p = 0.50) in the within-person analysis models. CONCLUSION This study identified multiple risk factors for oral candidiasis in SLE. Inspection of the oral cavity for signs of oral candidiasis is recommended especially in SLE patients with active disease, proteinuria, high white blood cell count, taking prednisone, immunosuppressive drugs or antibiotics.
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Affiliation(s)
- M Fangtham
- Johns Hopkins University, School of Medicine Division of Rheumatology, Baltimore, MD, USA
| | - L S Magder
- University of Maryland Department of Epidemiology and Public Health, Baltimore, MD, USA
| | - M A Petri
- Johns Hopkins University, School of Medicine Division of Rheumatology, Baltimore, MD, USA
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20
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Yang Y, Li Z, Wang L, Zhang F. The clinical and laboratory characteristics of Sjögren's syndrome that progresses to systemic lupus erythematosus: a retrospective case-control study. Int J Rheum Dis 2013; 16:173-7. [PMID: 23773641 DOI: 10.1111/1756-185x.12088] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Yunjiao Yang
- Department of Rheumatology; Peking Union Medical College Hospital; Chinese Academy of Medical Sciences; Beijing; China
| | - Zhengfu Li
- Department of Rheumatology; Xinhua Hospital; Zhejiang Provincial University of Traditional Chinese Medicine; Hangzhou; China
| | - Li Wang
- Department of Rheumatology; Peking Union Medical College Hospital; Chinese Academy of Medical Sciences; Beijing; China
| | - Fengchun Zhang
- Department of Rheumatology; Peking Union Medical College Hospital; Chinese Academy of Medical Sciences; Beijing; China
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21
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He J, Ding Y, Feng M, Guo J, Sun X, Zhao J, Yu D, Li Z. Characteristics of Sjögren's syndrome in rheumatoid arthritis. Rheumatology (Oxford) 2013; 52:1084-9. [PMID: 23382356 DOI: 10.1093/rheumatology/kes374] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To compare features of SS in RA with primary SS and RA without SS. METHODS Patients hospitalized between January 2007 and December 2010 were retrospectively studied. Seventy-four cases of overlap RA and SS (RA/SS) among 509 cases of RA were identified. Cases of SS (n = 187) detected during the same period acted as controls. RESULTS Among those with RA/SS, there were 46 cases of RA-onset SS and 12 cases of SS-onset RA. Sixteen patients had simultaneous-onset RA and SS. Compared with RA without SS, RA/SS patients had more severe arthritis; a higher incidence of haematological abnormality, fever and rash; and a higher frequency of RF, ANAs and anti-SSA and anti-SSB antibodies (P < 0.05). Compared with primary SS, RA/SS patients were older, had more severe arthritis, anaemia and lung involvement; a lower incidence of fever, rash, leucopenia, thrombocytopenia and hyperthyroidism; and a higher frequency of RF, anti-keratin antibody, anti-perinuclear factor and anti-cyclic citrullinated antibodies (P < 0.05). Compared with RA and primary SS, RA/SS patients had higher disease activity scores of both RA and SS. CONCLUSION RA/SS patients have distinctive features, with more complications and systemic involvement. In addition, disease activity is higher in RA/SS.
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Affiliation(s)
- Jing He
- Department of Rheumatology and Immunology, Peking University People's Hospital, 11 Xizhimen South Street, Beijing 100044, China
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22
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Amador-Patarroyo MJ, Arbelaez JG, Mantilla RD, Rodriguez-Rodriguez A, Cárdenas-Roldán J, Pineda-Tamayo R, Guarin MR, Kleine LL, Rojas-Villarraga A, Anaya JM. Sjögren’s syndrome at the crossroad of polyautoimmunity. J Autoimmun 2012; 39:199-205. [DOI: 10.1016/j.jaut.2012.05.008] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Accepted: 05/20/2012] [Indexed: 12/26/2022]
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23
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Ocular manifestations of systemic lupus erythematosus: a review of the literature. Autoimmune Dis 2012; 2012:290898. [PMID: 22811887 PMCID: PMC3395333 DOI: 10.1155/2012/290898] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2012] [Accepted: 05/31/2012] [Indexed: 01/14/2023] Open
Abstract
About one-third of patients suffering from systemic lupus erythematosus have ocular manifestations. The most common manifestation is keratoconjunctivitis sicca. The most vision threatening are retinal vasculitis and optic neuritis/neuropathy. Prompt diagnosis and treatment of eye disease is paramount as they are often associated with high levels of systemic inflammation and end-organ damage. Initial management with high-dose oral or IV corticosteroids is often necessary. Multiple "steroid-sparing" treatment options exist with the most recently studied being biologic agents.
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Systemic lupus erythematosus with Sjögren syndrome compared to systemic lupus erythematosus alone: a meta-analysis. J Clin Rheumatol 2012; 18:28-32. [PMID: 22157271 DOI: 10.1097/rhu.0b013e31823ecbdf] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES This study aimed to compare the difference of the clinical and laboratory features of the patients between the combined systemic lupus erythematosus (SLE) and Sjögren syndrome (SLE-SS) and SLE only. MATERIALS AND METHODS A systematic literature search was performed to identify the articles as to SLE with SS between 1970 and May 2011. The demographics, pertinent clinical, and laboratory data were extracted from 6 publications, and a meta-analysis was performed. The pooled odds ratios and 95% confidence interval were computed for the variability of these parameters between SLE-SS and SLE. RESULTS A total of 6 studies were included, consisting of 2489 patients with SLE and 444 with SLE-SS, and the estimated prevalence of the latter was 17.8%. Patients with SLE-SS were older and more often had associated oral ulcers and arthritis. In contrast, proteinuria (odds ratio = 1.77; 95% confidence interval, 1.39-2.25; P < 0.0001) was more common in SLE alone than SLE-SS, and central nervous system involvement tended to be more common. Anti-double-stranded DNA antibodies were equally prevalent in both groups. Anti-SSA/Ro and anti-SSB/La antibodies were more frequent, and anti-Sm and anti-cardiolipin antibodies were less prevalent in SLE-SS than SLE alone. CONCLUSIONS There are significant variances in certain clinical and laboratory aspects between SLE-SS and SLE. This combined disease of SLE-SS has distinct features with relatively less major internal organ involvement but has more specific autoantibody profile and favorable clinical outcome.
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The association of systemic lupus erythematosus and myasthenia gravis: a series of 17 cases, with a special focus on hydroxychloroquine use and a review of the literature. J Neurol 2011; 259:1290-7. [PMID: 22160434 DOI: 10.1007/s00415-011-6335-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Revised: 11/16/2011] [Accepted: 11/17/2011] [Indexed: 01/19/2023]
Abstract
The coexistence of systemic lupus erythematosus (SLE) and myasthenia gravis (MG) is rarely reported, and most of the published studies are case reports. Hydroxychloroquine, an antimalarial agent, is an essential treatment in patients with SLE but special caution is recommended when used in MG patients. We retrospectively analyzed the clinical features, laboratory findings, and outcome of 17 patients with both diseases with a special focus regarding hydroxychloroquine use and with a review of the literature. All patients were women. The mean age at MG onset and SLE diagnosis was 34.5 [14-64] and 37.8 [18-72] years, respectively. The presenting symptoms of MG were limb weakness (94%), ocular (88%) and bulbar involvement (53%). Autoantibodies against the acetylcholine receptor were positive in 94% of cases. The main manifestations of SLE included arthritis (88%), cytopenias (53%) and skin rash (41%). Treatment of SLE required hydroxychloroquine (94%), steroids (47%) and immunosuppressive drugs (18%). Among eight patients (47%) who developed MG after initiation of hydroxychloroquine, the question of induction of MG by hydroxychloroquine was raised in one patient. On the other hand, an exacerbation of myasthenic symptoms was only seen in one of the eight patients who received hydroxychloroquine after the diagnosis of MG. Including our cases, we reviewed a total of 70 patients with SLE and MG. Compared with a large series of 1,000 unselected SLE patients, those with associated MG were older, had lower incidence of cutaneous, renal, and neurological manifestations, and higher frequency of anticardiolipin antibodies and lupus anticoagulant. In conclusion, the clinical pattern of patients with SLE and MG seems to be characterized by a less severe course of SLE and higher frequency of antiphospholipid antibodies. Hydroxychloroquine treatment appears to be safe in this setting.
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Tseng JC, Lu LY, Hu JC, Wang LF, Yen LJ, Wu HC, Jiann BP. The Impact of Systemic Lupus Erythematosus on Women's Sexual Functioning. J Sex Med 2011; 8:3389-97. [DOI: 10.1111/j.1743-6109.2011.02464.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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27
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Baer AN, Maynard JW, Shaikh F, Magder LS, Petri M. Secondary Sjogren's syndrome in systemic lupus erythematosus defines a distinct disease subset. J Rheumatol 2010; 37:1143-9. [PMID: 20360189 DOI: 10.3899/jrheum.090804] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Sjögren's syndrome (SS) may occur in patients with systemic lupus erythematosus (SLE). We sought to determine whether the presence of SS in a large cohort of patients with SLE defines a subset with distinctive sociodemographic, clinical, and laboratory features. METHODS The Johns Hopkins Lupus Cohort was divided into 2 groups, based on the presence or absence of SS, defined by the presence of an objective measure of sicca or an abnormal minor salivary gland biopsy in a patient with sicca symptoms. These groups were compared with regard to sociodemographic, clinical, and laboratory features. Multivariable logistic regression was then performed to adjust the findings for potential sociodemographic, clinical, and laboratory confounders. RESULTS The 259 patients with SS (14% of the cohort), when compared with the 1531 patients without SS, were older at the time of SLE diagnosis and were more commonly women and white. Photosensitivity, oral ulcers, Raynaud's phenomenon, anti-Ro antibodies, and anti-La antibodies had a significant positive association while renal disease, anti-ribonucleoprotein (RNP) antibodies, and anti-dsDNA antibodies had a negative association with the presence of SS after adjustment for age (at last cohort visit), gender, ethnicity, and anti-Ro antibodies. The older age at diagnosis of SLE among the patients with SS did not remain a significant finding after adjustment for the age of the patient at last cohort visit. CONCLUSION The subset of patients with SLE and SS has a distinct clinical and laboratory phenotype, with a higher frequency of older white women with photosensitivity, oral ulcers, Raynaud's phenomenon, anti-Ro antibodies, and anti-La antibodies and a lower frequency of renal disease, anti-dsDNA antibodies, and anti-RNP antibodies.
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Affiliation(s)
- Alan N Baer
- Division of Rheumatology, Good Samaritan Hospital, Russell Morgan Building, Suite 508, 5601 Loch Raven Blvd., Baltimore, MD 21239, USA.
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