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Saleem RA, Ramadan M, Elshaaer Y, Sukkarieh H, Alissa R, Alhusseini N, Tamim H, Alshahrani A, Almaimoni H. Laboratory features and pharmacological management of early and late-onset primary Sjögren's syndrome. Rheumatol Int 2024; 44:1317-1325. [PMID: 38839658 PMCID: PMC11178593 DOI: 10.1007/s00296-024-05626-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 04/29/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND Primary Sjögren's Syndrome (pSS) is a systemic chronic autoimmune disorder that contributes to dry mouth (xerostomia) and eyes (xerophthalmia). It mainly affects females between 40 and 60 years old. So far, there is no treatment to cure SS; however, there is a list of medications that can ameliorate the symptoms. In addition, there has been no single test until now to detect pSS, but clinical and immunological investigations are applied as diagnostic tools. Therefore, this study aimed to explore the characteristics of pSS in Saudi patients based on the onset of the disease through laboratory findings and pharmaceutical management. METHODOLOGY This retrospective study examined diagnosed patients with pSS between 2018 and 2023 from the National Guard Hospital, Saudi Arabia. Data of pSS patients was categorized into two groups: early (under 40 years old) and late-onset (40 years old and above). Data on demographic information, mortality rate, and blood tests such as complete blood count (CBC), creatinine, erythrocyte sedimentation rate (ESR), and vitamin levels, in addition to prescribed medications, were collected from the patient's medical record. Chi-square and t-tests were mainly used, and statistical significance was determined at a P-value less than 0.05. RESULTS A total of 453 patients were included in the study, where the early-onset group comprised 136 and the late-onset group comprised 317 patients. The mean age of the early and late onset was 34.2 and 60.4, respectively. ESR was significantly higher in the early (46.3 mm/hr) and late-onset (49.8 mm/hr). The most common medication used by all pSS patients was hydroxychloroquine. However, artificial tears were mainly observed in the late-onset group. Other medications, such as pilocarpine, methotrexate, and azathioprine, were prescribed to pSS patients to a lesser extent. CONCLUSION This study suggests that the onset of pSS could occur even before the age of 40 among Saudi citizens. Notably, elevated ESR levels appeared to be a feature of pSS, which was consistent with other previous findings. The variability of some medications between early-onset and late-onset pSS may indicate disease progression. However, further investigations are required to confirm this observation.
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Affiliation(s)
- Rimah A Saleem
- College of Medicine, Alfaisal University, P.O. Box 50927, Riyadh, 11533, Saudi Arabia.
| | - Majed Ramadan
- King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia
| | - Yasmin Elshaaer
- College of Medicine, Alfaisal University, P.O. Box 50927, Riyadh, 11533, Saudi Arabia
| | - Hatouf Sukkarieh
- College of Medicine, Alfaisal University, P.O. Box 50927, Riyadh, 11533, Saudi Arabia
| | - Rasha Alissa
- College of Medicine, Alfaisal University, P.O. Box 50927, Riyadh, 11533, Saudi Arabia
| | - Noara Alhusseini
- College of Medicine, Alfaisal University, P.O. Box 50927, Riyadh, 11533, Saudi Arabia
| | - Hani Tamim
- College of Medicine, Alfaisal University, P.O. Box 50927, Riyadh, 11533, Saudi Arabia
- Department of Internal Medicine and Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Awad Alshahrani
- King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Hesham Almaimoni
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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Zhang Y, Yang JY, Chen JQ, Liao JH, Huang ZW, Wu TH, He Q, Yu XB, Wang Q, Song WJ, Luo J, Tao QW. Disease Duration Affects the Clinical Phenotype of Primary Sjögren Syndrome: A Medical Records Review Study of 952 Cases. J Clin Rheumatol 2024; 30:151-158. [PMID: 38389137 DOI: 10.1097/rhu.0000000000002076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
OBJECTIVES To investigate the impact of disease duration on clinical phenotypes in Chinese patients with primary Sjögren syndrome (pSS) and examine the correlation between clinical phenotypes and onset age, age at diagnosis, and disease duration. METHODS Data from 952 patients diagnosed with pSS in China between January 2013 and March 2022 were analyzed based on medical records. Patients were categorized into 3 groups based on disease duration: short (<5 years), moderate (≥5 and <10 years), and long (≥10 years) group. Clinical characteristics were compared among the 3 groups, and pSS patients with a long disease duration were compared with the other patients after matching age at diagnosis and age at onset. RESULTS Among the patients, 20.4% had a disease duration over 10 years. After matching for age at onset and age at diagnosis, pSS patients with a long disease duration exhibited a significantly higher prevalence of dry mouth ( p <0.001), dry eyes ( p <0.001), fatigue ( p <0.001), arthralgia ( p <0.001), and dental caries ( p <0.001) and higher rates of anti-Sjögren syndrome A ( p < 0.05), anti-Ro52 ( p < 0.05), and anti-SSB ( p < 0.05) positivity than their control groups, with prevalence increasing with disease duration ( ptrend < 0.001). However, no differences were noted in the prevalence of interstitial lung disease and leukopenia between different disease duration groups after matching for age at onset, although differences were shown when matching for age at diagnosis. CONCLUSION Longer disease duration in pSS patients correlates with increased prevalence of sicca symptoms, fatigue, and arthralgia and higher positivity of autoantibodies associated with pSS. However, the prevalence of interstitial lung disease and leukopenia did not correlate with disease duration after matching for age at onset.
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Affiliation(s)
- Yan Zhang
- From the Graduate School, Beijing University of Chinese Medicine
| | - Jian-Ying Yang
- From the Graduate School, Beijing University of Chinese Medicine
| | - Jia-Qi Chen
- From the Graduate School, Beijing University of Chinese Medicine
| | - Jia-He Liao
- From the Graduate School, Beijing University of Chinese Medicine
| | - Zi-Wei Huang
- From the Graduate School, Beijing University of Chinese Medicine
| | - Tzu-Hua Wu
- From the Graduate School, Beijing University of Chinese Medicine
| | - Qian He
- From the Graduate School, Beijing University of Chinese Medicine
| | - Xin-Bo Yu
- From the Graduate School, Beijing University of Chinese Medicine
| | - Qin Wang
- From the Graduate School, Beijing University of Chinese Medicine
| | - Wei-Jiang Song
- Traditional Chinese Medicine Department, Peking University Third Hospital
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Lee AYS, Putty T, Lin MW, Swaminathan S, Suan D, Chataway T, Thurlings RM, Gordon TP, Wang JJ, Reed JH. Isolated anti-Ro52 identifies a severe subset of Sjögren’s syndrome patients. Front Immunol 2023; 14:1115548. [PMID: 37006271 PMCID: PMC10061105 DOI: 10.3389/fimmu.2023.1115548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 02/24/2023] [Indexed: 03/18/2023] Open
Abstract
IntroductionSerum autoantibodies targeting the SSA/Ro proteins are a key component of the classification criteria for the diagnosis of Sjögren’s syndrome (SS). Most patients' serum reacts with both Ro60 and Ro52 proteins. Here we compare the molecular and clinical characteristics of patients diagnosed with SS with anti-Ro52 in the presence or absence of anti-Ro60/La autoantibodies.MethodsA cross-sectional study was performed. Patients in the SS biobank at Westmead Hospital (Sydney, Australia) that were positive for anti-Ro52 were included and stratified based on the absence (isolated) or presence (combined) of anti-Ro60/La, measured by line immunoassay. We examined clinical associations and the serological and molecular characteristics of anti-Ro52 using ELISA and mass spectrometry in serological groups.ResultsA total of 123 SS patients were included for study. SS patients with isolated anti-Ro52 (12%) identified a severe serological subset characterised by higher disease activity, vasculitis, pulmonary involvement, rheumatoid factor (RhF) and cryoglobulinaemia. Serum antibodies reacting with Ro52 in the isolated anti-Ro52 subset displayed less isotype switching, less immunoglobulin variable region subfamily usage and a lower degree of somatic hypermutation than the combined anti-Ro52 subset.ConclusionsIn our cohort of SS patients, isolated anti-Ro52 represents a severe subset of SS, and is associated with the presence of cryoglobulinaemia. We therefore provide clinical relevance to the stratification of SS patients by their sero-reactivities. It is possible that the autoantibody patterns may be immunological epiphenomena of the underlying disease process, and further work is required to unearth the mechanisms of the differential clinical phenotypes.
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Affiliation(s)
- Adrian Y. S. Lee
- Centre for Immunology and Allergy Research, Westmead Institute for Medical Research, The University of Sydney, Westmead, NSW, Australia
- Department of Clinical Immunology and Allergy, Westmead Hospital and Institute of Clinical Pathology & Medical Research (ICPMR), Westmead, NSW, Australia
- *Correspondence: Adrian Y. S. Lee,
| | - Trishni Putty
- Department of Immunology, Flinders University, Bedford Park, SA, Australia
- Department of Immunology, SA Pathology, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Ming-Wei Lin
- Centre for Immunology and Allergy Research, Westmead Institute for Medical Research, The University of Sydney, Westmead, NSW, Australia
- Department of Clinical Immunology and Allergy, Westmead Hospital and Institute of Clinical Pathology & Medical Research (ICPMR), Westmead, NSW, Australia
| | - Sanjay Swaminathan
- Centre for Immunology and Allergy Research, Westmead Institute for Medical Research, The University of Sydney, Westmead, NSW, Australia
- Department of Clinical Immunology and Allergy, Westmead Hospital and Institute of Clinical Pathology & Medical Research (ICPMR), Westmead, NSW, Australia
| | - Dan Suan
- Centre for Immunology and Allergy Research, Westmead Institute for Medical Research, The University of Sydney, Westmead, NSW, Australia
- Department of Clinical Immunology and Allergy, Westmead Hospital and Institute of Clinical Pathology & Medical Research (ICPMR), Westmead, NSW, Australia
| | - Tim Chataway
- Flinders Proteomic Facility, Flinders University, Bedford Park, SA, Australia
| | - Rogier M. Thurlings
- Department of Rheumatology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Tom P. Gordon
- Department of Immunology, Flinders University, Bedford Park, SA, Australia
- Department of Immunology, SA Pathology, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Jing Jing Wang
- Department of Immunology, Flinders University, Bedford Park, SA, Australia
- Department of Immunology, SA Pathology, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Joanne H. Reed
- Centre for Immunology and Allergy Research, Westmead Institute for Medical Research, The University of Sydney, Westmead, NSW, Australia
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Brito-Zerón P, Retamozo S, Ramos-Casals M. [Sjögren syndrome]. Med Clin (Barc) 2023; 160:163-171. [PMID: 36528400 DOI: 10.1016/j.medcli.2022.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 10/27/2022] [Accepted: 10/28/2022] [Indexed: 12/23/2022]
Abstract
In 1933, the Swedish ophthalmologist Hendrik Sjögren was the first to suggest that behind the dryness that several of his patients presented, there could be a systemic disease related to an abnormal immune response. Since then, the term Sjögren's syndrome (SjS) has been used and it has been considered a minor and infrequent disorder compared to other systemic autoimmune diseases (SAD) and, consequently, with little progress both in clinical and therapeutic research. The emergence of new technologies at the end of the 20th century rapidly promoted the development of international projects of great impact and diffusion, which have completely changed this scenario, and in the last 20 years significant progress has been made in understanding the main epidemiological determinants and pathogenic mechanisms to increase the diagnostic accuracy and to design specific and individualized therapeutic strategies. Currently, SjS should be considered one of the most frequent SADs with an undoubtedly systemic phenotype beyond dryness, in which the identification of prognostic factors can allow personalized follow-up and, therefore, early therapeutic interventions that avoid severe, irreversible outcomes.
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Affiliation(s)
- Pilar Brito-Zerón
- Research and Innovation Group in Autoimmune Diseases, Sanitas Digital Hospital, Hospital-CIMA-Centre Mèdic Milenium Balmes Sanitas, Barcelona, España; Línea de investigación de Sjögren del Grupo de Enfermedades Autoinmunes Sistémicas (GEAS), Sociedad Española de Medicina Interna (SEMI), España
| | - Soledad Retamozo
- Línea de investigación de Sjögren del Grupo de Enfermedades Autoinmunes Sistémicas (GEAS), Sociedad Española de Medicina Interna (SEMI), España; Servicio de Reumatología, Hospital Universitari Parc Taulí, Sabadell, Barcelona, España; Servicio de Reumatología, Hospital Quirón Salud, Barcelona, España
| | - Manuel Ramos-Casals
- Línea de investigación de Sjögren del Grupo de Enfermedades Autoinmunes Sistémicas (GEAS), Sociedad Española de Medicina Interna (SEMI), España; Departament de Medicina, Universitat de Barcelona, Barcelona, España; Servicio de Enfermedades Autoinmunes, Institut Clínic de Medicina i Dermatologia (ICMiD), Hospital Clínic, Barcelona, España.
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Renal involvement in Sjőgren's syndrome: predictors and impact on patient outcomes. Rheumatol Int 2023; 43:1297-1306. [PMID: 36650312 DOI: 10.1007/s00296-022-05242-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 10/25/2022] [Indexed: 01/19/2023]
Abstract
Renal disease in primary Sjogren's Syndrome(pSS) occurs as tubulointerstitial nephritis(TIN) or glomerulonephritis(GN). Data from India on pSS are sparse and even less on nephritis.We studied the prevalence and impact of renal disease on patient outcomes. We reviewed 179 (F:M 12.7:1, age 41.7 ± 12.9 years) patients of pSS from records at a single centre from 2000 to 2020. Data on nephritis, clinical and laboratory variables were collected from baseline visit. Outcomes studied were chronic kidney disease(CKD) and death. We identified predictors of nephritis and rising creatinine on follow-up.Fifty-four (30.17%) patients had nephritis. Their mean age was 40.19 ± 13.28 years with 157.3 person-years follow-up. Vasculitis (OR 2.33, 1.02-5.3), fatigue (OR 3.29, 1.63-6.65), ANA positivity (OR 7.79, 1-60.62), anti-Ro52 (OR 2.74, 1.18-6.39), anti-La (OR 2.13, 1.1-4.14), both Ro and La (OR 2.4, 1.23-4.69) and lymphopenia (OR 2.27, 1.16-4.41) predicted nephritis on univariate analysis. On multivariate analysis, only fatigue (OR 2.83, 1.22-6.57) and an interaction between polyarthritis and vasculitis (OR 9.17, 1.15-72.96) was associated with nephritis. Creatinine at one (1.6 ± 1.17 mg/dL vs. 0.8 ± 0.2 mg/dL) and 2 years (1.62 ± 1.19 mg/dL vs. 0.8 ± 0.2 mg/dL) follow-up was higher in the nephritis group. Baseline haematuria, leukocyturia, 24 h urinary protein and thrombocytopenia were independent predictors of rising creatinine. Six patients died and 10 developed CKD. Event-free (death or CKD) survival was 89.1% at 5 years. Patients with nephritis had worse event-free survival.Our cohort had a younger age of onset of Sjogren's syndrome and a higher prevalence of nephritis than previously reported. Fatigue, polyarthritis and vasculitis at baseline predicted the development of nephritis. Nephritis was associated with a higher probability of death or CKD.
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Oral immune-mediated disorders with malignant potential/association: An overview. Dis Mon 2023; 69:101349. [PMID: 35337657 DOI: 10.1016/j.disamonth.2022.101349] [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: 01/11/2023]
Abstract
A group of oral disorders or conditions, which may result from, or could be triggered by an abnormality in the normal immune response of an individual are known as oral immune-mediated disorders. Some of these disorders have malignant potential, while others are associated with malignancy. In this overview, we will discuss a few of the oral diseases (such as oral lichen planus, primary Sjogren's syndrome, systemic lupus erythematosus, dermatitis herpetiformis, and linear immunoglobulin A bullous dermatosis, to name a few), which are caused due to irregularity in the immune system and are either associated with malignancy or capable of undergoing malignant transforming, thereby increasing the morbidity and mortality rate.
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Predisposing Factors, Clinical Picture, and Outcome of B-Cell Non-Hodgkin’s Lymphoma in Sjögren’s Syndrome. IMMUNO 2022. [DOI: 10.3390/immuno2040037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Among other systemic autoimmune diseases, primary Sjögren syndrome (pSS) bears the highest risk for lymphoma development. In pSS, chronic antigenic stimulation gradually drives the evolution from polyclonal B-cell expansion to oligoclonal/monoclonal B-cell predominance to malignant B-cell transformation. Thus, most pSS-related lymphomas are B-cell non-Hodgkin lymphomas (NHLs), with mucosa-associated lymphoid tissue (MALT) lymphomas predominating, followed by diffuse large B-cell lymphomas (DLBCLs) and nodal marginal zone lymphomas (NMZLs). Since lymphomagenesis is one of the most serious complications of pSS, affecting patients’ survival, a plethora of possible predisposing factors has been studied over the years, ranging from classical clinical, serological, hematological, and histological, to the more recently proposed genetic and molecular, allowing clinicians to timely detect and to closely follow-up the subgroup of pSS patients with increased risk for lymphoma development. Overall predisposing factors for pSS-related lymphomagenesis reflect the status of B-cell hyperactivity. Different clinical features have been described for each of the distinct pSS-related B-cell NHL subtypes. While generally pSS patients developing B-cell NHLs display a fairly good prognosis, outcomes in terms of treatment response and survival rates seem to differ depending on the lymphoma subtype, with MALT lymphomas being characterized by a rather indolent course and DLBCLs gravely affecting patients’ survival.
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Stergiou IE, Bakasis AD, Giannouli S, Voulgarelis M. Biomarkers of lymphoma in Sjögren's syndrome: what's the latest? Expert Rev Clin Immunol 2022; 18:1155-1171. [PMID: 36097855 DOI: 10.1080/1744666x.2022.2123794] [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: 11/04/2022]
Abstract
INTRODUCTION Primary Sjögren's syndrome (pSS) is a chronic autoimmune disease standing in the crossroads of autoimmunity and lymphomagenesis, characterized by chronic B-cell hyperactivity and ectopic lymphoid tissue neoformation, potentially driving lymphoid malignant transformation. Lymphoma development is considered the most serious complication of pSS. AREAS COVERED: “ Old-classical" biomarkers (clinical, serological, hematological, and histological) validated in the past are analyzed under the perspective of recently published research. Biomarkers that have emerged during the last decade are subdivided to "old-new" and "newly proposed-novel" ones, including biomarkers pathophysiologically related to B-cell differentiation, lymphoid organization, and immune responses, identified in serum and tissue, both at genetic and protein level. Upcoming new imaging biomarkers, promising for further patient stratification, are also analyzed. EXPERT OPINION Salivary gland enlargement and cryoglobulinemia still remain the best validated "classical-old" biomarkers for lymphoma development. Though new biomarkers still need to be validated, some can be used for the identification of high-risk patients long before lymphoma diagnosis, some might be more relevant in distinct age subgroups, while others have an added value in the assessment of lymphoma remission or relapse. Future development of composite indices integrating old and recently proposed biomarkers could contribute to a more precise lymphoma prediction model.
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Affiliation(s)
- Ioanna E Stergiou
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanasios-Dimitrios Bakasis
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Stavroula Giannouli
- Hematology Unit, Second Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Michael Voulgarelis
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Abstract
The association between malignancy and rheumatic diseases has been demonstrated in a multitude of studies. Little is understood regarding the pathogenesis of rheumatic and musculoskeletal diseases in association with malignancy. There is strong evidence regarding the association between Sjögren syndrome and lymphoma as well as risk factors for development of lymphoma in these patients. This article discusses the accumulating data on various malignancies described in primary Sjögren syndrome, highlighting non-Hodgkin lymphoma and thyroid, multiple myeloma, and skin cancers. These reported associations may have clinical implications in daily practice and contribute to understanding of both autoimmunity and cancer.
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Affiliation(s)
- Ann Igoe
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Department of Medicine, University of Oklahoma Health Sciences Center, MS 38, 825 Northeast 13th Street, Oklahoma City, OK 73104, USA; Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center, MS 38, 825 Northeast 13th Street, Oklahoma City, OK 73104, USA
| | - Sali Merjanah
- The Metrohealth System, Case Western Reserve University, 2500 MetroHealth Drive, Cleveland, OH 44109, USA
| | - R Hal Scofield
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center, MS 38, 825 Northeast 13th Street, Oklahoma City, OK 73104, USA; US Department of Veterans Affairs, Oklahoma City, OK, USA.
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Wei L, Zhifei X, Xiaoran N, Meilu L, Yang L, Yixuan L, Xiuying R, Yashuang S, Jingjing C, Shaoying G, Liu Y, Lijun S, Fengxiao Z, Wen Z. Patients with early-onset primary Sjögren's syndrome have distinctive clinical manifestations and circulating lymphocyte profiles. Rheumatology (Oxford) 2021; 61:597-605. [PMID: 33878180 PMCID: PMC8824414 DOI: 10.1093/rheumatology/keab367] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/14/2021] [Indexed: 12/04/2022] Open
Abstract
Objectives To further investigate the clinical characteristics and circulating lymphocyte profiles of patients with early-onset primary Sjögren’s syndrome (pSS). Method Data of 333 patients with pSS were analysed retrospectively. Early onset was defined as a pSS diagnosis at an age of 35 years or younger. The clinical, laboratory and immunophenotypic profiles of peripheral blood lymphocyte subsets were compared between early- and later-onset pSS. Results Thirty-six (10.81%) patients matched the definition of early-onset pSS, with age at disease onset being 28.97 (5.53) years. Elevated serum IgG level (77.14% vs 31.16%, P <0.001), low C3 (41.67% vs 20.20%, P =0.004) and C4 levels (27.78% vs 6.40%, P <0.001), anti-SSA positivity (91.67% vs 51.85%, P <0.001) and anti-SSB positivity (50% vs 20.54%, P <0.001) were more frequent in early-onset patients. The frequencies of hematological (80.56% vs 52.53%, P =0.001), renal (19.44% vs 5.05%, P =0.005) and mucocutaneous involvement (50% vs 22.56%, P <0.001) were significantly higher in the early-onset pSS group, which showed a higher 2010 EULAR SS Disease Activity Index (ESSDAI) [11(6.25–17) vs 7(3–12); P =0.003], compared with the later-onset group. In addition, profound CD4+ T-cell lymphopenia was found in patients with early-onset. Conclusions Patients with early-onset pSS have distinctive clinical manifestations and greater activation of the cellular immune system, present with more severe clinical symptoms and immunological features, have increased activation of circulating T cells and have an unfavourable prognosis. Thus, they require more positive treatment with glucocorticoids and/or immunosuppressants and merit closer follow-up and regular monitoring.
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Affiliation(s)
- Lin Wei
- Department of Rheumatology and immunology, Hebei General Hospital, Shijiazhuang, 050017, China
| | - Xin Zhifei
- Department of Thoracic surgery, Hebei General Hospital, Shijiazhuang, 050017, China
| | - Ning Xiaoran
- Department of Rheumatology and immunology, Hebei General Hospital, Shijiazhuang, 050017, China
| | - Liu Meilu
- Department of Rheumatology and immunology, Hebei General Hospital, Shijiazhuang, 050017, China
| | - Li Yang
- Department of Oncology, Hebei General Hospital, Shijiazhuang, 050017, China
| | - Liu Yixuan
- Department of Rheumatology and immunology, Hebei General Hospital, Shijiazhuang, 050017, China
| | - Ren Xiuying
- Department of Rheumatology and immunology, Hebei General Hospital, Shijiazhuang, 050017, China
| | - Su Yashuang
- Department of Rheumatology and immunology, Hebei General Hospital, Shijiazhuang, 050017, China
| | - Cao Jingjing
- Department of Rheumatology and immunology, Hebei General Hospital, Shijiazhuang, 050017, China
| | - Guo Shaoying
- Department of Graduate School, Hebei Medical University, Shijiazhuang, 050017, China
| | - Yang Liu
- Department of Graduate School, Hebei Medical University, Shijiazhuang, 050017, China
| | - Sun Lijun
- Department of Rheumatology and immunology, Hebei General Hospital, Shijiazhuang, 050017, China
| | - Zhang Fengxiao
- Department of Rheumatology and immunology, Hebei General Hospital, Shijiazhuang, 050017, China
| | - Zhang Wen
- Department of Rheumatology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, State Key Laboratory of Complex Severe and Rare Diseases, Beijing, 100730, China
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Argyriou E, Nezos A, Roussos P, Venetsanopoulou A, Voulgarelis M, Boki K, Tzioufas AG, Moutsopoulos HM, Mavragani CP. Leukocyte Immunoglobulin-Like Receptor A3 (LILRA3): A Novel Marker for Lymphoma Development among Patients with Young Onset Sjogren's Syndrome. J Clin Med 2021; 10:jcm10040644. [PMID: 33567548 PMCID: PMC7915360 DOI: 10.3390/jcm10040644] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/24/2021] [Accepted: 02/03/2021] [Indexed: 01/19/2023] Open
Abstract
Background: Primary Sjogren’s syndrome (SS) is an autoimmune disease with a strong predilection for lymphoma development, with earlier disease onset being postulated as an independent risk factor for this complication. Variations of the Leukocyte immunoglobulin-like receptor A3(LILRA3) gene have been previously shown to increase susceptibility for both SS and non-Hodgkin B-cell lymphoma (B-NHL) in the general population. We aimed to investigate whether variations of the LILRA3 gene could predispose for lymphoma development in the context of SS. Methods: Study population, all of Greek origin, included 101 SS cases with a current or previous diagnosis of lymphoma (SS-lymphoma, SS-L) and 301 primary SS patients not complicated by lymphoma (SS-non-lymphoma, SS-nL). All SS patients fulfilled the 2016 SS American College of Rheumatology/European league against Rheumatism (ACR/EULAR) classification criteria. A total of 381 healthy controls (HC) of similar age/sex/race distribution were also included. On the basis of the age of SS onset and the presence or absence of adverse predictors for lymphoma development, SS patients were further stratified into younger (≤40 years) and older (>40 years) age of disease onset, as well as into high/medium and low risk groups. Polymerase chain reaction (PCR) was implemented for the detection of the following LILRA3 gene variants: homozygous non-deleted or functional wild type (+/+) heterozygous (+/−) and homozygous deleted (−/−). LILRA3 serum protein levels were quantitated by enzyme-linked immunosorbent assay (ELISA) in 85 individuals (29 SS-L, 35 SS-nL patients and 21 HC). Results: While no statistically significant differences were detected in the overall frequency of LILRA3 gene variants between SS-L, SS-nL and HC groups, LILRA3 serum protein levels were increased in the SS-L group compared to HC (1.27 ± 1.34 vs. 0.38 ± 0.34 ng/mL, p-value: 0.004). After stratification according to the age of SS onset and history of lymphoma, as well as the presence or absence of adverse predictors for lymphoma development, the prevalence of the functional LILRA3 gene variant was found to be significantly increased in the young onset SS-L group compared to the HC of similar age and sex distribution (100% vs. 82.9%, p = 0.03), as well as in the high/medium risk SS compared to the low risk SS (91.3 vs. 78.3%, p = 0.0012). Of note, young onset SS-L and SS-nL groups displayed higher LILRA3 serum levels compared to their older counterparts (p-values: 0.007 and 0.0005, respectively). Conclusion: The functional LILRA3 gene variant increases susceptibility to SS-related lymphoma development in patients with a disease onset of <40 years old, implying that genetically determined deranged immune responses in younger SS individuals could underly their pronounced risk for lymphoma development.
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Affiliation(s)
- Evangelia Argyriou
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (E.A.); (A.N.); (P.R.)
- Rheumatology Unit, Sismanogleio General Hospital, 15126 Athens, Greece;
| | - Adrianos Nezos
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (E.A.); (A.N.); (P.R.)
| | - Petros Roussos
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (E.A.); (A.N.); (P.R.)
| | - Aliki Venetsanopoulou
- Department of Pathophysiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.V.); (M.V.); (A.G.T.)
| | - Michael Voulgarelis
- Department of Pathophysiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.V.); (M.V.); (A.G.T.)
| | - Kyriaki Boki
- Rheumatology Unit, Sismanogleio General Hospital, 15126 Athens, Greece;
| | - Athanasios G. Tzioufas
- Department of Pathophysiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.V.); (M.V.); (A.G.T.)
- Joint Academic Rheumatology Program, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | | | - Clio P. Mavragani
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (E.A.); (A.N.); (P.R.)
- Department of Pathophysiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.V.); (M.V.); (A.G.T.)
- Joint Academic Rheumatology Program, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Correspondence: ; Tel.: +30-210-746-2714
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12
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Impact of comorbid Sjögren syndrome in anti-aquaporin-4 antibody-positive neuromyelitis optica spectrum disorders. J Neurol 2021; 268:1938-1944. [PMID: 33416998 DOI: 10.1007/s00415-020-10377-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 12/18/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Neuromyelitis optica spectrum disorders (NMOSD) are autoimmune neurological diseases of the central nervous system, which are characterized by the presence of serum anti-aquaporin-4 autoantibodies (AQP4-IgG). An association between Sjögren syndrome (SjS) and AQP4-IgG-positive NMOSD has been proposed, but the rate of coexistence has not been determined. METHODS In this study, 4,447 patients suspected of having NMOSD with acute neurological episodes were evaluated for the positivity of serum AQP4-IgG, serum SS-A/Ro antibody, and the presence of SjS-related symptoms (dry eye, dry mouth). RESULTS Of the 4,447 patients, 1,651 were positive for serum AQP4-IgG, and the remaining 2,796 were negative. A significantly higher proportion of AQP4-IgG-positive patients were positive for serum anti-SSA/Ro antibody (26.3 vs. 4.5%; p < 0.0001) and anti-SSB/La antibody (7.2 vs. 1.2%; p < 0.0001) and had dry eye (9.1 vs .4.9%; p < 0.0001) and dry mouth symptoms (8.9 vs. 3.7%; p < 0.0001). More than 80% of the patients with SjS with acute neurological events such as myelitis or optic neuritis were AQP4-IgG positive. AQ4-IgG-positive patients with comorbid SjS showed a higher female rate (97.1 vs. 89.0%; p = 0.0062), a higher positivity rate for oligoclonal bands (15.4 vs. 7.5%; p = 0.029), and a higher relapse frequency (p = 0.027) than AQP4-IgG-positive patients without comorbid SjS. CONCLUSIONS The prevalence of SjS is higher among AQP4-IgG-positive than AQP4-IgG-negative patients, with the potential prevalence of 10-20% at the diagnosis of AQP4-IgG-positive NMOSD. Comorbid SjS is more prevalent in females, and it has a higher relapse frequency among AQP4-IgG-positive patients.
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13
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Goules AV, Argyropoulou OD, Pezoulas VC, Chatzis L, Critselis E, Gandolfo S, Ferro F, Binutti M, Donati V, Zandonella Callegher S, Venetsanopoulou A, Zampeli E, Mavrommati M, Voulgari PV, Exarchos T, Mavragani CP, Baldini C, Skopouli FN, Fotiadis DI, De Vita S, Moutsopoulos HM, Tzioufas AG. Primary Sjögren's Syndrome of Early and Late Onset: Distinct Clinical Phenotypes and Lymphoma Development. Front Immunol 2020; 11:594096. [PMID: 33193443 PMCID: PMC7604905 DOI: 10.3389/fimmu.2020.594096] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 09/28/2020] [Indexed: 11/13/2022] Open
Abstract
Objectives To study the clinical, serological and histologic features of primary Sjögren’s syndrome (pSS) patients with early (young ≤35 years) or late (old ≥65 years) onset and to explore the differential effect on lymphoma development. Methods From a multicentre study population of 1997 consecutive pSS patients, those with early or late disease onset, were matched and compared with pSS control patients of middle age onset. Data driven analysis was applied to identify the independent variables associated with lymphoma in both age groups. Results Young pSS patients (19%, n = 379) had higher frequency of salivary gland enlargement (SGE, lymphadenopathy, Raynaud’s phenomenon, autoantibodies, C4 hypocomplementemia, hypergammaglobulinemia, leukopenia, and lymphoma (10.3% vs. 5.7%, p = 0.030, OR = 1.91, 95% CI: 1.11–3.27), while old pSS patients (15%, n = 293) had more frequently dry mouth, interstitial lung disease, and lymphoma (6.8% vs. 2.1%, p = 0.011, OR = 3.40, 95% CI: 1.34–8.17) compared to their middle-aged pSS controls, respectively. In young pSS patients, cryoglobulinemia, C4 hypocomplementemia, lymphadenopathy, and SGE were identified as independent lymphoma associated factors, as opposed to old pSS patients in whom SGE, C4 hypocomplementemia and male gender were the independent lymphoma associated factors. Early onset pSS patients displayed two incidence peaks of lymphoma within 3 years of onset and after 10 years, while in late onset pSS patients, lymphoma occurred within the first 6 years. Conclusion Patients with early and late disease onset constitute a significant proportion of pSS population with distinct clinical phenotypes. They possess a higher prevalence of lymphoma, with different predisposing factors and lymphoma distribution across time.
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Affiliation(s)
- Andreas V Goules
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,Joint Rheumatology Academic Program, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Ourania D Argyropoulou
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,Joint Rheumatology Academic Program, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasileios C Pezoulas
- Unit of Medical Technology and Intelligent Information Systems, University of Ioannina, Ioannina, Greece
| | - Loukas Chatzis
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,Joint Rheumatology Academic Program, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Elena Critselis
- Proteomics Facility, Center for Systems Biology, Biomedical Research Foundation of the Academy of Athens, Athens, Greece.,Department of Nutrition and Clinical Dietetics, Harokopio University of Athens, Athens, Greece
| | - Saviana Gandolfo
- Rheumatology Clinic, Department of Medical Area, University of Udine, Udine, Italy
| | - Francesco Ferro
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marco Binutti
- Rheumatology Clinic, Department of Medical Area, University of Udine, Udine, Italy
| | - Valentina Donati
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Aliki Venetsanopoulou
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,Joint Rheumatology Academic Program, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelia Zampeli
- Institute for Autoimmune Systemic and Neurological Diseases, Athens, Greece
| | - Maria Mavrommati
- Department of Nutrition and Clinical Dietetics, Harokopio University of Athens, Athens, Greece
| | - Paraskevi V Voulgari
- Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
| | | | - Clio P Mavragani
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Chiara Baldini
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Fotini N Skopouli
- Department of Nutrition and Clinical Dietetics, Harokopio University of Athens, Athens, Greece
| | - Dimitrios I Fotiadis
- Unit of Medical Technology and Intelligent Information Systems, University of Ioannina, Ioannina, Greece.,Department of Biomedical Research, Institute of Molecular Biology and Biotechnology, Foundation for Research and Technology - Hellas, Ioannina, Greece
| | - Salvatore De Vita
- Rheumatology Clinic, Department of Medical Area, University of Udine, Udine, Italy
| | - Haralampos M Moutsopoulos
- Institute for Autoimmune Systemic and Neurological Diseases, Athens, Greece.,Chair Medical Sciences/Immunology, Academy of Athens, Athens, Greece
| | - Athanasios G Tzioufas
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,Joint Rheumatology Academic Program, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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14
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McCoy SS, Sampene E, Baer AN. Association of Sjögren's Syndrome With Reduced Lifetime Sex Hormone Exposure: A Case-Control Study. Arthritis Care Res (Hoboken) 2020; 72:1315-1322. [PMID: 31233285 DOI: 10.1002/acr.24014] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 06/18/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To test whether cumulative estrogen exposure, as determined by age at menarche, age at menopause, female hormone use, hysterectomy, and parity, have an effect on the development of primary Sjögren's syndrome (SS). METHODS We performed a case-control study of 2,680 women from the Sjögren's International Collaborative Clinical Alliance registry, including 1,320 registrants with primary SS and 1,360 with sicca symptoms but no key features of primary SS (sicca controls). The composite estrogen score (CES) was calculated by point assignment for early menarche (age ≤10 years), high parity (>3 pregnancies), hysterectomy, female hormone use, and late menopause (age ≥53 years). Cumulative menstrual cycling (CMC) was calculated as years menstruating minus time pregnant. RESULTS Using a regression model that adjusted for age, recruitment site, ethnicity, education, employment status, and smoking, we observed a progressive inverse trend between primary SS and CES. The odds ratio (OR) and 95% confidence interval (95% CI) were as follows for the sicca control group: CES 1, OR 0.81 (95% CI 0.67-0.99); CES 2, OR 0.74 (95% CI 0.57-0.97); CES 3, OR 0.50 (95% CI 0.30-0.86). This trend was corroborated by analysis of CMC. At the highest level of CMC within the postmenopausal group there was a 24% reduction in cumulative sex hormone exposure among primary SS participants relative to controls. CONCLUSION Women with primary SS have lower estrogen exposure and CMC compared to sicca controls. Increasing estrogen exposure was negatively associated with development of primary SS. Further longitudinal studies of sex hormone exposure in primary SS are needed to confirm these findings.
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Affiliation(s)
- Sara S McCoy
- University of Wisconsin School of Medicine and Public Health, Madison
| | - Emmanuel Sampene
- University of Wisconsin School of Medicine and Public Health, Madison
| | - Alan N Baer
- Johns Hopkins University School of Medicine, Baltimore, Maryland
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15
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Akaycan J, Hidayet Ş, Bayramoğlu A, Yolbaş S, Karaca Y, Yiğit Y, Ulutaş Z. Subclinical left ventricular dysfunction in Sjögren's syndrome assessed by four-dimensional speckle tracking echocardiography. Echocardiography 2020; 37:1803-1808. [PMID: 32951254 DOI: 10.1111/echo.14867] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/16/2020] [Accepted: 08/23/2020] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the left ventricular (LV) systolic strain by four-dimensional speckle tracking echocardiography (4D-STE) in order to provide the early detection of myocardial dysfunction in patients with Sjögren's syndrome (SS). METHODS Forty consecutive patients with primary SS diagnosed at the rheumatology outpatient clinic and 35 age- and sex-matched healthy volunteers were included in the study. 4DSTE was performed, and global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS), and global area strain (GAS) were measured. 4DSTE results were compared with the healthy volunteers. RESULTS No significant differences were observed between the GRS and GCS values of the two groups. A significant difference was observed in the GLS and GAS measurements between the two groups (P = .005 for GLS, P < .001 for GAS). Positive correlation was detected between disease duration and LV-GLS and LV-GAS. CONCLUSION We demonstrated subclinical systolic dysfunction in SS patients by 4DSTE, which is a sensitive marker of ventricular dysfunction. Deterioration of the LV became more evident as duration of the disease increased. Therefore, we believe that a cardiac evaluation will be of benefit to patients with long-term SS.
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Affiliation(s)
- Jülide Akaycan
- Department of Cardiology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Şıho Hidayet
- Department of Cardiology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Adil Bayramoğlu
- Department of Cardiology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Servet Yolbaş
- Department of Rheuomatology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Yücel Karaca
- Department of Cardiology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Yakup Yiğit
- Department of Cardiology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Zeynep Ulutaş
- Department of Cardiology, Elazığ Fethi Sekin City Hospıtal, Elazığ, Turkey
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16
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Early onset primary Sjögren syndrome, clinical and laboratory characteristics. Clin Rheumatol 2020; 39:2689-2696. [DOI: 10.1007/s10067-020-05017-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 02/17/2020] [Accepted: 02/28/2020] [Indexed: 10/24/2022]
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17
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Shi X, Chen Z, Wang J, Wen Y, Zou L, Fei Y, Ye W, Qin Y, Li H, Li M, Li X, Zhang F, Li X, Chen L. Primary Sjӧgren's syndrome with renal Fanconi syndrome: Good responses to treatment with glucocorticoids. Semin Arthritis Rheum 2020; 50:1326-1332. [PMID: 32418614 DOI: 10.1016/j.semarthrit.2020.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/19/2020] [Accepted: 03/23/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Renal Fanconi syndrome (FS) is rare in primary Sjӧgren's syndrome (pSS). We aimed to describe the clinicopathological characteristics of pSS associated FS (pSS-FS) and its responses to treatment. METHODS We reported 25 cases of pSS-FS patients and retrospectively reviewed their clinical records, kidney pathology and follow-up data. RESULTS The 25 pSS-FS patients were mainly female (92.0%) and the mean age at diagnosis was 43.6±11.3 years. They showed different degrees of proximal tubular dysfunctions and eGFR decline (60.9±32.3 ml/min/1.73m2). Kidney pathology of pSS-FS patients showed tubulo-interstitial nephritis with defective brush border and lymphoplasmacytic infiltrates. After glucocorticoid treatment, the eGFR levels were significantly improved from 48.3±20.6 ml/min/1.73m2 to 55.0±19.9 ml/min/1.73m2 (P = 0.012) at the third month of follow-up. They also acquired good tubular (88.2%) and immunological (90.0%) responses. pSS-FS patients with young-onset pSS presented with a higher prevalence of positive anti-SSB antibody and hypocomplementemia, more severe hypokalemia, and better eGFR levels. CONCLUSIONS In pSS-FS patients, use of glucocorticoids could improve eGFR and tubular functions. The young-onset pSS group presented with a particular pattern in immunological features and kidney involvement.
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Affiliation(s)
- Xiaoxiao Shi
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, No 1, Shuaifuyan, Wangfujing St, Beijing 100730, China
| | - Zhixin Chen
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, No 1, Shuaifuyan, Wangfujing St, Beijing 100730, China
| | - Jing Wang
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Yubing Wen
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, No 1, Shuaifuyan, Wangfujing St, Beijing 100730, China
| | - Linfeng Zou
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, No 1, Shuaifuyan, Wangfujing St, Beijing 100730, China
| | - Yunyun Fei
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Wei Ye
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, No 1, Shuaifuyan, Wangfujing St, Beijing 100730, China
| | - Yan Qin
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, No 1, Shuaifuyan, Wangfujing St, Beijing 100730, China
| | - Hang Li
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, No 1, Shuaifuyan, Wangfujing St, Beijing 100730, China
| | - Mingxi Li
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, No 1, Shuaifuyan, Wangfujing St, Beijing 100730, China
| | - Xuemei Li
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, No 1, Shuaifuyan, Wangfujing St, Beijing 100730, China
| | - Fengchun Zhang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Xuewang Li
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, No 1, Shuaifuyan, Wangfujing St, Beijing 100730, China
| | - Limeng Chen
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, No 1, Shuaifuyan, Wangfujing St, Beijing 100730, China.
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18
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Skarlis C, Argyriou E, Mavragani CP. Lymphoma in Sjögren’s Syndrome: Predictors and Therapeutic Options. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2020. [DOI: 10.1007/s40674-020-00138-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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19
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De Vita S, Gandolfo S. Predicting lymphoma development in patients with Sjögren's syndrome. Expert Rev Clin Immunol 2019; 15:929-938. [PMID: 31347413 DOI: 10.1080/1744666x.2019.1649596] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Introduction: The issue of predicting lymphoma in primary Sjögren's syndrome (pSS) starts from its clinical and biologic essence, i.e., an autoimmune exocrinopathy with sicca syndrome, inflammation and lymphoproliferation of MALT (mucosa-associated lymphoid tissue) in exocrine glands. Areas covered: The two major predictors to be firstly focused are persistent salivary gland (SG) swelling and cryoglobulinemic vasculitis with related features as purpura and low C4, or the sole serum cryoglobulinemia repeatedly detected. They are pathogenetically linked and reflect a heavier MALT involvement by histopathology, with the expansion of peculiar rheumatoid factor (RF)-positive clones/idiotypes. Other predictors include lymphadenopathy, splenomegaly, neutropenia, lymphopenia, serum beta2-microglobulin, monoclonal immunoglobulins, light chains, and RF. Composite indexes/scores may also predict lymphoma. Expert opinion: Prediction at baseline needs amelioration, and must be repeated in the follow-up. Careful clinical characterization, with harmonization and stratification of large cohorts, is a relevant preliminary step. Validated and new biomarkers are needed in biologic fluids and tissues. SG echography with automatic scoring could represent a future imaging biomarker, still lacking. Scoring MALT involvement in pSS, as an additional tool to evaluate disease activity and possibly to predict lymphoma, is welcomed. All these efforts are now ongoing within the HarmonicSS project and in other research initiatives in pSS.
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Affiliation(s)
- Salvatore De Vita
- Rheumatology Clinic, Udine University Hospital, Department of Medical Area, University of Udine , Udine , Italy
| | - Saviana Gandolfo
- Rheumatology Clinic, Udine University Hospital, Department of Medical Area, University of Udine , Udine , Italy
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20
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Nezos A, Evangelopoulos ME, Mavragani CP. Genetic contributors and soluble mediators in prediction of autoimmune comorbidity. J Autoimmun 2019; 104:102317. [PMID: 31444033 DOI: 10.1016/j.jaut.2019.102317] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 08/03/2019] [Indexed: 12/20/2022]
Abstract
Comorbidities including subclinical atherosclerosis, neuropsychological aberrations and lymphoproliferation represent a major burden among patients with systemic autoimmune diseases; they occur either as a result of intrinsic disease related characteristics including therapeutic interventions or traditional risk factors similar to those observed in general population. Soluble molecules recently shown to contribute to subclinical atherosclerosis in the context of systemic lupus erythematosus (SLE) include among others B-cell activating factor (BAFF), hyperhomocysteinemia, parathormone (PTH) levels and autoantibodies against oxidized lipids. Variations of the 5, 10- methylenetetrahydrofolate reductase (MTHFR) gene -the main genetic determinant of hyperhomocystenemia in humans-as well the interferon regulatory factor-8 (IRF8), FcγRIIA and BAFF genes have been all linked to subclinical atherosclerosis in SLE. BAFF variants have been also found to confer increased risk for subclinical atherosclerosis and lymphoma development in Sjogren's syndrome (SS) patients. Other genes shown to be implicated in SS lymphoproliferation include genes involved a. in inflammatory responses such as the NFκB regulator Tumor necrosis factor alpha-induced protein 3 (TNFAIP3) and the Leukocyte immunoglobulin-like receptor A3 (LILRA3) immunoreceptor, b. B cell activation and signaling (BAFF/BAFF-receptor), c. type I IFN pathway such as three-prime repair exonuclease 1 (TREX1), d. epigenetic processes including DNA methylation (MTHFR rs1801133, 677T allele) and e. genomic instability (MTHFR rs1801131, 1298C allele). Emerging soluble biomarkers for SS related lymphoma include mediators of B cell growth and germinal center formation such as BAFF, FMS-like tyrosine kinase 3 ligand (Flt-3L) and CXCL13 as well as inflammatory contributors such as inteleukin (IL)-17, IL-18, ASC, LILRA3 and the extracellular lipoprotein-associated phospholipase A2 (Lp-PLA2). In regard to fatigue and neuropsychologic features in the setting of SS, contributing factors such as BAFF variants, antibodies against neuropeptides, proteins involved in nervous system function as well as inflammatory cytokines have been reported.
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Affiliation(s)
- Adrianos Nezos
- Department of Physiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria-Eleutheria Evangelopoulos
- First Department of Neurology, Demyelinating Diseases Unit, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Clio P Mavragani
- Department of Physiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece; Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece; Joint Academic Rheumatology Program, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece.
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21
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Kapsogeorgou EK, Voulgarelis M, Tzioufas AG. Predictive markers of lymphomagenesis in Sjögren's syndrome: From clinical data to molecular stratification. J Autoimmun 2019; 104:102316. [PMID: 31431317 DOI: 10.1016/j.jaut.2019.102316] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 08/03/2019] [Indexed: 12/26/2022]
Abstract
Sjögren's syndrome (SS) is a chronic systemic autoimmune disease, affecting predominantly the exocrine glands, a large array of systemic manifestations and high risk of lymphoma development. The latter constitutes the major adverse outcome of SS contributing in the increased morbidity and mortality of the disease. The vast majority of lymphomas in SS are B-cell non-Hodgkin's lymphomas (NHL), primarily indolent mucosa-associated lymphoid tissue (MALT) lymphomas, followed by nodal marginal zone lymphomas (NMZL) and diffuse large B cell lymphomas (DLBCL). In the last 3 decades and due to the adverse impact of NHL in disease outcome, an effort has been undertaken to identify markers and models predicting patients with SS at high risk for lymphoma development. Several epidemiological, clinical, laboratory and histological parameters, some of which are evident at the time of SS diagnosis, were proved to independently predict the development of NHL. These include salivary gland enlargement, skin vasculitis/purpura, glomerulonephritis, peripheral neuropathy, Raynaud's phenomenon, lymphadenopathy, splenomegaly, cytopenias, hypocomplementemia, cryoglobulinemia, rheumatoid factor, anti-Ro/La autoantibodies, hypergammaglobulinemia, serum monoclonal gammopathy, biopsy focus score and organization of lymphocytic infiltrates in the salivary glands into ectopic germinal centers. Prediction models combining some of the afore-mentioned predictors have also been described. However, the identification of specific and sensitive molecular biomarkers, related to the process of lymphomagenesis is still pending. Recently, we described a novel biomarker the miR200b-5p micro-RNA. Low levels of this miRNA in the minor salivary glands, appears to discriminate with high specificity and sensitivity the SS patients who have from those who do not have NHL. miR200b-5p, being expressed years before the clinical onset of NHL, independently predicts NHL development with a predictive value higher than the previously published multifactorial models and has a possible role in the monitoring of therapeutic response. Thus, it is a strong candidate for the identification and follow-up of patients at risk.
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Affiliation(s)
- Efstathia K Kapsogeorgou
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Greece; Academic Joint Rheumatology Program, School of Medicine, National and Kapodistrian University of Athens, Greece.
| | - Michael Voulgarelis
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Greece; Academic Joint Rheumatology Program, School of Medicine, National and Kapodistrian University of Athens, Greece.
| | - Athanasios G Tzioufas
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Greece; Academic Joint Rheumatology Program, School of Medicine, National and Kapodistrian University of Athens, Greece.
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Retamozo S, Brito-Zerón P, Ramos-Casals M. Prognostic markers of lymphoma development in primary Sjögren syndrome. Lupus 2019; 28:923-936. [PMID: 31215845 DOI: 10.1177/0961203319857132] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Sjögren syndrome is a systemic autoimmune disease that principally affects women between the fourth and sixth decades of life who present with sicca symptomatology caused by dryness of the main mucosal surfaces. The clinical spectrum of Sjögren syndrome extends from dryness to systemic involvement. Since 1978, Sjögren syndrome has been closely associated with an enhanced risk of lymphoma, one of the most severe complications a patient may develop. Primary Sjögren syndrome patients have a 10-44-fold greater risk of lymphoma than healthy individuals, higher than that reported for systemic lupus erythematosus and rheumatoid arthritis. The close link between lymphoma and Sjögren syndrome is clearly exemplified by the very specific type of lymphoma arising in Sjögren syndrome patients, mainly low-grade B-cell lymphomas (predominantly a marginal zone histological type) with primary extranodal involvement of the major salivary glands (overwhelmingly parotid), with a primordial role of cryoglobulinemic-related markers (both clinical and immunological). The most recent studies support a higher number of risk factors detected in an individual leads to a higher lymphoma risk. A close follow-up of high-risk groups with longitudinal assessments of all known risk factors, including cryoglobulin-related markers and EULAR Sjögren's syndrome disease activity index measurement in particular, is mandatory.
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Affiliation(s)
- S Retamozo
- 1 Instituto de Investigaciones en Ciencias de la Salud (INICSA), Universidad Nacional de Córdoba (UNC), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Córdoba, Argentina.,2 Instituto Universitario de Ciencias Biomédicas de Córdoba (IUCBC), Córdoba, Argentina.,3 Laboratory of Autoimmune Diseases Josep Font, IDIBAPS-CELLEX, Barcelona, Spain
| | - P Brito-Zerón
- 3 Laboratory of Autoimmune Diseases Josep Font, IDIBAPS-CELLEX, Barcelona, Spain.,4 Department of Medicine, Hospital CIMA-Sanitas, Barcelona, Spain
| | - M Ramos-Casals
- 3 Laboratory of Autoimmune Diseases Josep Font, IDIBAPS-CELLEX, Barcelona, Spain.,5 Department of Autoimmune Diseases, ICMiD, Barcelona, Spain.,6 Department of Medicine, University of Barcelona, Barcelona, Spain
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Subgroups of Sjögren's syndrome patients categorised by serological profiles: clinical and immunological characteristics. Reumatologia 2018; 56:346-353. [PMID: 30647480 PMCID: PMC6330679 DOI: 10.5114/reum.2018.80711] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 11/30/2018] [Indexed: 11/17/2022] Open
Abstract
Objectives Sjögren's syndrome (SS) is an autoimmune disease characterised by heterogeneous clinical presentation and presence of various autoantibodies - anti-SSA/Ro of diagnostic value, less specific anti-SSB/La and others. We searched for biomarker(s) and potential therapeutic target(s) of SS subsets that vary in their autoantibody profile. Material and methods Eighty-one patients with SS (70 female and 11 male) and 38 healthy volunteers (28 female and 10 male) were included in the study. Patients were categorised according to absence (group 1) or presence of anti-SSA/Ro antibody which occurred either alone (group 2) or together with anti-SSB/La (group 3). Clinical evaluation was performed, and presence of autoantibodies and concentrations of cytokines relevant to SS pathogenesis, i.e. a proliferation inducing ligand (APRIL), B-lymphocyte activating factor (BAFF), interleukin (IL) 4, IL-10, interferon α (IFN-α) and thymic stromal lymphopoietin (TSLP), in sera were determined. Results Frequency of autoantibodies other than anti-SSA/Ro and anti-SSB/La, the number of autoantibody specificities and anti-nuclear antibody titres were higher in group 2 and/or 3 than in group 1 of SS patients. Moreover, SS patients of groups 2 and 3 developed disease symptoms at younger age, and more often had positive Schirmer's test and skin lesions. In addition, serum concentrations of APRIL, but not other tested cytokines, were significantly higher in the patients of both groups 2 and 3 than those of group 1 and healthy volunteers. Conclusions Sjögren's syndrome patients with signs of B-cell epitope spreading are characterised by early disease onset, more frequent xerophthalmia and skin involvement, and up-regulated serum APRIL level. We suggest that therapeutic neutralisation of APRIL may be beneficial for these patients.
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TNFAIP3 F127C Coding Variation in Greek Primary Sjogren's Syndrome Patients. J Immunol Res 2018; 2018:6923213. [PMID: 30662920 PMCID: PMC6313987 DOI: 10.1155/2018/6923213] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 10/29/2018] [Indexed: 01/01/2023] Open
Abstract
Tumor necrosis factor, alpha-induced protein 3 (TNFAIP3) gene encodes the A20 protein, an important negative feedback regulator of the nuclear factor kappa-light-chain-enhancer of activated B cell (NF-κB) pathway. A coding TNFAIP3 variant, namely rs2230926, has been previously linked to B cell non-Hodgkin's lymphoma (NHL) development in patients with Sjogren's syndrome (SS) of French and UK origin. Herein, we aimed to determine the prevalence of rs2230926 in a Greek primary SS cohort and explore possible associations with disease characteristics. The rs2230926 gene variant was genotyped in 327 primary Greek SS patients (ninety-one complicated by NHL (SS-lymphoma)) and 448 Greek healthy controls (HC) of similar age and sex distribution. Clinical and laboratory characteristics were also recorded and gene expression of relevant genes of the NF-κB pathway was quantitated by real-time PCR in available whole peripheral blood (PB) from 165 primary SS patients. Increased prevalence of the rs2230926 mutant variant was detected in both SS-lymphoma and SS-nonlymphoma subgroups compared to HC (8.8% vs. 7.6% vs. 3.6%, p values: 0.04 and 0.03, respectively) in association with higher IgM, LDH serum levels, and PB Bcl-XL transcripts but lower leucocyte and neutrophil counts. Of interest, approximately one-fifth of SS-lymphoma cases with age at disease onset ≤ 40 years carried the rs2230926 variant (18.2% vs. 3.6%, OR 95% (CI): 6.0 (1.8–19.8), p value: 0.01). We postulate that deregulation of the NF-κB pathway as a result of the TNFAIP3 rs2230926 aberration increases SS and SS lymphoma susceptibility particularly in patients with early disease onset.
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Anquetil C, Hachulla E, Machuron F, Mariette X, Le Guern V, Vittecoq O, Dernis E, Larroche C, Dubost JJ, Perdriger A, Devauchelle-Pensec V, Fauchais AL, Morel J, Dieudé P, Rist S, Sene D, Gottenberg JE, Hatron PY. Is early-onset primary Sjögren’s syndrome a worse prognosis form of the disease? Rheumatology (Oxford) 2018; 58:1163-1167. [DOI: 10.1093/rheumatology/key392] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 10/05/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Céline Anquetil
- Service de médecine interne, CHU Claude Huriez, Lille Cedex, France
| | - Eric Hachulla
- Service de médecine interne, CHU Claude Huriez, Lille Cedex, France
| | - François Machuron
- Department of Biostatistics, Univ. Lille, CHU Lille, EA 2694 - Santé Publique : Épidémiologie et Qualité des Soins, Lille, France
| | - Xavier Mariette
- Service de rhumatologie, Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Sud, Le Kremlin-Bicêtre, France
| | - Véronique Le Guern
- Centre de référence des maladies auto-immunes rares, CHU Cochin APHP, Paris, France
| | | | - Emmanuelle Dernis
- Service de rhumatologie, Centre hospitalier Le Mans, Le Mans Cedex, France
| | - Claire Larroche
- Service de médecine interne, Hôpital Avicenne APHP, Bobigny Cedex, France
| | - Jean-Jacques Dubost
- Service de rhumatologie, CHU Gabriel Montpied, Clermont-Ferrand Cedex, France
| | | | | | | | - Jacques Morel
- Département de rhumatologie, CHU de Montpellier, Université de Montpellier, Montpellier, France
| | - Philippe Dieudé
- Service de rhumatologie, Hôpital Bichat AP-HP, Paris, France
| | | | - Damien Sene
- Département de médecine interne, Hôpital Lariboisière APHP, Paris, France
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Molano-González N, Olivares-Martínez E, Anaya JM, Hernández-Molina G. Anti-citrullinated protein antibodies and arthritis in Sjögren's syndrome: a systematic review and meta-analysis. Scand J Rheumatol 2018; 48:157-163. [PMID: 30270696 DOI: 10.1080/03009742.2018.1469164] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE The presence of anti-citrullinated protein antibodies (ACPAs) in primary Sjögren's syndrome (pSS) ranges from 3% to 9.9%; however, there is no agreement about their clinical significance. Our aim was to systematically review the literature regarding the association of arthritis and ACPAs in pSS and their role in the development of rheumatoid arthritis (RA). METHOD A comprehensive search of MEDLINE, ISI Web of Knowledge, and Cochrane Library from inception until June 2016 was undertaken using the combination of two or three of the keywords: primary Sjögren's syndrome, Sjögren's syndrome, arthritis, synovitis, arthropathy, anti-cyclic citrullinated peptide antibodies, and anti-citrullinated protein antibody - ACPA. No language restriction was used. Studies were included if they: assessed the association of arthritis and ACPAs, had sufficient data to construct a two-by-two table, tested immunoglobulin G ACPA by any method, and included patients with pSS according to a validated set of classification criteria. We used a random effects model and evaluated the heterogeneity and publication bias. RESULTS Ten studies were included (involving 1322 patients). We found a pooled odds ratio of 4.42 (95% confidence interval 1.15-16.94, p = 0.03). The test for heterogeneity was I2 = 0.87. Publication bias was not observed. Based on data from three studies, 33 of 58 pSS patients with ACPAs (57%) developed RA compared with none of 598 pSS patients with negative ACPA (p < 0.000001). CONCLUSION Patients with pSS disclosing ACPAs are prone to arthritis as part of the clinical spectrum of the disease, but are also at risk of developing RA.
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Affiliation(s)
- N Molano-González
- a Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences , del Rosario University , Bogotá , Colombia
| | - E Olivares-Martínez
- b Department of Immunology and Rheumatology , National Institute of Medical Science and Nutrition Salvador Zubiran , Mexico City , México
| | - J M Anaya
- a Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences , del Rosario University , Bogotá , Colombia
| | - G Hernández-Molina
- b Department of Immunology and Rheumatology , National Institute of Medical Science and Nutrition Salvador Zubiran , Mexico City , México
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Kobayashi I, Okura Y, Ueki M, Tozawa Y, Takezaki S, Yamada M, Ariga T. Evaluation of systemic activity of pediatric primary Sjögren’s syndrome by EULAR Sjögren’s syndrome disease activity index (ESSDAI). Mod Rheumatol 2018. [DOI: 10.1080/14397595.2018.1452174] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Ichiro Kobayashi
- Center for Pediatric Allergy and Rheumatology, KKR Medical Center, Sapporo, Japan
- Department of Pediatrics, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yuka Okura
- Center for Pediatric Allergy and Rheumatology, KKR Medical Center, Sapporo, Japan
| | - Masahiro Ueki
- Department of Pediatrics, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yusuke Tozawa
- Department of Pediatrics, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Shunichiro Takezaki
- Department of Pediatrics, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Masafumi Yamada
- Department of Pediatrics, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Tadashi Ariga
- Department of Pediatrics, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Lechtman S, Debray MP, Crestani B, Bancal C, Hourseau M, Dossier A, Alexandra JF, Chauveheid MP, Papo T, Sacre K. Cystic lung disease in Sjögren's syndrome: An observational study. Joint Bone Spine 2016; 84:317-321. [PMID: 27659405 DOI: 10.1016/j.jbspin.2016.05.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 05/24/2016] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To analyze the prevalence, characteristics and outcome of cystic lung disease associated with Sjögren's syndrome (SS). METHODS From June 2010 to February 2015, 90 consecutive SS patients [60.1±14.8years; 88 (97.8%) female, 75 (83.3%) primary SS] had a systematic chest CT-scan. The presence of thin-walled cysts was analyzed by one experienced radiologist. Demographic data, clinical history, laboratory findings, and pulmonary function tests were extracted retrospectively from medical records. RESULTS Twenty-one (23.3%) patients had cysts on CT scan performed 40.5±54.5months after SS diagnosis. Cysts number ranged from 1 to 25 were often bilateral (52.4%) and mostly located in the middle lung zone (76.2%). Cysts were isolated (n=6, 28.6%) or associated with other lesions, including bronchiectasis (n=5, 23.8%), micronodules (n=5, 23.8%), ground-glass opacity (n=4, 19%) and/or air trapping (n=3, 14.3%). Most patients with cysts (57.1%) had no respiratory symptoms. When comparing SS patients with and without cysts, patients with cysts tended to be older (65.3±15.3 versus 58.5±14.4years, P=0.06). Smoking habits were similar in both groups. Anti-SSB antibodies were more frequently detected in patients with cysts (57.1% vs. 26.1%, P=0.02). Pulmonary function tests were normal or displayed only mild small airways obstruction and reduced diffusion capacity to carbon monoxide. Four (19%) patients with cysts had a past history of associated pulmonary disease, including interstitial lung disease. During follow-up (25.1±17.7months), no patient developed specific lung disease or lymphoproliferative disorders. CONCLUSIONS Cystic lung disease is frequent, benign, associated with anti-SSB/La antibodies and has no impact on outcome in SS.
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Affiliation(s)
- Sarah Lechtman
- Département de médecine interne, hôpital Bichat, université Paris Diderot, PRES Sorbonne Paris Cité, Assistance publique-Hôpitaux de Paris, 75018 Paris, France
| | - Marie-Pierre Debray
- Département de radiologie, hôpital Bichat, université Paris Diderot, PRES Sorbonne Paris Cité, Assistance publique-Hôpitaux de Paris, 75018 Paris, France
| | - Bruno Crestani
- Département de pneumologie, hôpital Bichat, université Paris Diderot, PRES Sorbonne Paris Cité, Assistance publique-Hôpitaux de Paris, 75018 Paris, France; Département hospitalo-universitaire FIRE (Fibrosis, Inflammation and Remodelling in Renal and Respiratory Diseases), université Paris Diderot, PRES Sorbonne Paris Cité, 75018 Paris, France
| | - Catherine Bancal
- Département de physiologie, hôpital Bichat, université Paris Diderot, PRES Sorbonne Paris Cité, Assistance publique-Hôpitaux de Paris, 75018 Paris, France
| | - Muriel Hourseau
- Département de pathologie, hôpital Bichat, université Paris Diderot, PRES Sorbonne Paris Cité, Assistance publique-Hôpitaux de Paris, 75018 Paris, France
| | - Antoine Dossier
- Département de médecine interne, hôpital Bichat, université Paris Diderot, PRES Sorbonne Paris Cité, Assistance publique-Hôpitaux de Paris, 75018 Paris, France
| | - Jean-François Alexandra
- Département de médecine interne, hôpital Bichat, université Paris Diderot, PRES Sorbonne Paris Cité, Assistance publique-Hôpitaux de Paris, 75018 Paris, France
| | - Marie-Paule Chauveheid
- Département de médecine interne, hôpital Bichat, université Paris Diderot, PRES Sorbonne Paris Cité, Assistance publique-Hôpitaux de Paris, 75018 Paris, France
| | - Thomas Papo
- Département de médecine interne, hôpital Bichat, université Paris Diderot, PRES Sorbonne Paris Cité, Assistance publique-Hôpitaux de Paris, 75018 Paris, France; Département hospitalo-universitaire FIRE (Fibrosis, Inflammation and Remodelling in Renal and Respiratory Diseases), université Paris Diderot, PRES Sorbonne Paris Cité, 75018 Paris, France; Inserm U1149, université Paris Diderot, laboratoire d'excellence INFLAMEX, PRES Sorbonne Paris Cité, Paris, France
| | - Karim Sacre
- Département de médecine interne, hôpital Bichat, université Paris Diderot, PRES Sorbonne Paris Cité, Assistance publique-Hôpitaux de Paris, 75018 Paris, France; Département hospitalo-universitaire FIRE (Fibrosis, Inflammation and Remodelling in Renal and Respiratory Diseases), université Paris Diderot, PRES Sorbonne Paris Cité, 75018 Paris, France; Inserm U1149, université Paris Diderot, laboratoire d'excellence INFLAMEX, PRES Sorbonne Paris Cité, Paris, France.
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Chen LY, Tsai MH, Tsai LT, Lu HM, Jan CI. Primary Sjögren's syndrome initially presenting as submandibular mucosa-associated lymphoid tissue lymphoma: A case report. Oncol Lett 2015; 11:921-924. [PMID: 26893669 PMCID: PMC4734050 DOI: 10.3892/ol.2015.3980] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 05/29/2015] [Indexed: 02/05/2023] Open
Abstract
The present study reports the case of a 24-year-old female affected with primary Sjögren's syndrome (pSS), who presented with mucosa-associated lymphoid tissue (MALT) lymphoma of the submandibular gland. Reports of such cases, particularly in young patients, are very rare. The patient, who presented no oral or ocular symptoms prior to the development of the mass, underwent surgical ablation of the gland, and MALT lymphoma was diagnosed by histopathology. Since MALT lymphoma in the submandibular gland is rarely observed in otherwise healthy young females, a rheumatologist and an oncologist were consulted. Following a number of immunological tests, the results of the Schirmer's and Saxon tests were negative. However, the antinuclear antibody test revealed a speckled appearance, and there was also strong positivity for the serological markers of Sjögren's syndrome. Consequently, pSS was diagnosed, despite the fact that the patient did not fulfill all the diagnostic criteria for the disease. Therefore, MALT lymphoma in a single salivary gland should be used as a differential diagnosis for Sjögren's syndrome in young asymptomatic patients. Additionally, a multidisciplinary team is required for the treatment and management of these patients.
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Affiliation(s)
- Liang-Yu Chen
- Department of Otolaryngology - Head and Neck Surgery, China Medical University and Hospital, Taichung 40402, Taiwan, R.O.C
| | - Ming-Hsui Tsai
- Department of Otolaryngology - Head and Neck Surgery, China Medical University and Hospital, Taichung 40402, Taiwan, R.O.C.; Graduate Institute of Clinical Medical Science, China Medical University, Taichung 40402, R.O.C
| | - Li-Tai Tsai
- Department of Otolaryngology - Head and Neck Surgery, China Medical University and Hospital, Taichung 40402, Taiwan, R.O.C
| | - Hsin-Man Lu
- Department of Psychology, Asia University, Taichung 41354, Taiwan, R.O.C
| | - Chia-Ing Jan
- Department of Pathology, China Medical University Hospital, Taichung 40402, Taiwan, R.O.C.; Department of Pathology, China Medical University, Beigang Hospital, Beigang, Yunlin 65152, R.O.C.; Department of Dentistry, National Yang-Ming University, Taipei 11221, Taiwan, R.O.C
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Theander E, Jonsson R, Sjöström B, Brokstad K, Olsson P, Henriksson G. Prediction of Sjögren's Syndrome Years Before Diagnosis and Identification of Patients With Early Onset and Severe Disease Course by Autoantibody Profiling. Arthritis Rheumatol 2015; 67:2427-36. [PMID: 26109563 DOI: 10.1002/art.39214] [Citation(s) in RCA: 163] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 05/19/2015] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Autoantibodies are highly characteristic of primary Sjögren's syndrome (SS) and represent important tools for studying its pathogenesis. Nonetheless, thus far, no systematic investigations have assessed the presence of autoantibodies before diagnosis. This study was undertaken to analyze how early and in what order autoantibodies appear, how predictive they are of primary SS, and whether they identify disease subsets. METHODS A nested case-control design linking data from the Malmö primary SS registry and 3 Swedish healthcare biobanks was applied. In all, 175 serum samples obtained from 117 individuals before diagnosis of primary SS and 1 serum sample from each of 117 matched controls were analyzed for antinuclear antibodies (ANAs), rheumatoid factor (RF), and antibodies against Ro 60/SSA, Ro 52/SSA, and La/SSB. RESULTS Considering all patients with primary SS who were autoantibody positive after diagnosis, at least one autoantibody specificity was detected in 81% up to 20 years (median 4.3-5.1 years) before diagnosis. Those found most often were ANAs, followed by RF, anti-Ro 60/SSA, anti-Ro 52/SSA, and anti-La/SSB. Anti-Ro/SSA and anti-La/SSB antibodies were strongly associated with the risk of developing primary SS, especially early-onset disease and a severe disease course. When Bayesian prior prevalence estimates for primary SS were included in the calculation, prediagnostic anti-Ro 60/SSA and anti-Ro 52/SSA had the highest positive predictive values (25% and 100%, respectively). CONCLUSION Our findings indicate that autoantibodies are present for up to 18-20 years before the diagnosis of primary SS, but we cannot exclude even earlier seropositivity, since for most patients, the earliest sample analyzed was positive. In families with multiple cases of autoimmune disease, autoantibody profiling, along with assessment of genetic risk, enables identification of susceptible individuals in a predisease state.
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Affiliation(s)
| | - Roland Jonsson
- University of Bergen and Haukeland University Hospital, Bergen, Norway
| | - Bitte Sjöström
- Lund University and Skåne University Hospital, Malmö, Sweden
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Quartuccio L, Baldini C, Bartoloni E, Priori R, Carubbi F, Corazza L, Alunno A, Colafrancesco S, Luciano N, Giacomelli R, Gerli R, Valesini G, Bombardieri S, De Vita S. Anti-SSA/SSB-negative Sjögren's syndrome shows a lower prevalence of lymphoproliferative manifestations, and a lower risk of lymphoma evolution. Autoimmun Rev 2015; 14:1019-22. [DOI: 10.1016/j.autrev.2015.07.002] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 07/06/2015] [Indexed: 10/23/2022]
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32
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Papageorgiou A, Mavragani CP, Nezos A, Zintzaras E, Quartuccio L, De Vita S, Koutsilieris M, Tzioufas AG, Moutsopoulos HM, Voulgarelis M. A BAFF Receptor His159Tyr Mutation in Sjögren's Syndrome-Related Lymphoproliferation. Arthritis Rheumatol 2015; 67:2732-41. [DOI: 10.1002/art.39231] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 06/04/2015] [Indexed: 01/05/2023]
Affiliation(s)
| | | | | | - Elias Zintzaras
- University of Thessaly School of Medicine, Larissa, Greece, and The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, and Tufts University School of Medicine; Boston Massachusetts
| | - Luca Quartuccio
- University Hospital Santa Maria della Misericordia; Udine Italy
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Chebbi W, Ben Salem W, Klii R, Kessomtini W, Jerbi S, Sfar MH. [Primitive Sjögren syndrome in the elderly: clinical and immunological characteristics]. Pan Afr Med J 2015; 20:8. [PMID: 25995805 PMCID: PMC4430148 DOI: 10.11604/pamj.2015.20.8.5042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 10/31/2014] [Indexed: 11/11/2022] Open
Abstract
Les objectifs de notre étude est d’étudier les caractéristiques cliniques et immunologiques du syndrome de Gougerot Sjogren primitif (SGSp) du sujet âgé et les comparer à une population témoin plus jeune. Nous avons analysé rétrospectivement les dossiers de 60 patients atteints de SGSp consécutifs, suivis au service de Médecine interne du CHU Taher Sfar de Mahdia, en Tunisie, durant une période de 7 ans (janvier 2007 à décembre 2013). Les patients avec SGSp étaient classés en deux groupes selon l’âge de début de la maladie: groupe de sujets âgés (≥ 65 ans) et groupe de sujets jeunes (<65 ans). Chez 18 patients (30%), le SGSp a débuté après 65 ans. Il s'agissait de 17 femmes (94,5%) et un homme (5,5%). L’âge moyen du début du SGSp était de 70,5 ans ±3,1. Le délai moyen du diagnostic était de 38,6 mois ±26,8. Les manifestations glandulaires étaient constantes. La comparaison entre le groupe du SGSp du sujet âgé et celui du sujet jeune montrait que le délai moyen du diagnostic du SGSp était significativement plus long chez les sujets âgés. Les manifestations pulmonaires étaient significativement plus fréquentes chez les sujets âgés. En revanche, les fréquences des anticorps antinucléaires, anti-SSA et anti-SSB étaient significativement plus élevées chez les sujets jeunes. Bien que le SGSp soit une maladie typique d'adultes d’âge moyen, les cliniciens ne devraient pas ignorer que cette maladie peut être diagnostiquée aussi chez les patients âgés. Notre étude montre que l’âge du début avancé influence le profil clinique et immunologique du SGSp.
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Affiliation(s)
- Wafa Chebbi
- Service de Médecine Interne, CHU Taher Sfar, Mahdia, Tunisie
| | - Wafa Ben Salem
- Service de Médecine Interne, CHU Taher Sfar, Mahdia, Tunisie
| | - Rim Klii
- Service de Médecine Interne, CHU Fattouma Bourguiba, Monastir, Tunisie
| | - Wassia Kessomtini
- Unité de Médecine Physique, CHU Taher Sfar Mahdia, 5100 Mahdia, Tunisie
| | - Saida Jerbi
- Service de Radiologie, CHU Taher Sfar, Mahdia, Tunisie
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Kvarnström M, Ottosson V, Nordmark B, Wahren-Herlenius M. Incident cases of primary Sjögren’s syndrome during a 5-year period in Stockholm County: a descriptive study of the patients and their characteristics. Scand J Rheumatol 2014; 44:135-42. [DOI: 10.3109/03009742.2014.931457] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Yang JM, Heo H, Park SW. Relationship between retinal morphological findings and autoantibody profile in primary Sjögren's syndrome. Jpn J Ophthalmol 2014; 58:359-68. [PMID: 24882397 DOI: 10.1007/s10384-014-0327-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Accepted: 04/28/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE To investigate the morphological changes of the retina measured with the Cirrus high-definition optical coherence tomography in patients with primary Sjögren's syndrome (pSS). METHODS One hundred ninety six eyes of 196 patients with pSS and 200 eyes of 200 age and sex-matched normal controls were enrolled. Patients with pSS were divided into four subgroups based on their presence of autoantibodies (antinuclear antibody (ANA), anti-Ro/SSA, and anti-La/SSB). Peripapillary retinal nerve fiber layer (pRNFL) thickness, macular ganglion cell-inner plexiform layer (mGCIPL) thickness, and optic nerve head parameters were compared between groups. RESULTS Compared with controls, a significant decrease was observed in the average, inferior, and temporal thicknesses of pRNFL and in the minimum, superotemporal, inferonasal, inferior, and inferotemporal thicknesses of mGCIPL of eyes with pSS (all P < 0.05). In subgroup analyses, all eyes with positive tested autoantibodies [ANA(+), anti-Ro/SSA(+), anti-La/SSB(+)] showed a significant decrease of mGCIPL thicknesses, except for the superonasal portion, compared with eyes with any positivity for autoantibody (all P < 0.05). There was a negative linear relationship between the number of positive autoantibodies and average and inferior pRNFL thicknesses or all mGCIPL parameters, except for the superonasal portion, with a Spearman correlation analysis in patients with pSS (all P < 0.05). CONCLUSIONS Compared with controls, eyes with pSS showed thinning of pRNFL and mGCIPL thicknesses. The degree of thinning correlated with increased numbers of the positive autoantibody.
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Affiliation(s)
- Jee Myung Yang
- Department of Ophthalmology, Chonnam National University Medical School and Hospital, 8 Hak-Dong, Dong-Gu, Gwangju, 501-757, South Korea
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Ramos-Casals M, Brito-Zeron P, Solans R, Camps MT, Casanovas A, Sopena B, Diaz-Lopez B, Rascon FJ, Qanneta R, Fraile G, Perez-Alvarez R, Callejas JL, Ripoll M, Pinilla B, Akasbi M, Fonseca E, Canora J, Nadal ME, Red GDL, Fernandez-Regal I, Jimenez-Heredia I, Bosch JA, Ayala MDM, Morera-Morales L, Maure B, Mera A, Ramentol M, Retamozo S, Kostov B. Systemic involvement in primary Sjogren's syndrome evaluated by the EULAR-SS disease activity index: analysis of 921 Spanish patients (GEAS-SS Registry). Rheumatology (Oxford) 2013; 53:321-31. [DOI: 10.1093/rheumatology/ket349] [Citation(s) in RCA: 140] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Tarella C, Gueli A, Ruella M, Cignetti A. Lymphocyte transformation and autoimmune disorders. Autoimmun Rev 2013; 12:802-13. [DOI: 10.1016/j.autrev.2012.11.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Abstract
This article reviews current understanding of the clinical manifestations, diagnosis and treatment of Sjögren's syndrome. Sjögren's syndrome is a chronic inflammatory disorder of the exocrine glands with multiple nonexocrine features. It is found predominantly in middle-aged women but exists throughout the population. The diagnosis of Sjögren's syndrome can be challenging because the cardinal sicca symptoms may be subclinical or attributed to other causes, such as medications or aging. Differential diagnosis of Sjögren's syndrome can be confounded by the multiple exocrine manifestations in the mouth, eyes, ears, nose, skin, vagina, and respiratory and gastrointestinal tracts, as well as seemingly unrelated nonexocrine involvement in the thyroid, liver, kidneys and the musculoskeletal, vascular and nervous systems. This article concludes that early diagnosis of Sjögren's syndrome is crucial to prevent and/or minimize potentially life-threatening complications. Periodic follow-up of patients' status and collaboration between the primary-care physician and the rheumatologist, dentist, ophthalmologist and other specialists are indispensable.
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Affiliation(s)
- Ibtisam Al-Hashimi
- Baylor College of Dentistry, Salivary Dysfunction Clinic, Department of Periodontics, 3302 Gaston Avenue, Dallas, TX 75246, USA and University of Texas Southwestern Medical Centre, Faculty of Surgery, Division of Oral Surgery, Dallas, TX, USA.
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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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40
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Martel C, Gondran G, Launay D, Lalloué F, Palat S, Lambert M, Ly K, Loustaud-Ratti V, Bezanahary H, Hachulla E, Jauberteau MO, Vidal E, Hatron PY, Fauchais AL. Active Immunological Profile Is Associated with Systemic Sjögren’s Syndrome. J Clin Immunol 2011; 31:840-7. [DOI: 10.1007/s10875-011-9553-3] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Accepted: 05/27/2011] [Indexed: 10/18/2022]
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Botsios C, Furlan A, Ostuni P, Sfriso P, Andretta M, Ometto F, Raffeiner B, Todesco S, Punzi L. Elderly onset of primary Sjögren's syndrome: Clinical manifestations, serological features and oral/ocular diagnostic tests. Comparison with adult and young onset of the disease in a cohort of 336 Italian patients. Joint Bone Spine 2011; 78:171-4. [DOI: 10.1016/j.jbspin.2010.05.008] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2009] [Accepted: 05/20/2010] [Indexed: 11/29/2022]
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Hernández-Molina G, Leal-Alegre G, Michel-Peregrina M. The meaning of anti-Ro and anti-La antibodies in primary Sjögren's syndrome. Autoimmun Rev 2011; 10:123-5. [DOI: 10.1016/j.autrev.2010.09.001] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Accepted: 09/06/2010] [Indexed: 10/19/2022]
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Abstract
According to the classification criteria of the American-European Consensus Group (AECG), the prevalence of primary Sjögren's syndrome (pSS) of about 0.2% in the adult population and a yearly incidence of 4/100.000 in the general population are far lower than previously assumed. Moreover, the repeatedly reported male/female ratio of 1:9 seems to lie more in the range of 1:20. Male pSS patients show fewer immunological, histopathological or sialographic findings and organ involvement. Information on age at disease onset has also changed over the last decade. Recent studies indicate an onset age of approximately 45 years as compared to 56 in earlier studies of the last decade. Patients with an early disease onset are more frequently positive for rheumatoid factor (RF) and/or anti-Ro/SS-A. These patients also seem to have a higher risk of developing hypocomplementemia or lymphadenopathy. As compared to earlier cohorts, the introduction of the rather specific AECG criteria will probably result in the participation of fewer men, younger patients in general and of more seriously ill patients in future cohorts. The change in the spectrum of pSS patients obviously reflects the altered classification criteria since the AECG criteria require anti-Ro/La positivity and therefore exclude a high number of patients with other immunological markers who also show severe sicca symptoms and organ involvements. About 5%-10% of pSS patients in rheumatological care suffer from severe extraglandular manifestations, which generally occur soon after disease onset. In particular, palpable purpura, hypocomplementemia, cryoglobulinemia and lymphoma are associated with increased mortality. In Germany, approximately one tenth of Sjögren syndrome patients receive specialized rheumatological care. There is still insufficient knowledge about the vast majority of pSS patients who are not treated by rheumatologists. These patients, as well as all those who, according to the AECG criteria, are not classified as having pSS either due to anti-Ro/La negativity or having secondary Sjögren's syndrome, probably add up to at least 0.4% of the adult population which, at present, suffers from considerable immunopathologic sicca symptoms.
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Affiliation(s)
- G Westhoff
- Forschungsbereich Epidemiologie, Deutsches Rheuma-Forschungszentrum Berlin, Charitéplatz 1, 10117 Berlin.
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44
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Fauchais AL, Ouattara B, Gondran G, Lalloue F, Petit D, Ly K, Lambert M, Launay D, Loustaud-Ratti V, Bezanahari H, Liozon E, Hachulla E, Jauberteau MO, Vidal E, Hatron PY. Articular manifestations in primary Sjogren's syndrome: clinical significance and prognosis of 188 patients. Rheumatology (Oxford) 2010; 49:1164-72. [DOI: 10.1093/rheumatology/keq047] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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45
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HUO AP, LIN KC, CHOU CT. Predictive and prognostic value of antinuclear antibodies and rheumatoid factor in primary Sjogren’s syndrome. Int J Rheum Dis 2010; 13:39-47. [DOI: 10.1111/j.1756-185x.2009.01444.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Ambatipudi KS, Lu B, Hagen FK, Melvin JE, Yates JR. Quantitative analysis of age specific variation in the abundance of human female parotid salivary proteins. J Proteome Res 2009; 8:5093-102. [PMID: 19764810 PMCID: PMC2834885 DOI: 10.1021/pr900478h] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Human saliva is a protein-rich, easily accessible source of potential local and systemic biomarkers to monitor changes that occur under pathological conditions; however, little is known about the changes in abundance associated with normal aging. In this study, we performed a comprehensive proteomic profiling of pooled saliva collected from the parotid glands of healthy female subjects, divided into two age groups 1 and 2 (20-30 and 55-65 years old, respectively). Hydrophobic charge interaction chromatography was used to separate high- from low-abundance proteins prior to characterization of the parotid saliva using multidimensional protein identification technology (MudPIT). Collectively, 532 proteins were identified in the two age groups. Of these proteins, 266 were identified exclusively in one age group, while 266 proteins were common to both groups. The majority of the proteins identified in the two age groups belonged to the defense and immune response category. Of note, several defense related proteins (e.g., lysozyme, lactoferrin and histatin-1) were significantly more abundant in group 2 as determined by G-test. Selected representative mass spectrometric findings were validated by Western blot analysis. Our study reports the first quantitative analysis of differentially regulated proteins in ductal saliva collected from young and older female subjects. This study supports the use of high-throughput proteomics as a robust discovery tool. Such results provide a foundation for future studies to identify specific salivary proteins which may be linked to age-related diseases specific to women.
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Affiliation(s)
- Kiran S. Ambatipudi
- Center for Oral Biology, University of Rochester Medical Center; Rochester, New York 14642
| | - Bingwen Lu
- Department of Chemical Physiology, The Scripps Research Institute; 10550 North Torrey Pines Road, SR-11, La Jolla, CA 92037
| | - Fred K Hagen
- Center for Oral Biology, University of Rochester Medical Center; Rochester, New York 14642
| | - James E. Melvin
- Center for Oral Biology, University of Rochester Medical Center; Rochester, New York 14642
| | - John R. Yates
- Department of Chemical Physiology, The Scripps Research Institute; 10550 North Torrey Pines Road, SR-11, La Jolla, CA 92037
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Martin DN, Mikhail IS, Landgren O. Autoimmunity and hematologic malignancies: associations and mechanisms. Leuk Lymphoma 2009; 50:541-50. [DOI: 10.1080/10428190902780677] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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48
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Ramos-Casals M, Solans R, Rosas J, Camps MT, Gil A, Del Pino-Montes J, Calvo-Alen J, Jiménez-Alonso J, Micó ML, Beltrán J, Belenguer R, Pallarés L. Primary Sjögren syndrome in Spain: clinical and immunologic expression in 1010 patients. Medicine (Baltimore) 2008; 87:210-219. [PMID: 18626304 DOI: 10.1097/md.0b013e318181e6af] [Citation(s) in RCA: 338] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
We conducted the current study to characterize the clinical presentation of primary Sjögren syndrome (SS) in a large cohort of Spanish patients and to determine whether epidemiologic, clinical, and analytical features modulate disease expression. Patients were from the GEMESS Study group, which was formed in 2005 and included 12 Spanish reference centers. By March 2007, the database included 1010 consecutive patients, recruited since 1994, both incident and prevalent cases. The cohort included 937 women and 73 men (ratio, 13:1), with a mean age of 53 years at diagnosis and 59 years at inclusion in the registry. Multivariate analysis showed that male patients had a lower frequency of thyroiditis, Raynaud phenomenon, and antinuclear antibodies. Young-onset patients had a low degree of sicca involvement (xerostomia and parotid enlargement) and a high frequency of immunologic markers (anti-Ro/SS-A and low C4 levels). Patients with disease duration of more than 10 years had a higher prevalence of xerophthalmia, parotid enlargement, lung involvement, and peripheral neuropathy in comparison with incident cases. The subset of patients with anti-Ro/La antibodies had the highest prevalence of most systemic, hematologic, and immunologic alterations (higher frequency of Raynaud phenomenon, altered parotid scintigraphy, positive salivary gland biopsy, peripheral neuropathy, thrombocytopenia, and rheumatoid factor). Hypocomplementemia was associated with a higher frequency of vasculitis and lymphoma, and cryoglobulins with a higher frequency of parotid enlargement, vasculitis, and leukopenia.Epidemiologic, clinical, and analytical features have a significant impact on the clinical presentation of primary SS, influencing the results of the main diagnostic tests, the prevalence and diversity of extraglandular involvement, and the frequency of the main immunologic markers. Primary SS should be considered as a systemic autoimmune disease that can express in many guises beyond sicca involvement.
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Affiliation(s)
- Manuel Ramos-Casals
- From Laboratory of Autoimmune Diseases "Josep Font," Department of Autoimmune Diseases, IDIBAPS, Hospital Clínic (MRC), Barcelona; Department of Internal Medicine, Hospital Vall d'Hebron (RS), Barcelona; Rheumatology Unit, Hospital de Villajoyosa (JR), Alicante; Department of Internal Medicine, Hospital Carlos Haya (MTC), Malaga; Department of Internal Medicine, Hospital La Paz (AG), Madrid; Department of Internal Medicine and Rheumatology, Hospital Universitario de Salamanca (JdPM), Salamanca; Rheumatology Section, Hospital de Sierrallana (JCA), Torrelavega; Department of Internal Medicine, Hospital Virgen de las Nieves (JJA), Granada; Department of Internal Medicine, Hospital La Fe (MLM), Valencia; Rheumatology Unit, Hospital General de Castellón (JB), Castellón; Rheumatology Unit, Hospital 9 d'Octubre (RB), Valencia; Department of Internal Medicine, Hospital de Son Dureta (LP), Palma de Mallorca; Spain
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Abstract
Xerostomia is a common symptom in the elderly population. Studies have suggested that the underlying cause of approximately 40% of xerostomia in the elderly is Sjögren's syndrome. Although it is highly prevalent among middle-aged individuals, elderly patients account for up to 20% of Sjögren's syndrome cases. Sjögren's syndrome is a multisystem exocrinopathy characterised by dry mouth and dry eyes with wide-ranging extraglandular involvement. The exocrine manifestations of Sjögren's syndrome affect the mouth, eyes, nose, ears, skin, vagina and the entire respiratory and gastrointestinal systems. The nonexocrine involvement may include the joints, thyroid gland, liver, kidneys and the musculoskeletal, vascular and central nervous systems. Currently, the mechanism(s) of development and progression of Sjögren's syndrome is/are not clear. Inflammation and lymphocytic infiltration of the exocrine glands is a classical feature of Sjögren's syndrome. During the progression of the disease, the acinar cells of the exocrine glands are replaced by fibrosis, rendering the glands nonfunctional. Sjögren's syndrome remains one of the most underdiagnosed conditions, particularly in the elderly population, because the cardinal sicca symptoms, which are the hallmark of the disease, are frequently attributed to aging and/or medications, which consequently delays the diagnosis. This delay in diagnosis imposes significant physical, psychological and economic burdens on elderly patients. The diagnosis of Sjögren's syndrome requires evaluation of both the exocrine and nonexocrine components of the disease. Management of Sjögren's syndrome requires collaboration by the primary-care physician, rheumatologist, ophthalmologist and dentist. This article reviews current understanding of the clinical manifestations, diagnosis and treatment of Sjögren's syndrome with special emphasis on the oral component of the disease.
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Affiliation(s)
- Ibtisam Al-Hashimi
- Department of Periodontics, Salivary Dysfunction Clinic, Baylor College of Dentistry, Dallas, TX 75246, USA.
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50
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Ramos-Casals M, García-Carrasco M, Brito Zerón MP, Cervera R, Font J. Viral etiopathogenesis of Sjögren's syndrome: role of the hepatitis C virus. Autoimmun Rev 2002; 1:238-43. [PMID: 12849002 DOI: 10.1016/s1568-9972(02)00057-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Patients with hepatitis C virus (HCV) chronic infection present some extrahepatic manifestations that may mimic the clinical, immunologic and histological manifestations of primary Sjögren's syndrome (SS). Thus, HCV patients with sicca symptomatology and positive autoantibodies could be misdiagnosed as a 'primary' SS. Nevertheless, there are several clinical and immunologic features that could help us differentiate both processes.
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Affiliation(s)
- Manuel Ramos-Casals
- Department of Autoimmune Diseases, C/Villaroel 170, Hospital Clínic, Institut Clínic d'Infeccions i Immunologia, 08036 Barcelona, Catalonia, Spain.
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