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Kamounah S, Tayob N, Chiang S, Wei F, Park JK, Kwon HM, Feng Z, Chia D, Pedersen AML, Song YW, Wong DTW. Immunoassay Detects Salivary Anti-SSA/Ro-52 Autoantibodies in Seronegative Patients with Primary Sjögren's Syndrome. Immunohorizons 2023; 7:554-561. [PMID: 37466644 PMCID: PMC10587502 DOI: 10.4049/immunohorizons.2300043] [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: 06/29/2023] [Accepted: 06/29/2023] [Indexed: 07/20/2023] Open
Abstract
The diagnostic work-up for Sjögren's syndrome is challenging and complex, including testing for serum autoantibodies to SSA/Ro and a labial salivary gland biopsy. Furthermore, the diagnosis is often delayed. In this study, we tested the hypothesis that anti-SSA/Ro autoantibodies are detectable in the saliva of patients with primary Sjögren's syndrome (pSS) because the disease affects the salivary glands, and these autoantibodies display greater discriminatory performance in saliva than in serum. SSA/Ro-52 Ags were used to develop what is, to our knowledge, a novel quantitative electrochemical-based immunoassay: the electric field-induced release and measurement (EFIRM) platform. The clinical utility was determined by measuring salivary anti-SSA/Ro-52 autoantibodies in patients with pSS and sicca (n = 34), patients without pSS with sicca (n = 35), and healthy subjects (n = 41). The statistical analysis of discrimination included the area under the receiver operating characteristic curve. Salivary anti-SSA/Ro-52 autoantibodies were measured in 94% (32 of 34) of patients with pSS with 85% (29 of 34) seropositivity. Four of the five seronegative patients with pSS had EFIRM-measurable anti-SSA/Ro-52 autoantibodies in saliva. Additionally, 60% (21 of 35) of the seronegative patients without pSS who had sicca had EFIRM-detectable SSA/Ro-52 autoantibodies in saliva, indicating the onset of autoimmune disease. Two of the 41 healthy control subjects had EFIRM-detectable SSA/Ro-52 autoantibodies in their saliva. Salivary SSA/Ro-52 autoantibodies significantly discriminated patients with pSS or patients with the initial stage of autoimmune disease from healthy subjects with an area under the receiver operating characteristic curve of 0.91. Our findings suggest that the proposed saliva SSA/Ro-52 immunoassay improves early and accurate diagnosis of seronegative patients with pSS and patients with early-onset autoimmune disease.
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Affiliation(s)
- Sarah Kamounah
- Center of Oral/Head & Neck Oncology Research, School of Dentistry, University of California, Los Angeles, Los Angeles, CA
- Department of Odontology, Section of Oral Biology and Immunopathology/Oral Medicine & Pathology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen N, Denmark
| | - Nabihah Tayob
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Samantha Chiang
- Center of Oral/Head & Neck Oncology Research, School of Dentistry, University of California, Los Angeles, Los Angeles, CA
| | - Fang Wei
- Center of Oral/Head & Neck Oncology Research, School of Dentistry, University of California, Los Angeles, Los Angeles, CA
| | - Jin Kyun Park
- Division of Rheumatology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyun Mi Kwon
- Division of Rheumatology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Ziding Feng
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - David Chia
- Department of Pathology & Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Anne Marie Lynge Pedersen
- Department of Odontology, Section of Oral Biology and Immunopathology/Oral Medicine & Pathology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen N, Denmark
| | - Yeong Wook Song
- Division of Rheumatology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - David T W Wong
- Center of Oral/Head & Neck Oncology Research, School of Dentistry, University of California, Los Angeles, Los Angeles, CA
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Genetics and epigenetics of primary Sjögren syndrome: implications for future therapies. Nat Rev Rheumatol 2023; 19:288-306. [PMID: 36914790 PMCID: PMC10010657 DOI: 10.1038/s41584-023-00932-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2023] [Indexed: 03/14/2023]
Abstract
In primary Sjögren syndrome (pSS), chronic inflammation of exocrine glands results in tissue destruction and sicca symptoms, primarily of the mouth and eyes. Fatigue, arthralgia and myalgia are also common symptoms, whereas extraglandular manifestations that involve the respiratory, nervous and vascular systems occur in a subset of patients. The disease predominantly affects women, with an estimated female to male ratio of 14 to 1. The aetiology of pSS, however, remains incompletely understood, and effective treatment is lacking. Large-scale genetic and epigenetic investigations have revealed associations between pSS and genes in both innate and adaptive immune pathways. The genetic variants mediate context-dependent effects, and both sex and environmental factors can influence the outcome. As such, genetic and epigenetic studies can provide insight into the dysregulated molecular mechanisms, which in turn might reveal new therapeutic possibilities. This Review discusses the genetic and epigenetic features that have been robustly connected with pSS, putting them into the context of cellular function, carrier sex and environmental challenges. In all, the observations point to several novel opportunities for early detection, treatment development and the pathway towards personalized medicine.
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Nortey J, Shiboski C, Rose-Nussbaumer J, Bunya VY, Lietman T, Gonzales JA. How Are Sicca Signs and Symptoms Associated With Depression Among Men Classified With and Without Sjögren Disease? Am J Ophthalmol 2023; 247:96-102. [PMID: 36220352 DOI: 10.1016/j.ajo.2022.09.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 09/29/2022] [Accepted: 09/29/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE Sjögren disease (SjD) cohorts represent rich resources to study associations between dry eye/mouth (sicca) signs/symptoms and depression. Because SjD affects mainly women, little is known about men with sicca signs/symptoms and associations with depression. The Sjögren's International Collaborative Clinical Alliance contained many men allowing for studying associations between sicca signs/symptoms and depression. We hypothesized that sicca symptoms would be positively associated with depression in males. DESIGN Cross-sectional study. METHODS At baseline, participants completed questionnaires and underwent ocular and oral examinations. Depression was assessed using the Patient Health Questionnaire-9. Logistic regression models were used to identify associations between depression and SjD diagnostic criteria and sicca symptoms. RESULTS Of 309 males, 98 were classified as SjD, whereas 198 were classified as non-SjD. We found that having a labial salivary gland biopsy with focus score ≥1 foci/mm2 was associated with a lower odds of being classified as depressed (odds ratio [OR]: 0.36, 95% CI: 0.18-0.73, P = .01). Having positive anti-Sjögren syndrome antigen A antibody was associated with lower odds of being classified as depressed (OR: 0.44, 95% CI: 0.23-0.88, P = .02). Higher odds of depression were found with ocular burning (OR: 3.16, 95% CI: 1.74-5.73, P < .001), light sensitivity (OR: 2.59, 95% CI: 1.48-4.55, P = .001), and complaints of dry mouth (OR: 4.58, 95% CI: 1.54-13.63, P = .006). CONCLUSION Ophthalmologists should be specific when inquiring about ocular discomfort (focusing on burning and light sensitivity) and consider querying about depression and/or providing mental health resources to those who endorse such qualities.
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Affiliation(s)
- Jeremy Nortey
- From the Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California (J.N., J.R.-N., T.L., J.A.G.), USA; University of North Carolina School of Medicine, University of North Carolina, Chapel Hill, North Carolina (J.N.), USA
| | - Caroline Shiboski
- Department of Orofacial Sciences, School of Dentistry, University of California, San Francisco, San Francisco, California (C.S.), USA
| | - Jennifer Rose-Nussbaumer
- From the Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California (J.N., J.R.-N., T.L., J.A.G.), USA
| | - Vatinee Y Bunya
- Scheie Eye Institute, Department of Ophthalmology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania (V.Y.B.), USA and
| | - Tom Lietman
- From the Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California (J.N., J.R.-N., T.L., J.A.G.), USA; Department of Ophthalmology, University of California, San Francisco, San Francisco, California (T.L., J.A.G.), USA
| | - John A Gonzales
- From the Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California (J.N., J.R.-N., T.L., J.A.G.), USA; Department of Ophthalmology, University of California, San Francisco, San Francisco, California (T.L., J.A.G.), USA.
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Bruno KA, Morales-Lara AC, Bittencourt EB, Siddiqui H, Bommarito G, Patel J, Sousou JM, Salomon GR, Paloka R, Watford ST, Hodge DO, Lieberman SM, Rozen TD, Atwal PS, Dorsher PT, Seim LA, Fairweather D. Sex differences in comorbidities associated with Sjögren's disease. Front Med (Lausanne) 2022; 9:958670. [PMID: 35991633 PMCID: PMC9387724 DOI: 10.3389/fmed.2022.958670] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 07/01/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundLittle is known about the association of comorbidities with sex and age at diagnosis in Sjögren's disease. We tested the hypothesis that sex differences occur in comorbidities in patients with Sjögren's disease.MethodsPatients with Sjögren's disease were identified from 11/1974 to 7/2018 in the Mayo Clinic electronic medical record and assessed for 22 comorbidities according to sex and age at diagnosis.ResultsOf the 13,849 patients identified with Sjögren's disease, 11,969 (86%) were women and 1,880 (14%) men, primarily white (88%) with a sex ratio of 6.4:1 women to men. The mean age at diagnosis was 57 years for women and 59.7 years for men, and 5.6% had a diagnosis of fibromyalgia at Sjögren's diagnosis. Men with Sjögren's disease were more likely than women to be a current or past smoker. The average time to diagnosis of comorbidities after diagnosis of Sjögren's disease was 2.6 years. The top comorbidities in patients with Sjögren's disease were fibromyalgia (25%), depression (21.2%) and pain (16.4%). Comorbidities that occurred more often in women were hypermobile syndromes (31:1), CREST (29:1), migraine (23:1), Ehlers-Danlos syndrome (EDS) (22:1), Raynaud's syndrome (15:1), SLE (13:1), systemic sclerosis (SSc) (13:1), and fibromyalgia (12:1). Women with Sjögren's disease were at increased risk of developing hypermobile syndromes (RR 7.27, CI 1.00–52.71, p = 0.05), EDS (RR 4.43, CI 1.08–18.14, p = 0.039), CREST (RR 4.24, CI 1.56–11.50, p = 0.005), migraine (RR 3.67, CI 2.39–5.62, p < 0.001), fibromyalgia (RR 2.26, CI 1.92–2.66, p < 0.001), Raynaud's syndrome (RR 2.29, CI 1.77–2.96, p < 0.001), SLE (RR 2.13, CI 1.64–2.76, p < 0.001), and SSc (RR 2.05 CI 1.44–2.92; p < 0.001). In contrast, men with Sjögren's were at increased risk for developing myocardial infarction (RR 0.44, CI 0.35–0.55, p < 0.001), atherosclerosis/CAD (RR 0.44, CI 0.39–0.49, p < 0.001), cardiomyopathy (RR 0.63, CI 0.46–0.86, p = 0.003), stroke (RR 0.66 CI 0.51–0.85, p = 0.001), and congestive heart failure (RR 0.70, CI 0.57–0.85, p < 0.001).ConclusionsThe top comorbidities in Sjögren's disease were fibromyalgia, depression, and pain. Women with Sjögren's disease had a higher relative risk of developing fibromyalgia, depression, pain, migraine, hypermobile syndrome, EDS and other rheumatic autoimmune diseases. Men with Sjögren's disease had higher risk of developing cardiovascular diseases.
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Affiliation(s)
- Katelyn A. Bruno
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, United States
- Department of Clinical and Translational Science, Mayo Clinic, Jacksonville, FL, United States
- Department of Immunology, Mayo Clinic, Jacksonville, FL, United States
| | | | - Edsel B. Bittencourt
- Department of Physical Rehabilitation, Mayo Clinic, Jacksonville, FL, United States
| | - Habeeba Siddiqui
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, United States
| | - Gabriella Bommarito
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - Jenil Patel
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - John M. Sousou
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - Gary R. Salomon
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - Rinald Paloka
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - Shelby T. Watford
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - David O. Hodge
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, United States
| | - Scott M. Lieberman
- Division of Rheumatology, Allergy and Immunology, Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, IA, United States
| | - Todd D. Rozen
- Department of Neurology, Mayo Clinic, Jacksonville, FL, United States
| | | | - Peter T. Dorsher
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Jacksonville, FL, United States
| | - Lynsey A. Seim
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL, United States
- *Correspondence: DeLisa Fairweather
| | - DeLisa Fairweather
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, United States
- Department of Clinical and Translational Science, Mayo Clinic, Jacksonville, FL, United States
- Department of Immunology, Mayo Clinic, Jacksonville, FL, United States
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Lynsey A. Seim
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Khunsriraksakul C, Markus H, Olsen NJ, Carrel L, Jiang B, Liu DJ. Construction and Application of Polygenic Risk Scores in Autoimmune Diseases. Front Immunol 2022; 13:889296. [PMID: 35833142 PMCID: PMC9271862 DOI: 10.3389/fimmu.2022.889296] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 04/25/2022] [Indexed: 11/13/2022] Open
Abstract
Genome-wide association studies (GWAS) have identified hundreds of genetic variants associated with autoimmune diseases and provided unique mechanistic insights and informed novel treatments. These individual genetic variants on their own typically confer a small effect of disease risk with limited predictive power; however, when aggregated (e.g., via polygenic risk score method), they could provide meaningful risk predictions for a myriad of diseases. In this review, we describe the recent advances in GWAS for autoimmune diseases and the practical application of this knowledge to predict an individual’s susceptibility/severity for autoimmune diseases such as systemic lupus erythematosus (SLE) via the polygenic risk score method. We provide an overview of methods for deriving different polygenic risk scores and discuss the strategies to integrate additional information from correlated traits and diverse ancestries. We further advocate for the need to integrate clinical features (e.g., anti-nuclear antibody status) with genetic profiling to better identify patients at high risk of disease susceptibility/severity even before clinical signs or symptoms develop. We conclude by discussing future challenges and opportunities of applying polygenic risk score methods in clinical care.
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Affiliation(s)
- Chachrit Khunsriraksakul
- Graduate Program in Bioinformatics and Genomics, Pennsylvania State University College of Medicine, Hershey, PA, United States
- Institute for Personalized Medicine, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Havell Markus
- Graduate Program in Bioinformatics and Genomics, Pennsylvania State University College of Medicine, Hershey, PA, United States
- Institute for Personalized Medicine, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Nancy J. Olsen
- Department of Medicine, Division of Rheumatology, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Laura Carrel
- Department of Biochemistry and Molecular Biology, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Bibo Jiang
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Dajiang J. Liu
- Institute for Personalized Medicine, Pennsylvania State University College of Medicine, Hershey, PA, United States
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, United States
- *Correspondence: Dajiang J. Liu,
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Moos J, Moos Ł, Brzoza Z. Can smoking have a positive effect on the course of certain diseases? A systematic review. MEDICAL SCIENCE PULSE 2022. [DOI: 10.5604/01.3001.0015.8804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Smoking cigarettes is a process during which many harmful substances are introduced into the lungs and the influence of these substances on the human body is not completely known. There are many diseases caused by smoking. Interestingly, there are also reports of positive consequences of smoking on some disorders. Aim of the study: The purpose of this article is to review the literature in regards to the diseases in which cigarettes might have a paradoxically beneficial effect — both on the onset and their course. We also want to focus on the mechanisms responsible for this impact. Material and Methods: Electronic searching of PubMed was performed. We analyzed articles published in the last 10 years with a particular emphasis on the most recent publications. Combinations of the following words were used: “smoking”, “nicotine”, and “autoimmune”. Publications were selected for reliability and non-bias. Results: A total of 69 articles out of 2979 qualified for the review. Only studies involving humans were included. The positive effect of smoking cigarettes is observed especially in immunological diseases. It is possible that it is mediated by both stimulating and suppressing the immune system. It is assumed that cigarettes can reduce the risk of developing certain diseases. Smoking might also have an impact on the course of different comorbidities in the same patient. Conclusions: There are many different mechanisms through which cigarette smoke and nicotine affect the human body. The harmful impact of these substances on one’s health has been demonstrated and their addictive component disqualifies them as remedies. Analysis of the mechanisms responsible for the beneficial effects of nicotine can lead to the search for new forms of therapy and prevention.
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Affiliation(s)
- Justyna Moos
- Department of Internal Diseases with Division of Diabetology, Hospital of the Ministry of Interior and Administration in Opole, Poland
| | - Łukasz Moos
- Department of Internal Diseases with Division of Allergology, Institute of Medical Sciences, University of Opole, Poland
| | - Zenon Brzoza
- Department of Internal Diseases with Division of Allergology, Institute of Medical Sciences, University of Opole, Poland
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McCoy SS, Greenlee RT, VanWormer JJ, Schletzbaum M, Bartels CM. Smoking associated with reduced odds of Sjögren's syndrome among rheumatoid arthritis patients. Scand J Rheumatol 2022; 51:97-101. [PMID: 34169792 PMCID: PMC8709876 DOI: 10.1080/03009742.2021.1925584] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE The objective of this medical record review study is to define the association between smoking and Sjӧgren's syndrome (SS) in a large rheumatoid arthritis (RA) cohort. METHODS Electronic health records from a population-based cohort were screened for RA eligibility between 2005 and 2018. Inclusion criteria were age ≥ 18 years, two or more RA diagnoses, including two diagnoses by a rheumatologist, or positive rheumatoid factor or anti-cyclic citrullinated peptide (anti-CCP) antibody. The independent variable, smoking status, was defined as never, current, or past. The outcome, SS, was defined by two or more ICD-9 codes. Multivariable logistic regression was performed to determine odds ratios (ORs) of SS adjusted for age, sex, and race. RESULTS Among 1861 patients with RA identified for cohort inclusion, 1296 had a reported smoking status. Current smokers were younger and less likely to be female than never smokers. The adjusted OR of current compared to never smokers was negatively associated with SS [OR 0.20, 95% confidence interval (CI) 0.06-0.65]. Female sex and age were associated with SS (OR 2.70, 95% CI 1.18-6.14; OR 3.75, 95% CI 1.23-11.4). CONCLUSION We report that RA patients who currently smoke had 80% lower odds of SS. Age had a 3.7-fold association and female sex a 2.7-fold association with SS among RA patients. Our data suggest a negative correlation between current smoking and prevalent SS among RA patients. Prospective studies examining pack-year relationships or smoking cessation could further examine risk reduction and causality to follow-up our cross-sectional observational study.
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Affiliation(s)
- Sara S. McCoy
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Robert T. Greenlee
- Marshfield Clinic Research Institute, Center for Clinical Epidemiology and Population Health, Marshfield, WI, USA
| | - Jeffrey J. VanWormer
- Marshfield Clinic Research Institute, Center for Clinical Epidemiology and Population Health, Marshfield, WI, USA
| | - Maria Schletzbaum
- University of Wisconsin School of Medicine and Public Health, Department of Population Health Sciences, Madison, WI, USA
| | - Christie M. Bartels
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Yu K, Ying GS, Vivino FB, Gonzales JA, Massaro-Giordano M, Bunya VY. Preliminary Screening Questionnaire for Sjögren's Syndrome in the Rheumatology Setting. J Clin Rheumatol 2022; 28:e456-e461. [PMID: 34262002 PMCID: PMC9110110 DOI: 10.1097/rhu.0000000000001760] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Sjögren's syndrome (SS) is frequently undetected or misdiagnosed as other rheumatologic diseases. We aimed to develop an SS screening questionnaire for the rheumatology practice. METHODS We developed the Sjögren's Syndrome Screening Questionnaire (SSSQ) via secondary analysis of data from 974 participants referred by rheumatologists to the Sjögren's International Collaborative Clinical Alliance (SICCA) study. Participants answered 88 questions regarding symptoms, medical history, and demographics. They underwent ocular, dental, and serologic tests and were classified as SS or non-SS using the 2016 American College of Rheumatology/European League Against Rheumatism classification criteria. We conducted univariate and multivariate logistic regression to identify questions most discriminative of SS, from which we derived an individual's likelihood of SS ("SSSQ score"). RESULTS Five questions were significantly discriminative of SS in the multivariate analysis (p < 0.05): (1) Can you eat a cracker without drinking a fluid/liquid? (no: odds ratio [OR], 1.39; 95% confidence interval [CI], 1.06-1.82]); (2) How would you describe your dental and oral health in general? (fair/poor: OR, 1.68; 95% CI, 1.04-2.75); (3) During the last week, have you experienced tearing? (none of the time: OR, 2.26; 95% CI, 1.23-4.34); (4) Are you able to produce tears? (no: OR, 1.62; 95% CI, 1.12-2.37); and (5) Do you currently smoke cigarettes? (no: OR, 2.83; 95% CI, 1.69-4.91). SSSQ score ≥7 (possible range, 0-11) distinguishes SS from non-SS patients with 64% sensitivity and 58% specificity (area under receiver operating characteristic curve, 0.65). CONCLUSIONS The SSSQ is a simple 5-item questionnaire designed to screen for SS in clinical practice, with a potential impact to reduce delays in diagnosis.
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Affiliation(s)
- Kimberley Yu
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gui-Shuang Ying
- Department of Ophthalmology, Scheie Eye Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Frederick B. Vivino
- Department of Rheumatology, Penn Presbyterian Medical Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - John A. Gonzales
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA
| | - Mina Massaro-Giordano
- Department of Ophthalmology, Scheie Eye Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Vatinee Y. Bunya
- Department of Ophthalmology, Scheie Eye Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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Gebreegziabher EA, Oldenburg CE, Shiboski SC, Baer AN, Jordan RC, Rose‐Nussbaumer JR, Bunya VY, Akpek EK, Criswell LA, Shiboski CH, Lietman TM, Gonzales JA. Associations Between Smoking and Primary Sjögren Syndrome Classification Using the Sjögren's International Collaborative Clinical Alliance Cohort. ACR Open Rheumatol 2021; 4:231-237. [PMID: 34889071 PMCID: PMC8916552 DOI: 10.1002/acr2.11362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 08/11/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE The objective of this study was to examine the association of smoking with Primary Sjögren syndrome (pSS) classification and pSS diagnostic test results. We hypothesized that past and current smokers would have lower odds of being classified as having Sjögren syndrome (SS) and lower odds of having abnormal individual SS diagnostic test results compared with nonsmokers. METHODS Participants with suspected or established pSS were enrolled into the Sjögren's International Collaborative Clinical Alliance (SICCA) registry and had oral, ocular, and rheumatologic examinations performed; blood and saliva samples collected; and labial salivary gland biopsy examinations performed; they also completed questionnaires at baseline. Logistic regression was used to determine whether smoking status was associated with pSS classification and individual pSS diagnostic test results. RESULTS A total of 3514 participants were enrolled in SICCA. A total of 1541 (52.9%) met classification criteria for pSS. Compared with never smokers, current smokers had reduced odds of being classified as having pSS, reduced odds of having a focus score ≥ 1 and serologic positivity for anti-SSA/anti-SSB antibodies, and lower odds of having abnormal signs or test results of dry eye disease. Compared with never smokers, past smokers did not have a statistically significant reduction in odds of being classified as having pSS and of having abnormal individual pSS diagnostic test results. CONCLUSION Compared with never smokers, current smokers in the SICCA cohort had lower odds of being classified as having pSS, lower odds of exhibiting abnormal signs and test results for dry eye disease, and lower odds of having a labial salivary gland biopsy supportive of pSS classification. Such negative associations, however, do not suggest that current smoking is of any benefit with respect to pSS.
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A brief history of carbon monoxide and its therapeutic origins. Nitric Oxide 2021; 111-112:45-63. [PMID: 33838343 DOI: 10.1016/j.niox.2021.04.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/03/2021] [Accepted: 04/01/2021] [Indexed: 02/06/2023]
Abstract
It is estimated that 10% of carbon throughout the cosmos is in the form of carbon monoxide (CO). Earth's earliest prebiotic atmosphere included the trinity of gasotransmitters CO, nitric oxide (NO), and hydrogen sulfide (H2S), for which all of life has co-evolved with. The history of CO can be loosely traced to mythological and prehistoric origins with rudimentary understanding emerging in the middle ages. Ancient literature is focused on CO's deadly toxicity which is understandable in the context of our primitive relationship with coal and fire. Scientific inquiry into CO appears to have emerged throughout the 1700s followed by chemical and toxicological profiling throughout the 1800s. Despite CO's ghastly reputation, several of the 18th and 19th century scientists suggested a therapeutic application of CO. Since 2000, the fundamental understanding of CO as a deadly nuisance has undergone a paradigm shift such that CO is now recognized as a neurotransmitter and viable pharmaceutical candidate. This review is intended to provide a brief history on the trace origins pertaining to endogenous formation and therapeutic application of CO.
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Ayesha B, Fernandez-Ruiz R, Shrock D, Snyder BM, Lieberman SM, Tuetken R, Field E, Singh N. Clinical and laboratory features of patients with focal lymphocytic sialadenitis on minor salivary gland biopsy for sicca symptoms: A single-center experience. Medicine (Baltimore) 2021; 100:e25325. [PMID: 33787627 PMCID: PMC8021287 DOI: 10.1097/md.0000000000025325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 03/01/2021] [Indexed: 01/04/2023] Open
Abstract
Minor salivary gland biopsy (MSGB) is often used in patients lacking specific autoantibodies (seronegative patients) to confirm the presence of focal lymphocytic sialadenitis (FLS), which would suggest a diagnosis of Sjogren syndrome. There are no current guidelines indicating when to refer patients for MSGB. The objective of our study was to ascertain distinguishing clinical and laboratory features among individuals with sicca symptoms based on their serologic and histopathologic status, and to identify factors associated with FLS.Using a cross-sectional study design, patients ages 18 years or older with sicca symptoms who had MSGB performed at the University of Iowa from January 2000 to December 2016 were selected for chart reviews. The clinical and laboratory features of patients with and without FLS were analyzed using exact univariate and multivariable logistic regression, with Bonferroni correction for multiple comparisons.We identified 177 patients who had MSGB performed and available clinical data. A total of 133 patients had FLS, 37 (27.8%) were seropositive (positive-anti-Sjogren syndrome type A [SSA] and/or anti-Sjogren syndrome type B) and 96 (72.2%) were seronegative. Dry eyes (unadjusted odds ratio [OR]: 5.17, 95% confidence interval [CI]: 1.16-26.30; adjusted odds ratio [aOR]: 12.58, 95% CI: 1.70-167.77) and the presence of anti-SSA (OR: 7.16, 95% CI: 1.70-64.24; aOR: 8.82, 95% CI: 1.73-93.93) were associated with FLS. Smoking (aOR 0.27, 95% CI: 0.11-0.63) and antihistamine use (aOR 0.23, 95% CI: 0.08-0.63) were associated with lower odds of FLS.Our study suggests that dry eyes and anti-SSA positivity are associated with FLS. Smoking and antihistamine use were associated with lower odds of FLS. In the appropriate clinical context, seronegative patients with sicca symptoms and no smoking history could be considered for MSGB. A thorough medication and smoking history should be performed in all patients before referral for MSGB.
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Affiliation(s)
- Bibi Ayesha
- Albert Einstein College of Medicine, Montefiore Medical Center, New York, NY
| | - Ruth Fernandez-Ruiz
- Department of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA
- Division of Rheumatology, New York University Langone Health, New York, NY
| | - Devin Shrock
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Brittney M. Snyder
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | | | - Rebecca Tuetken
- Division of Immunology, University of Iowa Hospitals and Clinics
| | - Elizabeth Field
- Division of Immunology, University of Iowa Hospitals and Clinics and VA Medical Center, Iowa City, IA
| | - Namrata Singh
- Division of Rheumatology, University of Washington School of Medicine, Seattle, Washington
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12
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Mofors J, Björk A, Richardsdotter Andersson E, Kvarnström M, Forsblad d'Elia H, Magnusson-Bucher S, Padyukov L, Kockum I, Hillert J, Eriksson P, Mandl T, Nordmark G, Alfredsson L, Wahren-Herlenius M. Cigarette smoking patterns preceding primary Sjögren's syndrome. RMD Open 2020; 6:rmdopen-2020-001402. [PMID: 32994363 PMCID: PMC7547543 DOI: 10.1136/rmdopen-2020-001402] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/20/2020] [Accepted: 09/09/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Cigarette smoking is a well-established risk factor for several autoimmune diseases, but its role in primary Sjögren's syndrome (pSS) remains unclear. Here, we investigated the association between cigarette smoking and subsequent development of pSS. METHODS Information on smoking habits was collected from lifestyle habit questionnaires of patients with pSS (n=815) and a matched control group (n=4425) for a case-control study. Differences in smoking exposure were analysed by conditional logistic regression. Potential interactions between smoking and risk-associated human leucocyte antigens (HLA) were assessed by multivariate regression. RESULTS The fraction of patients with pSS having ever smoked prior to diagnosis was lower than in controls (OR 0.67, 95% CI 0.55 to 0.81). Current smoking at diagnosis was also less prevalent in cases (OR 0.37, 95% CI 0.26 to 0.53). However, period prevalence of smoking during early adulthood was not statistically different from controls (OR 0.89, 95% CI 0.66 to 1.22) but markedly decreased over time. This was partly due to patients being more prone to stop smoking, starting already 30 years prior to diagnosis (OR 2.01, 95% CI 1.22 to 3.30). Smoking patterns were also stratified by autoantibody status, yielding similar estimates. No interaction effects between HLA-DRB1 haplotypes and smoking were observed. CONCLUSION The observed smoking patterns indicate that individuals who develop pSS smoke equally much as the general population during early life but are then more prone to stop. The data can be interpreted as smoking conferring protective effects, or reflecting early symptoms of pSS that affect smoking habits, emphasising the slow, progressive development of the disease.
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Affiliation(s)
- Johannes Mofors
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Albin Björk
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Elina Richardsdotter Andersson
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Marika Kvarnström
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Helena Forsblad d'Elia
- Department of Public Health and Clinical Medicine, Rheumatology, Umeå University, Umeå, Sweden
| | - Sara Magnusson-Bucher
- Department of Rheumatology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Leonid Padyukov
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Ingrid Kockum
- Department of Clinical Neuroscience, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Jan Hillert
- Department of Clinical Neuroscience, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Per Eriksson
- Division of Rheumatology, Department of Clinical Experimental Medicine, Linköping University, Linköping, Sweden
| | - Thomas Mandl
- Department of Clinical Sciences, Malmö, Rheumatology, Lund University, Malmö, Sweden
| | - Gunnel Nordmark
- Department of Medical Sciences, Rheumatology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Lars Alfredsson
- Department of Clinical Neuroscience, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Marie Wahren-Herlenius
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden .,Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway
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13
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Abstract
People living with rheumatic diseases frequently encounter cancer, either as a potential harm of antirheumatic therapies or as a comorbidity that alters the conversation about management. This article provides a general overview of the issues related to cancer and rheumatic disease and serves as a springboard for the remaining chapters in this issue. Several topics are reviewed, including epidemiology, bidirectional causal pathways, and issues related to medications. Although uncertainties remain, the issue of cancer is of great importance to patients with rheumatic diseases, and an individualized, person-centered approach to assessment and management is necessary.
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Affiliation(s)
- John Manley Davis
- Division of Rheumatology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA.
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14
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Björk A, Mofors J, Wahren-Herlenius M. Environmental factors in the pathogenesis of primary Sjögren's syndrome. J Intern Med 2020; 287:475-492. [PMID: 32107824 DOI: 10.1111/joim.13032] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Primary Sjögren's syndrome (SS) is a systemic autoimmune disease in which exocrine organs, primarily the salivary and lacrimal glands, are targets of chronic inflammation, leading to severe dryness of eyes and mouth. Fatigue and arthralgia are also common, and extraglandular manifestations involving the respiratory, nervous and vascular systems occur in a subset of patients. Persistent activation of the type I interferon system, and autoreactive B and T cells with production of disease-associated autoantibodies are central to the pathogenesis. Genetic polymorphisms that associate with an increased risk of SS have been described, though the risk-increase contributed by the respective variant is generally low. It is thus becoming increasingly clear that genetics cannot alone account for the development of SS and that other, presumably exogenous, factors must play a critical role. Relatively few studies have investigated exposure to potential risk factors prior to SS disease onset. Rather, many factors have been studied in prevalent cases. In this review, we summarize current literature on exogenous factors in the pathogenesis of SS including infections, hormones, smoking, solvents and additional compounds. We delineate for which factors there is current evidence of increased disease risk, and for which our present knowledge is confined to suggesting their role in SS pathogenesis. Finally, we outline future perspectives in the continued search for environmental risk factors for SS, a research area of great importance considering the possibilities for preventive measures.
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Affiliation(s)
- A Björk
- From the, Division of Rheumatology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - J Mofors
- From the, Division of Rheumatology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - M Wahren-Herlenius
- From the, Division of Rheumatology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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15
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Mofors J, Arkema EV, Björk A, Westermark L, Kvarnström M, Forsblad-d'Elia H, Magnusson Bucher S, Eriksson P, Mandl T, Nordmark G, Wahren-Herlenius M. Infections increase the risk of developing Sjögren's syndrome. J Intern Med 2019; 285:670-680. [PMID: 30892751 DOI: 10.1111/joim.12888] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Environmental factors have been suggested in the pathogenesis of rheumatic diseases. We here investigated whether infections increase the risk of developing primary Sjögren's syndrome (pSS). METHODS Patients with pSS in Sweden (n = 945) and matched controls from the general population (n = 9048) were included, and data extracted from the National Patient Register to identify infections occurring before pSS diagnosis during a mean observational time of 16.0 years. Data were analysed using conditional logistic regression models. Sensitivity analyses were performed by varying exposure definition and adjusting for previous health care consumption. RESULTS A history of infection associated with an increased risk of pSS (OR 1.9, 95% CI 1.6-2.3). Infections were more prominently associated with the development of SSA/SSB autoantibody-positive pSS (OR 2.7, 95% CI 2.0-3.5). When stratifying the analysis by organ system infected, respiratory infections increased the risk of developing pSS, both in patients with (OR 2.9, 95% CI 1.8-4.7) and without autoantibodies (OR 2.1, 95% CI 1.1-3.8), whilst skin and urogenital infections only significantly associated with the development of autoantibody-positive pSS (OR 3.2, 95% CI 1.8-5.5 and OR 2.7, 95% CI 1.7-4.2). Furthermore, a dose-response relationship was observed for infections and a risk to develop pSS with Ro/SSA and La/SSB antibodies. Gastrointestinal infections were not significantly associated with a risk of pSS. CONCLUSIONS Infections increase the risk of developing pSS, most prominently SSA/SSB autoantibody-positive disease, suggesting that microbial triggers of immunity may partake in the pathogenetic process of pSS.
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Affiliation(s)
- J Mofors
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - E V Arkema
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - A Björk
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - L Westermark
- Department of Medical Sciences, Rheumatology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - M Kvarnström
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - H Forsblad-d'Elia
- Department of Public Health and Clinical Medicine, Rheumatology, Umeå University, Umeå, Sweden
| | - S Magnusson Bucher
- Department of Rheumatology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - P Eriksson
- Division of Rheumatology, Department of Clinical Experimental Medicine, Linköping University, Linköping, Sweden
| | - T Mandl
- Department of Clinical Sciences, Malmö, Rheumatology, Lund University, Malmö, Sweden
| | - G Nordmark
- Department of Medical Sciences, Rheumatology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - M Wahren-Herlenius
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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16
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Associations of cigarette smoking with disease phenotype and type I interferon expression in primary Sjögren’s syndrome. Rheumatol Int 2019; 39:1575-1584. [DOI: 10.1007/s00296-019-04335-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 05/23/2019] [Indexed: 12/31/2022]
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17
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Lin CY, Tseng CF, Liu JM, Chuang HC, Lei WT, Liu LYM, Yu YC, Hsu RJ. Association between Periodontal Disease and Subsequent Sjögren's Syndrome: A Nationwide Population-Based Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16050771. [PMID: 30832451 PMCID: PMC6427323 DOI: 10.3390/ijerph16050771] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 02/20/2019] [Accepted: 02/27/2019] [Indexed: 12/11/2022]
Abstract
Xerostomia (dry mouth) is the cardinal symptom of Sjögren’s syndrome (SS), which is an autoimmune disease involving the exocrine glands and other organs. Xerostomia may predispose patients to periodontal disease (PD) and an association between SS and PD has been reported. This association may be bidirectional; therefore, we conducted this study to investigate the risk of SS in patients with PD using data from the National Health Insurance Research Database of Taiwan. A total of 135,190 patients were enrolled in our analysis. In all, 27,041 patients with PD were matched by gender, age, insured region, urbanization and income, with cases and controls in a 1:4 ratio. Both groups were followed and the risks of SS were calculated by Cox proportional hazards regression. Finally, 3292 (2.4%) patients had newly diagnosed SS. Patients with PD had a significantly higher risk of subsequent SS (903 (3.3%) vs. 2389 (2.2%), adjusted hazard 1.47, 95% confidence interval: 1.36–1.59). In conclusion, patients with PD had an approximately 50% increased risk of subsequent SS. Physicians should be aware of the symptoms and signs of SS in patients with PD.
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Affiliation(s)
- Chien-Yu Lin
- Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu City 30071, Taiwan.
| | - Chien-Fu Tseng
- Department of Dentistry and Oral Surgery, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan 33004, Taiwan.
| | - Jui-Ming Liu
- Division of Urology, Department of Surgery, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan 33004, Taiwan.
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei 11490, Taiwan.
| | - Heng-Chang Chuang
- Division of Urology, Department of Surgery, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan 33004, Taiwan.
| | - Wei-Te Lei
- Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu City 30071, Taiwan.
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan City 33302, Taiwan.
| | - Lawrence Yu-Min Liu
- Department of Internal Medicine, Hsinchu MacKay Memorial Hospital, Hsinchu City 30071, Taiwan.
- Department of Medical Science & Institute of Bioinformatics and Structural Biology, National Tsing Hua University, Hsinchu City 30071, Taiwan.
| | - Yu-Chin Yu
- Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu City 30071, Taiwan.
| | - Ren-Jun Hsu
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei 11490, Taiwan.
- Cancer Medicine Center of Buddhist Hualien Tzu Chi Hospital, Tzu Chi University, Hualien 97002, Taiwan.
- Department of Pathology and Graduate Institute of Pathology and Parasitology, The Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan.
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18
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Servioli L, Maciel G, Nannini C, Crowson CS, Matteson EL, Cornec D, Berti A. Association of Smoking and Obesity on the Risk of Developing Primary Sjögren Syndrome: A Population-based Cohort Study. J Rheumatol 2019; 46:727-730. [PMID: 30647188 DOI: 10.3899/jrheum.180481] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2018] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To explore the role of smoking and obesity in primary Sjögren syndrome (pSS). METHODS Olmsted County (Minnesota, USA) residents (n = 106) diagnosed with pSS from 2000 to 2015 were compared to 3 controls without pSS and matched for age and sex who were randomly selected from Olmsted County residents. RESULTS Current smokers were less likely to be pSS cases (OR 0.34, 95% CI 0.14-0.85), while there was no association between former smoking and case/control status (OR 1.27, 95% CI 0.80-2.03) compared to never smokers. Smoking status was not associated with antinuclear antibody, anti-SSA, anti-SSB, or rheumatoid factor positivity (p > 0.05). OR for obesity was 0.79 (95% CI 0.48-1.30). CONCLUSION In this population-based study, current smoking was inversely associated with case/control status, while body mass index lacked any association.
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Affiliation(s)
- Luisa Servioli
- From the Division of Rheumatology, and Division of Biomedical Statistics and Informatics, and Division of Epidemiology, and Division of Pulmonary and Critical Care Medicine, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Autoimmune Diseases Department, Medical Clinic 1, Hospital Maciel, Montevideo, Uruguay; Department of Rheumatology, Hospital of Prato, Prato, Italy; Rheumatology Department, Brest Teaching Hospital, Brest, France; Immunology, Rheumatology, Allergy and Rare Diseases Department, San Raffaele Scientific Institute, Milan, Italy; Rheumatology Department, Santa Chiara Hospital, Trento, Italy.,L. Servioli, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science, and Autoimmune diseases Department, Medical Clinic 1, Hospital Maciel; G. Maciel, MD, Autoimmune Diseases Department, Medical Clinic 1, Hospital Maciel; C. Nannini, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science, and Department of Rheumatology, Hospital of Prato; C.S. Crowson, PhD, Division of Rheumatology, and Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science; E.L. Matteson, MD, MPH, Division of Rheumatology, and Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science; D. Cornec, MD, PhD, Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, and Rheumatology Department, Brest Teaching Hospital; A. Berti, MD, Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, and the Immunology, Rheumatology, Allergy and Rare Diseases Department, San Raffaele Scientific Institute, and the Rheumatology Department, Santa Chiara Hospital
| | - Gabriel Maciel
- From the Division of Rheumatology, and Division of Biomedical Statistics and Informatics, and Division of Epidemiology, and Division of Pulmonary and Critical Care Medicine, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Autoimmune Diseases Department, Medical Clinic 1, Hospital Maciel, Montevideo, Uruguay; Department of Rheumatology, Hospital of Prato, Prato, Italy; Rheumatology Department, Brest Teaching Hospital, Brest, France; Immunology, Rheumatology, Allergy and Rare Diseases Department, San Raffaele Scientific Institute, Milan, Italy; Rheumatology Department, Santa Chiara Hospital, Trento, Italy.,L. Servioli, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science, and Autoimmune diseases Department, Medical Clinic 1, Hospital Maciel; G. Maciel, MD, Autoimmune Diseases Department, Medical Clinic 1, Hospital Maciel; C. Nannini, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science, and Department of Rheumatology, Hospital of Prato; C.S. Crowson, PhD, Division of Rheumatology, and Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science; E.L. Matteson, MD, MPH, Division of Rheumatology, and Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science; D. Cornec, MD, PhD, Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, and Rheumatology Department, Brest Teaching Hospital; A. Berti, MD, Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, and the Immunology, Rheumatology, Allergy and Rare Diseases Department, San Raffaele Scientific Institute, and the Rheumatology Department, Santa Chiara Hospital
| | - Carlotta Nannini
- From the Division of Rheumatology, and Division of Biomedical Statistics and Informatics, and Division of Epidemiology, and Division of Pulmonary and Critical Care Medicine, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Autoimmune Diseases Department, Medical Clinic 1, Hospital Maciel, Montevideo, Uruguay; Department of Rheumatology, Hospital of Prato, Prato, Italy; Rheumatology Department, Brest Teaching Hospital, Brest, France; Immunology, Rheumatology, Allergy and Rare Diseases Department, San Raffaele Scientific Institute, Milan, Italy; Rheumatology Department, Santa Chiara Hospital, Trento, Italy.,L. Servioli, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science, and Autoimmune diseases Department, Medical Clinic 1, Hospital Maciel; G. Maciel, MD, Autoimmune Diseases Department, Medical Clinic 1, Hospital Maciel; C. Nannini, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science, and Department of Rheumatology, Hospital of Prato; C.S. Crowson, PhD, Division of Rheumatology, and Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science; E.L. Matteson, MD, MPH, Division of Rheumatology, and Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science; D. Cornec, MD, PhD, Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, and Rheumatology Department, Brest Teaching Hospital; A. Berti, MD, Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, and the Immunology, Rheumatology, Allergy and Rare Diseases Department, San Raffaele Scientific Institute, and the Rheumatology Department, Santa Chiara Hospital
| | - Cynthia S Crowson
- From the Division of Rheumatology, and Division of Biomedical Statistics and Informatics, and Division of Epidemiology, and Division of Pulmonary and Critical Care Medicine, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Autoimmune Diseases Department, Medical Clinic 1, Hospital Maciel, Montevideo, Uruguay; Department of Rheumatology, Hospital of Prato, Prato, Italy; Rheumatology Department, Brest Teaching Hospital, Brest, France; Immunology, Rheumatology, Allergy and Rare Diseases Department, San Raffaele Scientific Institute, Milan, Italy; Rheumatology Department, Santa Chiara Hospital, Trento, Italy.,L. Servioli, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science, and Autoimmune diseases Department, Medical Clinic 1, Hospital Maciel; G. Maciel, MD, Autoimmune Diseases Department, Medical Clinic 1, Hospital Maciel; C. Nannini, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science, and Department of Rheumatology, Hospital of Prato; C.S. Crowson, PhD, Division of Rheumatology, and Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science; E.L. Matteson, MD, MPH, Division of Rheumatology, and Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science; D. Cornec, MD, PhD, Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, and Rheumatology Department, Brest Teaching Hospital; A. Berti, MD, Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, and the Immunology, Rheumatology, Allergy and Rare Diseases Department, San Raffaele Scientific Institute, and the Rheumatology Department, Santa Chiara Hospital
| | - Eric L Matteson
- From the Division of Rheumatology, and Division of Biomedical Statistics and Informatics, and Division of Epidemiology, and Division of Pulmonary and Critical Care Medicine, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Autoimmune Diseases Department, Medical Clinic 1, Hospital Maciel, Montevideo, Uruguay; Department of Rheumatology, Hospital of Prato, Prato, Italy; Rheumatology Department, Brest Teaching Hospital, Brest, France; Immunology, Rheumatology, Allergy and Rare Diseases Department, San Raffaele Scientific Institute, Milan, Italy; Rheumatology Department, Santa Chiara Hospital, Trento, Italy. .,L. Servioli, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science, and Autoimmune diseases Department, Medical Clinic 1, Hospital Maciel; G. Maciel, MD, Autoimmune Diseases Department, Medical Clinic 1, Hospital Maciel; C. Nannini, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science, and Department of Rheumatology, Hospital of Prato; C.S. Crowson, PhD, Division of Rheumatology, and Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science; E.L. Matteson, MD, MPH, Division of Rheumatology, and Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science; D. Cornec, MD, PhD, Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, and Rheumatology Department, Brest Teaching Hospital; A. Berti, MD, Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, and the Immunology, Rheumatology, Allergy and Rare Diseases Department, San Raffaele Scientific Institute, and the Rheumatology Department, Santa Chiara Hospital.
| | - Divi Cornec
- From the Division of Rheumatology, and Division of Biomedical Statistics and Informatics, and Division of Epidemiology, and Division of Pulmonary and Critical Care Medicine, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Autoimmune Diseases Department, Medical Clinic 1, Hospital Maciel, Montevideo, Uruguay; Department of Rheumatology, Hospital of Prato, Prato, Italy; Rheumatology Department, Brest Teaching Hospital, Brest, France; Immunology, Rheumatology, Allergy and Rare Diseases Department, San Raffaele Scientific Institute, Milan, Italy; Rheumatology Department, Santa Chiara Hospital, Trento, Italy.,L. Servioli, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science, and Autoimmune diseases Department, Medical Clinic 1, Hospital Maciel; G. Maciel, MD, Autoimmune Diseases Department, Medical Clinic 1, Hospital Maciel; C. Nannini, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science, and Department of Rheumatology, Hospital of Prato; C.S. Crowson, PhD, Division of Rheumatology, and Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science; E.L. Matteson, MD, MPH, Division of Rheumatology, and Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science; D. Cornec, MD, PhD, Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, and Rheumatology Department, Brest Teaching Hospital; A. Berti, MD, Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, and the Immunology, Rheumatology, Allergy and Rare Diseases Department, San Raffaele Scientific Institute, and the Rheumatology Department, Santa Chiara Hospital
| | - Alvise Berti
- From the Division of Rheumatology, and Division of Biomedical Statistics and Informatics, and Division of Epidemiology, and Division of Pulmonary and Critical Care Medicine, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Autoimmune Diseases Department, Medical Clinic 1, Hospital Maciel, Montevideo, Uruguay; Department of Rheumatology, Hospital of Prato, Prato, Italy; Rheumatology Department, Brest Teaching Hospital, Brest, France; Immunology, Rheumatology, Allergy and Rare Diseases Department, San Raffaele Scientific Institute, Milan, Italy; Rheumatology Department, Santa Chiara Hospital, Trento, Italy.,L. Servioli, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science, and Autoimmune diseases Department, Medical Clinic 1, Hospital Maciel; G. Maciel, MD, Autoimmune Diseases Department, Medical Clinic 1, Hospital Maciel; C. Nannini, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science, and Department of Rheumatology, Hospital of Prato; C.S. Crowson, PhD, Division of Rheumatology, and Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science; E.L. Matteson, MD, MPH, Division of Rheumatology, and Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science; D. Cornec, MD, PhD, Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, and Rheumatology Department, Brest Teaching Hospital; A. Berti, MD, Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, and the Immunology, Rheumatology, Allergy and Rare Diseases Department, San Raffaele Scientific Institute, and the Rheumatology Department, Santa Chiara Hospital
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Sjögren’s Syndrome and Autoimmune Thyroid Disease: Two Sides of the Same Coin. Clin Rev Allergy Immunol 2018; 56:362-374. [DOI: 10.1007/s12016-018-8709-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Olsson P, Skogstrand K, Nilsson A, Turesson C, Jacobsson LTH, Theander E, Houen G, Mandl T. Smoking, disease characteristics and serum cytokine levels in patients with primary Sjögren's syndrome. Rheumatol Int 2018; 38:1503-1510. [PMID: 29846789 PMCID: PMC6060795 DOI: 10.1007/s00296-018-4063-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 05/23/2018] [Indexed: 01/21/2023]
Abstract
Smoking affects several disease processes. Epidemiological studies have previously found a negative association between primary Sjögren’s syndrome (pSS) and smoking. The aim of this study was to examine whether markers of disease activity and cytokine expression in pSS patients differ between ever and never smokers. Fifty-one consecutive pSS patients and 33 population controls were included in the study. Clinical and standard laboratory parameters were registered. Serum cytokines (IL-1β, IL-2, IL-3, IL-4, IL-6, IL-8, IL-10, IL-12, IL-17, IL-18, IL-33, IFN-α, IFN-γ, TNF-α, EGF, BAFF, Fas-ligand, RANTES, TGF-β1) were assessed. A positive lip biopsy was less prevalent among ever smoking patients compared to never smokers (81 vs 100%; p = 0.03). However, except for TNF-α, which was higher in ever smokers, no differences in cytokine levels were found when comparing ever and never smoking pSS patients. Furthermore, no significant differences were found between ever and never smoking patients in the ESSDAI total score, IgG levels, or complement levels. However, IL-6, IL-12, IL-17 and IL-18 were significantly increased in pSS patients compared to controls. In this study, a negative association between ever smoking and positive lip biopsy was found, confirming previous reports. Expected differences in cytokine levels compared to controls were noted, but no major differences were found between ever and never smoking pSS patients. Taking into account the negative association between pSS diagnosis and smoking in epidemiological studies, possible explanations include a local effect of smoking on salivary glands rather than systemic effects by cigarette smoke.
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Affiliation(s)
- Peter Olsson
- Department of Clinical Sciences, Malmö, Rheumatology, Lund University, Malmö, Sweden. .,Department of Rheumatology, Skåne University Hospital, Malmö, Sweden. .,Reumatologmottagningen SUS Malmö, Jan Waldenströms gata 1B, 20502, Malmö, Sweden.
| | - Kristin Skogstrand
- Department of Congenital Disorders, Center for Neonatal Screening, Statens Serum Institut, Copenhagen, Denmark
| | - Anna Nilsson
- Department of Clinical Sciences, Malmö, Rheumatology, Lund University, Malmö, Sweden.,Department of Rheumatology, Linköping University Hospital, Linköping, Sweden
| | - Carl Turesson
- Department of Clinical Sciences, Malmö, Rheumatology, Lund University, Malmö, Sweden.,Department of Rheumatology, Skåne University Hospital, Malmö, Sweden
| | - Lennart T H Jacobsson
- Department of Clinical Sciences, Malmö, Rheumatology, Lund University, Malmö, Sweden.,Department of Rheumatology and Inflammation Research, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - Elke Theander
- Department of Clinical Sciences, Malmö, Rheumatology, Lund University, Malmö, Sweden.,Janssen Cilag, Solna, Sweden
| | - Gunnar Houen
- Department of Autoimmunology and Biomarkers, Statens Serum Institut, Copenhagen, Denmark
| | - Thomas Mandl
- Department of Clinical Sciences, Malmö, Rheumatology, Lund University, Malmö, Sweden.,Department of Rheumatology, Skåne University Hospital, Malmö, Sweden
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Díaz-González JM, Vega-Memije ME, Mosqueda-Taylor A, García-Edgar VN, Cuevas-González JC. Dermoscopic patterns of filiform papillae of the tongue in patients with and without connective tissue autoimmune diseases. Int J Dermatol 2018; 57:938-942. [PMID: 29774953 DOI: 10.1111/ijd.14038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 03/11/2018] [Accepted: 04/22/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Connective tissue autoimmune diseases (CTADs) constitute a group of conditions, including rheumatoid arthritis; systemic lupus erythematosus; mixed connective tissue disease; calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia (CREST) syndrome; scleroderma; dermatomyositis; and Sjögren syndrome. There are few studies on the alterations in filiform papillae in CTAD. Thus, the objective of this work was to determine whether there are changes in the macroscopic and dermoscopic patterns of filiform papillae. METHODS This case-control study included patients who were diagnosed with CTAD. The dependent variable was the dermoscopic pattern of filiform papillae of the tongue, and the independent variables were age, gender, time of evolution, and current treatment. A photograph of the back of the tongue was taken, and subsequently, the same site was examined by dermatoscopy. The microscopic and dermoscopic patterns of filiform papillae were classified (Maeda). RESULTS We included 50 cases and 50 controls, 94% of whom were female. The mean age was 43.96 ± 14.65 years. Of the cases with CTAD, 25% presented with a normal macroscopic pattern, versus 36% (18) with pattern II, 12% (6) with pattern III, and 20% (10) with pattern IV. The dermoscopic pattern was type I in 23 cases (46%), type II in 16 (32%), type III in 10 (20%), and type IV in one patient (2%). CONCLUSIONS We have noted alterations in filiform papillae in CTADs, which emphasizes the importance of a detailed intraoral exploration and the macroscopic and dermoscopic evaluation of the dorsum of the tongue, specifically the filiform papillae.
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Affiliation(s)
- José Manuel Díaz-González
- Department of Dermatology, National Institute of Medical Sciences and Nutrition "Dr. Salvador Zubirán", Mexico City, Mexico
| | - María E Vega-Memije
- Department of Dermatology, General Hospital "Dr. Manuel Gea González", Mexico City, Mexico
| | | | - Víctor Noé García-Edgar
- Division of Epidemiological Research, General Hospital "Dr. Manuel Gea González", Mexico City, Mexico
| | - Juan Carlos Cuevas-González
- Department of Stomatology, Institute of Biomedical Sciences, Autonomous University of Ciudad Juárez, Ciudad Juárez, Chihuahua, Mexico
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Current Concepts in Pathogenesis, Diagnosis, and Management of Smoking-Related Interstitial Lung Diseases. Chest 2017; 154:394-408. [PMID: 29222007 DOI: 10.1016/j.chest.2017.11.023] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 11/01/2017] [Accepted: 11/26/2017] [Indexed: 11/21/2022] Open
Abstract
Tobacco exposure results in various changes to the airways and lung parenchyma. Although emphysema represents the more common injury pattern, in some individuals, cigarette smoke injures alveolar epithelial cells and other lung cells, resulting in diffuse infiltrates and parenchymal fibrosis. Smoking can trigger interstitial injury patterns mediated via recruitment and inappropriate persistence of myeloid and other immune cells, including eosinophils. As our understanding of the role of cigarette smoke constituents in triggering lung injury continues to evolve, so does our recognition of the spectrum of smoking-related interstitial lung changes. Although respiratory bronchiolitis-interstitial lung disease, desquamative interstitial pneumonia, pulmonary Langerhans cell histiocytosis, and acute eosinophilic pneumonia have a well-established association with tobacco use, its role and impact on idiopathic pulmonary fibrosis, combined pulmonary fibrosis and emphysema, and connective tissue disease-related interstitial lung diseases is still ambiguous. Smoking-related interstitial fibrosis is a relatively newly appreciated entity with distinct histopathologic features but with unclear clinical ramifications. Increased implementation of lung cancer screening programs and utilization of CT scans in thoracic imaging have also resulted in increased identification of "incidental" or "subclinical" interstitial lung changes in smokers, the ensuing impact of which remains to be studied.
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