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Hoshina Y, Wong KH, Galli J, Bacharach R, Klein J, Lebiedz-Odrobina D, Rose JW, Trump B, Hull C, Greenlee JE, Clardy SL. Neurologic involvement in seronegative primary Sjögren's syndrome with positive minor salivary gland biopsy: a single-center experience. Front Neurol 2023; 14:1174116. [PMID: 37360347 PMCID: PMC10289021 DOI: 10.3389/fneur.2023.1174116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 05/25/2023] [Indexed: 06/28/2023] Open
Abstract
Objective To assess the demographics, neurologic manifestations, comorbidities, and treatment of patients with seronegative primary Sjögren's syndrome (pSS). Patients and methods We conducted a retrospective chart review on patients with seronegative pSS evaluated by a neurologist at the University of Utah Health between January 2010 and October 2018. The diagnosis was based on characteristic symptoms, positive minor salivary gland biopsy according to the American-European Consensus Group 2002 criteria, and seronegative antibody status. Results Of 45 patients who met the study criteria, 42 (93.3%) were Caucasian, and 38 (84.4%) were female. The patients' mean age at diagnosis was 47.8 ± 12.6 (range 13-71) years. Paresthesia, numbness and dizziness, and headache were noted in 40 (88.9%), 39 (86.7%), and 36 patients (80.0%), respectively. Thirty-four patients underwent brain magnetic resonance imaging. Of these, 18 (52.9%) showed scattered nonspecific periventricular and subcortical cerebral white matter T2/fluid-attenuated inversion recovery hyperintense foci. Twenty-nine patients (64.4%) presented to the neurology clinic prior to pSS diagnosis, and the median delay in diagnosis from the first neurology clinic visit was 5 (interquartile ranges 2.0-20.5) months. Migraine and depression were the most common comorbidities in 31 patients (68.9%). Thirty-six patients received at least one immunotherapy, and 39 were on at least one medication for neuropathic pain. Conclusion Patients often display various nonspecific neurological symptoms. Clinicians should express a high degree of skepticism regarding seronegative pSS and consider minor salivary gland biopsy to avoid delaying diagnosis, as undertreatment can affect patients' quality of life.
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Affiliation(s)
- Yoji Hoshina
- Department of Neurology, University of Utah, Salt Lake City, UT, United States
| | - Ka-Ho Wong
- Department of Neurology, University of Utah, Salt Lake City, UT, United States
| | - Jonathan Galli
- Department of Neurology, University of Utah, Salt Lake City, UT, United States
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, United States
| | - Rae Bacharach
- Department of Neurology, University of Utah, Salt Lake City, UT, United States
- Department of Neurology, Penn State Health, Hershey, PA, United States
| | - Julia Klein
- Department of Neurology, University of Utah, Salt Lake City, UT, United States
| | - Dorota Lebiedz-Odrobina
- Department of Medicine, Division of Rheumatology, University of Utah, Salt Lake City, UT, United States
| | - John W. Rose
- Department of Neurology, University of Utah, Salt Lake City, UT, United States
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, United States
| | - Bryan Trump
- School of Dentistry, University of Utah, Salt Lake City, UT, United States
| | - Christopher Hull
- Department of Dermatology, University of Utah, Salt Lake City, UT, United States
| | - John E. Greenlee
- Department of Neurology, University of Utah, Salt Lake City, UT, United States
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, United States
| | - Stacey L. Clardy
- Department of Neurology, University of Utah, Salt Lake City, UT, United States
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, United States
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Liampas A, Parperis K, Erotocritou MF, Nteveros A, Papadopoulou M, Moschovos C, Akil M, Coaccioli S, Hadjigeorgiou GM, Hadjivassiliou M, Zis P. Primary Sjögren syndrome-related peripheral neuropathy: A systematic review and meta-analysis. Eur J Neurol 2023; 30:255-265. [PMID: 36086910 PMCID: PMC10087501 DOI: 10.1111/ene.15555] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 08/24/2022] [Accepted: 08/31/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND PURPOSE Primary Sjögren syndrome (pSS) is a chronic, systemic, autoimmune disorder characterized by lymphocytic infiltrates of the exocrine organs, leading to sicca symptoms and parotid enlargement. pSS has been linked to various neurological manifestations, including peripheral neuropathy (PN). We aimed to provide a comprehensive analysis of the currently available evidence regarding pSS-related PN. METHODS A literature search in the PubMed database was performed, and 49 papers were eligible to be included in this systematic review and meta-analysis. RESULTS The pooled prevalence of PN in pSS is estimated to be 15.0% (95% confidence interval = 10.7%-20.7%). The mean age of pSS patients at PN diagnosis is 59 years. Among the patients with pSS and PN, 83% are females. Neuropathic symptoms usually precede or lead to the pSS diagnosis at a 2:1 ratio in patients with pSS-related PN. The commonest type of pSS-related PN is distal axonal polyneuropathy (80% of patients with pSS-related PN), followed by sensory ganglionopathy. Peripheral and cranial mononeuropathies-particularly trigeminal-are also frequent. Risk factors for developing PN include increasing age and presence of vasculitis. Immune-mediated pathogenetic mechanisms are discussed. Glucocorticoids are the most commonly used treatment option for managing pSS-related PN, when associated with vasculitis, followed by the use of intravenous immunoglobulin. CONCLUSIONS PN is very common in pSS patients. Evidence on long-term prognosis of PN in pSS is limited, and further research is needed. Research into the use of immunosuppressive medication in nonvasculitic neuropathies in the context of pSS merits further consideration.
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Affiliation(s)
- Andreas Liampas
- Medical School, University of Cyprus, Nicosia, Cyprus.,Department of Neurology, Nicosia General Hospital, Nicosia, Cyprus
| | | | | | | | - Marianna Papadopoulou
- Department of Physiotherapy, Laboratory of Neuromuscular and Cardiovascular Study of Motion, University of West Attica, Egaleo, Greece
| | - Christos Moschovos
- Second Department of Neurology, Attikon Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Mohammed Akil
- Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Stefano Coaccioli
- European League Against Pain, Zurich, Switzerland.,Department of Internal Medicine, Perugia University, Perugia, Italy
| | - Georgios M Hadjigeorgiou
- Medical School, University of Cyprus, Nicosia, Cyprus.,Department of Neurology, Nicosia General Hospital, Nicosia, Cyprus
| | | | - Panagiotis Zis
- Medical School, University of Cyprus, Nicosia, Cyprus.,Department of Neurology, Nicosia General Hospital, Nicosia, Cyprus.,Second Department of Neurology, Attikon Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,Medical School, University of Sheffield, Sheffield, UK
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