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Gao H, Sun Y, Zhang XY, Xie L, Zhang XW, Zhong YC, Zhang J, Hou YK, Li ZG. Characteristics and mortality in primary Sjögren syndrome-related interstitial lung disease. Medicine (Baltimore) 2021; 100:e26777. [PMID: 34477117 PMCID: PMC8415932 DOI: 10.1097/md.0000000000026777] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 06/30/2021] [Indexed: 01/05/2023] Open
Abstract
ABSTRACT Aim of the study was to determine the characteristics and prognosis, and to identify the risk factors for mortality in patients with primary Sjögren syndrome (pSS) with interstitial lung disease (pSS-ILD).A total of 1422 patients with SS were screened and 178 patients with pSS-ILD were recruited. The medical records and outcomes were retrospectively reviewed. Overall survival and case control study were performed to explore the predictors of death.Among 178 pSS-ILD patients, 87.1% were women. Mean age was 61.59 ± 11.69-year-old. Median disease duration was 72.0 (24.0, 156.0) months. Nonspecific interstitial pneumonia was the predominant high-resolution computed tomography pattern (44.9%). Impairment in diffusion capacity was the most common abnormality of pulmonary function test (75.8%) and the most severe consequence. Type 1 respiratory failure and hypoxia were observed in 15.0% and 30.0% patients, respectively. Mean survival time after confirmation of pSS-ILD diagnosis was 9.0 (6.8, 13.0) years. The 10-year survival rate for all patients with pSS-ILD was 81.7%. Forty-four (24.7%) of 178 patients died during the follow-up period. The most predominant cause of death was respiratory failure (n = 27). Twenty-seven patients died of ILD and formed study group. The 78 patients who survived formed control group. Age and smoking were risk factors for mortality in patients with pSS-ILD. In addition, severity of ILD, as reflected by high-resolution computed tomography, pulmonary function test, and arterial blood gas, was an independent risk factor. However, inflammation status (erythrocyte sedimentation rate, C-reactive protein) and anti-Sjögren syndrome-related antigen A and anti-Sjögren syndrome-related antigen B were not.ILD is a severe complication of pSS. Age, smoking, and severity of lung involvement are more critical for prognosis rather than inflammation status and autoantibodies.
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Affiliation(s)
- Hui Gao
- Department of Rheumatology and Immunology, Peking University International Hospital, Beijing, China
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China
| | - Ye Sun
- Radiology Department, Peking University People's Hospital, Beijing, China
| | - Xiao-Ying Zhang
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China
| | | | - Xue-Wu Zhang
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China
| | - Yu-Chao Zhong
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China
| | - Jing Zhang
- Department of Rheumatology and Immunology, Peking University International Hospital, Beijing, China
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China
| | - Yu-Ke Hou
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China
| | - Zhan-Guo Li
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China
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Gairy K, Knight C, Anthony P, Hoskin B. Burden of illness among subgroups of patients with primary Sjögren's syndrome and systemic involvement. Rheumatology (Oxford) 2021; 60:1871-1881. [PMID: 33147609 PMCID: PMC8023993 DOI: 10.1093/rheumatology/keaa508] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/19/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To describe how patients with primary SS (pSS) and systemic organ involvement are classified and clustered in routine practice. METHODS This multinational, cross-sectional survey of real-world quantitative data was conducted across Europe and the US. Rheumatologists who treated seven or more adult patients per month with pSS and current/past systemic manifestations undertook a survey before completing a patient record form capturing demographic, clinical and treatment information for their next six eligible patients. Patients with a completed patient record form were invited to complete a patient self-completion questionnaire capturing insights into their disease and treatment. Subgroups were defined by physicians' assessment of disease severity; clusters were derived based on key clinical characteristics using latent class analysis. RESULTS Rheumatologists completed 316 physician surveys and 1879 patient record forms; 888 patients completed the patient self-completion questionnaire. pSS severity reflected organ involvement and symptomatology. Latent class analysis produced five clusters distinguished by the organ systems involved and the presence of pain and fatigue symptoms at the time of the survey. A minority of patients [n = 67 (4%)] were categorized with multiple organ involvement and the highest frequency of pain and fatigue. A total of 324 patients (17%) were categorized as 'low burden'. The remaining three clusters exhibited high frequencies of articular involvement but were distinguished by the extent of other organ system involvement. CONCLUSION Cluster analysis using a real-world cohort of patients with pSS and systemic organ involvement highlights the heterogeneous presentation of patients with pSS and confirms the importance of pain and fatigue as well as organ involvement when determining disease burden.
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Affiliation(s)
- Kerry Gairy
- Value Evidence & Outcomes, GlaxoSmithKline, Brentford, Middlesex, UK
| | - Claudia Knight
- Adelphi Real World, Adelphi Group, Macclesfield, Cheshire, UK
| | - Papa Anthony
- Adelphi Real World, Adelphi Group, Macclesfield, Cheshire, UK
| | - Ben Hoskin
- Adelphi Real World, Adelphi Group, Macclesfield, Cheshire, UK
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Thorlacius GE, Hultin-Rosenberg L, Sandling JK, Bianchi M, Imgenberg-Kreuz J, Pucholt P, Theander E, Kvarnström M, Forsblad-d'Elia H, Bucher SM, Norheim KB, Johnsen SJA, Hammenfors D, Skarstein K, Jonsson MV, Baecklund E, Aqrawi LA, Jensen JL, Palm Ø, Morris AP, Meadows JRS, Rantapää-Dahlqvist S, Mandl T, Eriksson P, Lind L, Omdal R, Jonsson R, Lindblad-Toh K, Rönnblom L, Wahren-Herlenius M, Nordmark G. Genetic and clinical basis for two distinct subtypes of primary Sjögren's syndrome. Rheumatology (Oxford) 2021; 60:837-848. [PMID: 32889544 PMCID: PMC7850528 DOI: 10.1093/rheumatology/keaa367] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 04/21/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Clinical presentation of primary Sjögren's syndrome (pSS) varies considerably. A shortage of evidence-based objective markers hinders efficient drug development and most clinical trials have failed to reach primary endpoints. METHODS We performed a multicentre study to identify patient subgroups based on clinical, immunological and genetic features. Targeted DNA sequencing of 1853 autoimmune-related loci was performed. After quality control, 918 patients with pSS, 1264 controls and 107 045 single nucleotide variants remained for analysis. Replication was performed in 177 patients with pSS and 7672 controls. RESULTS We found strong signals of association with pSS in the HLA region. Principal component analysis of clinical data distinguished two patient subgroups defined by the presence of SSA/SSB antibodies. We observed an unprecedented high risk of pSS for an association in the HLA-DQA1 locus of odds ratio 6.10 (95% CI: 4.93, 7.54, P=2.2×10-62) in the SSA/SSB-positive subgroup, while absent in the antibody negative group. Three independent signals within the MHC were observed. The two most significant variants in MHC class I and II respectively, identified patients with a higher risk of hypergammaglobulinaemia, leukopenia, anaemia, purpura, major salivary gland swelling and lymphadenopathy. Replication confirmed the association with both MHC class I and II signals confined to SSA/SSB antibody positive pSS. CONCLUSION Two subgroups of patients with pSS with distinct clinical manifestations can be defined by the presence or absence of SSA/SSB antibodies and genetic markers in the HLA locus. These subgroups should be considered in clinical follow-up, drug development and trial outcomes, for the benefit of both subgroups.
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Affiliation(s)
| | - Lina Hultin-Rosenberg
- Science for Life Laboratory, Department of Medical Biochemistry and Microbiology, Uppsala, Sweden
| | - Johanna K Sandling
- Department of Medical Sciences, Rheumatology, and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Matteo Bianchi
- Science for Life Laboratory, Department of Medical Biochemistry and Microbiology, Uppsala, Sweden
- Department of Medical Sciences, Rheumatology, and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Juliana Imgenberg-Kreuz
- Department of Medical Sciences, Rheumatology, and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Pascal Pucholt
- Department of Medical Sciences, Rheumatology, and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Elke Theander
- Department of Rheumatology, Skåne University Hospital, Malmö, Sweden
| | | | - Helena Forsblad-d'Elia
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Sara Magnusson Bucher
- Department of Rheumatology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Katrine B Norheim
- Department of Internal Medicine, Stavanger University Hospital, Stavanger, Norway
| | | | - Daniel Hammenfors
- Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
| | - Kathrine Skarstein
- Department of Clinical Science and Department of Clinical Dentistry, University of Bergen, Bergen, Norway
| | - Malin V Jonsson
- Department of Clinical Science and Department of Clinical Dentistry, University of Bergen, Bergen, Norway
| | - Eva Baecklund
- Department of Medical Sciences, Rheumatology, and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Lara A Aqrawi
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Janicke Liaaen Jensen
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Øyvind Palm
- Department of Rheumatology, Oslo University Hospital, Oslo, Norway
| | - Andrew P Morris
- Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Manchester, UK
| | - Jennifer R S Meadows
- Science for Life Laboratory, Department of Medical Biochemistry and Microbiology, Uppsala, Sweden
| | | | - Thomas Mandl
- Department of Rheumatology, Skåne University Hospital, Malmö, Sweden
| | - Per Eriksson
- Department of Clinical and Experimental Medicine, Rheumatology/Division of Neuro and Inflammation Sciences, Linköping University, Linköping, Sweden
| | - Lars Lind
- Department of Medical Sciences, Clinical Epidemiology, Uppsala University, Uppsala, Sweden
| | - Roald Omdal
- Department of Internal Medicine, Stavanger University Hospital, Stavanger, Norway
- Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Roland Jonsson
- Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
- Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Kerstin Lindblad-Toh
- Science for Life Laboratory, Department of Medical Biochemistry and Microbiology, Uppsala, Sweden
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Lars Rönnblom
- Department of Medical Sciences, Rheumatology, and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | | | - Gunnel Nordmark
- Department of Medical Sciences, Rheumatology, and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
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Seghieri C, Lupi E, Exarchos TP, Ferro F, Tzioufas AG, Baldini C. Variation in primary Sjögren's syndrome care among European countries. Clin Exp Rheumatol 2019; 37 Suppl 118:27-28. [PMID: 31464679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 07/11/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Chiara Seghieri
- Institute of Management and Department EMbeDS, Scuola Superiore Sant'Anna, Pisa, Italy.
| | - Enrico Lupi
- Institute of Management and Department EMbeDS, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Themis P Exarchos
- Unit of Medical Technology and IntelligentInformation Systems, University of Ioannina, Greece
| | - Francesco Ferro
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Athanasios G Tzioufas
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Chiara Baldini
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
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Jonsson R, Brokstad KA, Jonsson MV, Delaleu N, Skarstein K. Current concepts on Sjögren's syndrome - classification criteria and biomarkers. Eur J Oral Sci 2018; 126 Suppl 1:37-48. [PMID: 30178554 PMCID: PMC6586012 DOI: 10.1111/eos.12536] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2018] [Indexed: 12/13/2022]
Abstract
Sjögren's syndrome is a lymphoproliferative disease with autoimmune features characterized by mononuclear cell infiltration of exocrine glands, notably the lacrimal and salivary glands. These lymphoid infiltrations lead to dryness of the eyes (keratoconjunctivitis sicca), dryness of the mouth (xerostomia), and, frequently, dryness of other surfaces connected to exocrine glands. Sjögren's syndrome is associated with the production of autoantibodies because B-cell activation is a consistent immunoregulatory abnormality. The spectrum of the disease extends from an organ-specific autoimmune disorder to a systemic process and is also associated with an increased risk of B-cell lymphoma. Current treatments are mainly symptomatic. As a result of the diverse presentation of the syndrome, a major challenge remains to improve diagnosis and therapy. For this purpose an international set of classification criteria for primary Sjögren's syndrome has recently been developed and validated and seems well suited for enrolment in clinical trials. Salivary gland biopsies have been examined and histopathology standards have been developed, to be used in clinical trials and patient stratification. Finally, ultrasonography and saliva meet the need of non-invasive imaging and sampling methods for discovery and validation of disease biomarkers in Sjögren's syndrome.
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Affiliation(s)
- Roland Jonsson
- Broegelmann Research LaboratoryDepartment of Clinical ScienceUniversity of BergenBergenNorway
- Department of RheumatologyHaukeland University HospitalBergenNorway
| | - Karl A. Brokstad
- Broegelmann Research LaboratoryDepartment of Clinical ScienceUniversity of BergenBergenNorway
| | - Malin V. Jonsson
- Department of Clinical Dentistry – Section for Oral and Maxillofacial RadiologyUniversity of BergenBergenNorway
| | - Nicolas Delaleu
- Broegelmann Research LaboratoryDepartment of Clinical ScienceUniversity of BergenBergenNorway
- 2C SysBioMedContraSwitzerland
| | - Kathrine Skarstein
- Gade Laboratory for PathologyDepartment of Clinical MedicineUniversity of BergenBergenNorway
- Department of PathologyHaukeland University HospitalBergenNorway
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Abstract
Ultrasound of the salivary glands is a specific examination for detecting pathology of salivary glands in the diagnosis of Sjögren's syndrome. It is easy to learn, rapidly performed, non-invasive and inexpensive. Other imaging techniques, such as sialography and scintigraphy, are currently only rarely performed. For the examination, linear ultrasound probes with frequencies between 7 and 12 MHz are recommended. Such probes are already widely available to the rheumatologist performing musculoskeletal ultrasound. The parotid and submandibular glands are bilaterally scanned both in longitudinal and transverse planes as a standard.Normal salivary glands have uniformly hyperechoic and homogeneous tissue. They can be clearly delineated from the surrounding muscles and soft tissue and appear similar to the thyroid gland. The salivary glands are typically hypoechoic and inhomogeneous in Sjögren's syndrome. Focal or diffuse hypoechoic or anechoic foci are found in the glands. The submandibular glands may become atrophic (sagittal diameter <8 mm). Particularly in disease flares, the parotid glands may become enlarged (sagittal diameter >20 mm). The sensitivity for the diagnosis is 60 to 90% and the specificity is over 90%.Doppler sonography does not further improve the diagnostic accuracy. Sonography has thus become an important tool in the diagnosis of Sjögren's syndrome.
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Affiliation(s)
- V S Schäfer
- Innere Medizin, Rheumatologie und Klinische Immunologie, Standort Berlin-Buch, Immanuel Krankenhaus Berlin, Lindenberger Weg 19, 13125, Berlin, Deutschland.
| | - W A Schmidt
- Innere Medizin, Rheumatologie und Klinische Immunologie, Standort Berlin-Buch, Immanuel Krankenhaus Berlin, Lindenberger Weg 19, 13125, Berlin, Deutschland
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Shiboski CH, Shiboski SC, Seror R, Criswell LA, Labetoulle M, Lietman TM, Rasmussen A, Scofield H, Vitali C, Bowman SJ, Mariette X. 2016 American College of Rheumatology/European League Against Rheumatism Classification Criteria for Primary Sjögren's Syndrome: A Consensus and Data-Driven Methodology Involving Three International Patient Cohorts. Arthritis Rheumatol 2017; 69:35-45. [PMID: 27785888 PMCID: PMC5650478 DOI: 10.1002/art.39859] [Citation(s) in RCA: 815] [Impact Index Per Article: 116.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 08/25/2016] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To develop and validate an international set of classification criteria for primary Sjögren's syndrome (SS) using guidelines from the American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR). These criteria were developed for use in individuals with signs and/or symptoms suggestive of SS. METHODS We assigned preliminary importance weights to a consensus list of candidate criteria items, using multi-criteria decision analysis. We tested and adapted the resulting draft criteria using existing cohort data on primary SS cases and non-SS controls, with case/non-case status derived from expert clinical judgment. We then validated the performance of the classification criteria in a separate cohort of patients. RESULTS The final classification criteria are based on the weighted sum of 5 items: anti-SSA/Ro antibody positivity and focal lymphocytic sialadenitis with a focus score of ≥1 foci/4 mm2 , each scoring 3; an abnormal ocular staining score of ≥5 (or van Bijsterveld score of ≥4), a Schirmer's test result of ≤5 mm/5 minutes, and an unstimulated salivary flow rate of ≤0.1 ml/minute, each scoring 1. Individuals with signs and/or symptoms suggestive of SS who have a total score of ≥4 for the above items meet the criteria for primary SS. Sensitivity and specificity against clinician-expert-derived case/non-case status in the final validation cohort were high, i.e., 96% (95% confidence interval [95% CI] 92-98%) and 95% (95% CI 92-97%), respectively. CONCLUSION Using methodology consistent with other recent ACR/EULAR-approved classification criteria, we developed a single set of data-driven consensus classification criteria for primary SS, which performed well in validation analyses and are well-suited as criteria for enrollment in clinical trials.
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Affiliation(s)
- Caroline H. Shiboski
- Department of Orofacial Sciences, School of Dentistry, University of California San Francisco, California, USA
| | - Stephen C. Shiboski
- Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, California, USA
| | - Raphaèle Seror
- Université Paris-Sud; Assistance Publique – Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud; INSERM U1184; Le Kremlin-Bicêtre; Paris, France
| | - Lindsey A. Criswell
- Rosalind Russell / Ephraim P. Engleman Rheumatology Research Center, Department of Medicine, School of Medicine, University of California San Francisco, California, USA
| | - Marc Labetoulle
- Université Paris-Sud; Assistance Publique – Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud; INSERM U1184; Le Kremlin-Bicêtre; Paris, France
| | - Thomas M. Lietman
- Francis I. Proctor Foundation for Research in Ophthalmology, University of California San Francisco, California, USA
| | | | - Hal Scofield
- Oklahoma Medical Research Foundation, Oklahoma, USA
- University of Oklahoma Health Sciences Center, and Department of Veterans Affairs Medical Center, Oklahoma, USA
| | - Claudio Vitali
- Istituto Villa San Giuseppe, Como, and Casa di Cura di Lecco, Lecco, Italy
| | - Simon J. Bowman
- Rheumatology Department, University Hospitals Birmingham, Edgbaston, Birmingham, UK
| | - Xavier Mariette
- Université Paris-Sud; Assistance Publique – Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud; INSERM U1184; Le Kremlin-Bicêtre; Paris, France
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Luciano N, Valentini V, Calabrò A, Elefante E, Vitale A, Baldini C, Bartoloni E. One year in review 2015: Sjögren's syndrome. Clin Exp Rheumatol 2015; 33:259-271. [PMID: 25896475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 03/23/2015] [Indexed: 06/04/2023]
Abstract
Primary Sjögren's syndrome (pSS) is a chronic autoimmune disease mainly characterised by the inflammation of exocrine glands; however, a broad spectrum of systemic manifestations may characterise the disease. Recently, pSS has been the object of considerable immunologic and clinical research which has led to significant advances in the diagnosis, prognostic assessment and management of the disease. Herewith, we provide a critical digest of the recent literature on this topic.
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Affiliation(s)
- Nicoletta Luciano
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Andrea Calabrò
- Department of Rheumatology, University of Florence, Florence, Italy
| | - Elena Elefante
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Antonio Vitale
- Department of Rheumatology, Policlinico Le Scotte, University of Siena, Siena, Italy
| | - Chiara Baldini
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Elena Bartoloni
- Department of Rheumatology, University of Perugia, Perugia, Italy
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Wei P, Lu SH, Fu JY, Yan ZM, Hua H. [Validation of the American College of Rheumatology classification criteria for primary Sjogren's syndrome in Chinese patients]. Beijing Da Xue Xue Bao Yi Xue Ban 2014; 46:306-310. [PMID: 24743827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To validate the American College of Rheumatology Classification (ACR) Criteria (2012) for the diagnosis of primary Sjogren's syndrome in Chinese patients. METHODS All patients involved in this study came from the Department of Oral Medicine Peking University Stomatology Hospital. They were devided into two groups of pSS and non-pSS according to the diagnoses made by two experts. Both groups of the patients had completed medical records kept in the hospital. RESULTS A total of 239 pSS patients (160 with labial salivary gland biopsy, and 79 without biopsy) and 52 age-matched non-pSS patients [(55.17±14.295),and (55.90±13.38) years old, P>0.05] (9 with biopsy, and 43 without biopsy) were involved in this study. The sensitivity and specificity of ACR criteria in diagnosing pSS were 90.37 % and 88.46 % respectively. The positive and negative likelihood ratios were 7.83 and 0.109, respectively. The sensitivities of ACR criteria in diagnosing pSS patients with and without labial biopsy were 88.75% and 93.67 %, respectively, with specificities of 88.89% and 88.37%, respectively. The most sensitive item adopted in ACR criteria was the ocular staining score with a sensitivity of 85.77%, and the most specific item was the labial salivary gland biopsy, with a specificity of 88.89%. CONCLUSION The sensitivity and specificity of ACR criteria in diagnosing Chinese pSS patients were relatively high, and may serve as the diagnosis criteria in research and clinical practice. However, the ACR criteria need to be validated and further revised in the future .
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Affiliation(s)
- Pan Wei
- Department of Oral Medicine,Peking University School and Hospital of Stomatology,Beijing 100081,China
| | - Song-he Lu
- Peking University School and Hospital of Stomatology 2nd Dental Center, Beijing 100081, China
| | - Jing-ya Fu
- Department of Oral Medicine,Peking University School and Hospital of Stomatology,Beijing 100081,China
| | - Zhi-min Yan
- Department of Oral Medicine,Peking University School and Hospital of Stomatology,Beijing 100081,China
| | - Hong Hua
- Department of Oral Medicine,Peking University School and Hospital of Stomatology,Beijing 100081,China
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Cornec D, Saraux A, Cochener B, Pers JO, Jousse-Joulin S, Renaudineau Y, Marhadour T, Devauchelle-Pensec V. Level of agreement between 2002 American-European Consensus Group and 2012 American College of Rheumatology classification criteria for Sjögren's syndrome and reasons for discrepancies. Arthritis Res Ther 2014; 16:R74. [PMID: 24642022 PMCID: PMC4060239 DOI: 10.1186/ar4514] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 03/04/2014] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The aims of this study were to assess agreement between the currently used 2002 American-European Consensus Group (AECG) classification criteria and the new 2012 American College of Rheumatology (ACR) criteria for Sjögren's syndrome (SS) and to identify potential sources of disagreement. METHODS We studied 105 patients between 2006 and 2013 from the Brittany cohort of patients with suspected SS. AECG criteria were applied using only Schimer's test and unstimulated whole salivary flow (UWSF) to assess objective ocular and oral involvement, since these are the tests most physicians use in clinical practice. Agreement between the two sets of criteria was assessed using Cohen's κ coefficient. RESULTS Of those studied, 42 patients fulfilled AECG and 35 ACR criteria. Agreement between the two sets was moderate (κ = 0.53). Patients fulfilling ACR but not AECG criteria (n = 8) were significantly younger and had shorter symptom durations, but only three of them had SS in the opinion of the evaluating physician. Xerostomia and xerophthalmia (AECG set only) did not discriminate between patients with and without SS. The use of UWSF in the AECG but not the ACR criteria explained part of the disagreement. The serological item in the ACR set (positive rheumatoid factor and antinuclear antibody ≥1:320 or anti-SSA/SSB positivity) did not result in classification differences compared to anti-SSA/SSB antibody alone (AECG set). Agreement between ocular staining score ≥3 (ACR set) and Schirmer's test ≤5 mm/5 min (AECG set) was very low (κ = 0.14). CONCLUSIONS Agreement was only moderate between ACR and AECG criteria, suggesting these two sets would not select comparable patient populations. An international consensus about which classification criteria should be used in clinical studies is needed.
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Affiliation(s)
- Divi Cornec
- CedexService de Rhumatologie, CHRU Brest, Hôpital de la Cavale Blanche, Boulevard Tanguy Prigent, 29609 Brest Cedex, France
- EA 2216 Immunologie et Pathologie, SFR ScinBios, Labex ‘Immunotherapy, Graft, Oncology’, Faculté de médecine de Brest, avenue Camille Desmoulins, 29200 Brest, France
| | - Alain Saraux
- CedexService de Rhumatologie, CHRU Brest, Hôpital de la Cavale Blanche, Boulevard Tanguy Prigent, 29609 Brest Cedex, France
- EA 2216 Immunologie et Pathologie, SFR ScinBios, Labex ‘Immunotherapy, Graft, Oncology’, Faculté de médecine de Brest, avenue Camille Desmoulins, 29200 Brest, France
| | - Béatrice Cochener
- Service d'Ophtalmologie, CHRU Brest, Hôpital Morvan, Avenue Foch, 29609 Brest Cedex, France
| | - Jacques-Olivier Pers
- EA 2216 Immunologie et Pathologie, SFR ScinBios, Labex ‘Immunotherapy, Graft, Oncology’, Faculté de médecine de Brest, avenue Camille Desmoulins, 29200 Brest, France
- Service d'Odontologie, CHRU Brest, Hôpital Morvan, Avenue Foch, 29609 Brest Cedex, France
| | - Sandrine Jousse-Joulin
- CedexService de Rhumatologie, CHRU Brest, Hôpital de la Cavale Blanche, Boulevard Tanguy Prigent, 29609 Brest Cedex, France
- EA 2216 Immunologie et Pathologie, SFR ScinBios, Labex ‘Immunotherapy, Graft, Oncology’, Faculté de médecine de Brest, avenue Camille Desmoulins, 29200 Brest, France
| | - Yves Renaudineau
- EA 2216 Immunologie et Pathologie, SFR ScinBios, Labex ‘Immunotherapy, Graft, Oncology’, Faculté de médecine de Brest, avenue Camille Desmoulins, 29200 Brest, France
- Laboratoire d'Immunologie, CHRU Brest, Hôpital Morvan, Avenue Foch, 29609 Brest Cedex, France
| | - Thierry Marhadour
- CedexService de Rhumatologie, CHRU Brest, Hôpital de la Cavale Blanche, Boulevard Tanguy Prigent, 29609 Brest Cedex, France
| | - Valérie Devauchelle-Pensec
- CedexService de Rhumatologie, CHRU Brest, Hôpital de la Cavale Blanche, Boulevard Tanguy Prigent, 29609 Brest Cedex, France
- EA 2216 Immunologie et Pathologie, SFR ScinBios, Labex ‘Immunotherapy, Graft, Oncology’, Faculté de médecine de Brest, avenue Camille Desmoulins, 29200 Brest, France
- Service de Rhumatologie, Hôpital de la Cavale Blanche, BP 824, F 29609 Brest Cedex, France
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12
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Usuba FS, Lopes JB, Fuller R, Yamamoto JH, Alves MR, Pasoto SG, Caleiro MTC. Sjögren's syndrome: An underdiagnosed condition in mixed connective tissue disease. Clinics (Sao Paulo) 2014; 69:158-62. [PMID: 24626939 PMCID: PMC3935126 DOI: 10.6061/clinics/2014(03)02] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 07/29/2013] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE To determine the prevalence of sicca symptoms, dry eye, and secondary Sjögren's syndrome and to evaluate the severity of dry eye in patients with mixed connective tissue disease. METHODS In total, 44 consecutive patients with mixed connective tissue disease (Kasukawa's criteria) and 41 healthy controls underwent Schirmer's test, a tear film breakup time test, and ocular surface staining to investigate dry eye. In addition, the dry eye severity was graded. Ocular and oral symptoms were assessed using a structured questionnaire. Salivary gland scintigraphy was performed in all patients. Classification of secondary Sjögren's syndrome was assessed according to the American-European Consensus Group criteria. RESULTS The patients and controls had comparable ages (44.7±12.4 vs. 47.2±12.2 years) and frequencies of female gender (93 vs. 95%) and Caucasian ethnicity (71.4 vs. 85%). Ocular symptoms (47.7 vs. 24.4%) and oral symptoms (52.3 vs. 9.7%) were significantly more frequent in patients than in controls. Fourteen (31.8%) patients fulfilled Sjögren's syndrome criteria, seven of whom (50%) did not have this diagnosis prior to study inclusion. A further comparison of patients with mixed connective tissue disease with or without Sjögren's syndrome revealed that the former presented significantly lower frequencies of polyarthritis and cutaneous involvement than did the patients without Sjögren's syndrome. Moderate to severe dry eye was found in 13 of 14 patients with mixed connective tissue disease and Sjögren's syndrome (92.8%). CONCLUSIONS Sjögren's syndrome, particularly with moderate to severe dry eye, is frequent in patients with mixed connective tissue disease. These findings alert the physician regarding the importance of the appropriate diagnosis of this syndrome in such patients.
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Affiliation(s)
- Fany Solange Usuba
- Faculdade de Medicina, Universidade de São Paulo, Hospital das Clínicas, Department of Ophthalmology, São PauloSP, Brazil, Faculdade de Medicina da Universidade de São Paulo, Hospital das Clínicas, Department of Ophthalmology, São Paulo/SP, Brazil
| | - Jaqueline Barros Lopes
- Faculdade de Medicina, Universidade de São Paulo, Hospital das Clínicas, Rheumatology Division, São PauloSP, Brazil, Faculdade de Medicina da Universidade de São Paulo, Hospital das Clínicas, Rheumatology Division, São Paulo/SP, Brazil
| | - Ricardo Fuller
- Faculdade de Medicina, Universidade de São Paulo, Hospital das Clínicas, Rheumatology Division, São PauloSP, Brazil, Faculdade de Medicina da Universidade de São Paulo, Hospital das Clínicas, Rheumatology Division, São Paulo/SP, Brazil
| | - Joyce Hisae Yamamoto
- Faculdade de Medicina, Universidade de São Paulo, Hospital das Clínicas, Department of Ophthalmology, São PauloSP, Brazil, Faculdade de Medicina da Universidade de São Paulo, Hospital das Clínicas, Department of Ophthalmology, São Paulo/SP, Brazil
| | - Milton Ruiz Alves
- Faculdade de Medicina, Universidade de São Paulo, Hospital das Clínicas, Department of Ophthalmology, São PauloSP, Brazil, Faculdade de Medicina da Universidade de São Paulo, Hospital das Clínicas, Department of Ophthalmology, São Paulo/SP, Brazil
| | - Sandra Gofinet Pasoto
- Faculdade de Medicina, Universidade de São Paulo, Hospital das Clínicas, Rheumatology Division, São PauloSP, Brazil, Faculdade de Medicina da Universidade de São Paulo, Hospital das Clínicas, Rheumatology Division, São Paulo/SP, Brazil
| | - Maria Teresa C Caleiro
- Faculdade de Medicina, Universidade de São Paulo, Hospital das Clínicas, Rheumatology Division, São PauloSP, Brazil, Faculdade de Medicina da Universidade de São Paulo, Hospital das Clínicas, Rheumatology Division, São Paulo/SP, Brazil
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13
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Rasmussen A, Ice JA, Li H, Grundahl K, Kelly JA, Radfar L, Stone DU, Hefner KS, Anaya JM, Rohrer M, Gopalakrishnan R, Houston GD, Lewis DM, Chodosh J, Harley JB, Hughes P, Maier-Moore JS, Montgomery CG, Rhodus NL, Farris AD, Segal BM, Jonsson R, Lessard CJ, Scofield RH, Moser Sivils KL. Comparison of the American-European Consensus Group Sjogren's syndrome classification criteria to newly proposed American College of Rheumatology criteria in a large, carefully characterised sicca cohort. Ann Rheum Dis 2014; 73:31-8. [PMID: 23968620 PMCID: PMC3855629 DOI: 10.1136/annrheumdis-2013-203845] [Citation(s) in RCA: 135] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To compare the performance of the American-European Consensus Group (AECG) and the newly proposed American College of Rheumatology (ACR) classification criteria for Sjögren's Syndrome (SS) in a well-characterised sicca cohort, given ongoing efforts to resolve discrepancies and weaknesses in the systems. METHODS In a multidisciplinary clinic for the evaluation of sicca, we assessed features of salivary and lacrimal gland dysfunction and autoimmunity as defined by tests of both AECG and ACR criteria in 646 participants. Global gene expression profiles were compared in a subset of 180 participants. RESULTS Application of the AECG and ACR criteria resulted in classification of 279 and 268 participants with SS, respectively. Both criteria were met by 244 participants (81%). In 26 of the 35 AECG+/ACR participants, the minor salivary gland biopsy focal score was ≥1 (74%), while nine had positive anti-Ro/La (26%). There were 24 AECG-/ACR+ who met ACR criteria mainly due to differences in the scoring of corneal staining. All patients with SS, regardless of classification, had similar gene expression profiles, which were distinct from the healthy controls. CONCLUSIONS The two sets of classification criteria yield concordant results in the majority of cases and gene expression profiling suggests that patients meeting either set of criteria are more similar to other SS participants than to healthy controls. Thus, there is no clear evidence for increased value of the new ACR criteria over the old AECG criteria from the clinical or biological perspective. It is our contention, supported by this report, that improvements in diagnostic acumen will require a more fundamental understanding of the pathogenic mechanisms than is at present available.
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Affiliation(s)
- Astrid Rasmussen
- Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - John A. Ice
- Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - He Li
- Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Kiely Grundahl
- Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - Jennifer A. Kelly
- Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - Lida Radfar
- Department of Oral Diagnosis and Radiology, University of Oklahoma College of Dentistry, Oklahoma City, OK, USA
| | - Donald U. Stone
- Department of Ophthalmology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | | | - Juan-Manuel Anaya
- Center for Autoimmune Diseases Research (CREA), Universidad del Rosario, Bogotá, Colombia
| | - Michael Rohrer
- Hard Tissue Research Laboratory, University of Minnesota School of Dentistry, Minneapolis, MN, USA
| | - Rajaram Gopalakrishnan
- Division of Oral Pathology, Department of Developmental and Surgical Science, University of Minnesota School of Dentistry, Minneapolis, MN, USA
| | - Glen D. Houston
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - David M. Lewis
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - James Chodosh
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - John B. Harley
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- US Department of Veterans Affairs Medical Center, Cincinnati, OH, USA
| | - Pamela Hughes
- Division of Oral and Maxillofacial Surgery, Department of Developmental and Surgical Science, University of Minnesota School of Dentistry, Minneapolis, MN, USA
| | - Jacen S. Maier-Moore
- Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - Courtney G. Montgomery
- Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - Nelson L. Rhodus
- Department of Oral Surgery, University of Minnesota School of Dentistry, Minneapolis, MN, USA
| | - A. Darise Farris
- Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | | | - Roland Jonsson
- Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen and Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
| | - Christopher J. Lessard
- Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - R. Hal Scofield
- Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Veterans Affairs Medical Center, Oklahoma City, OK, USA
| | - Kathy L. Moser Sivils
- Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
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14
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Retamozo S, Akasbi M, Brito-Zerón P, Bosch X, Bove A, Perez-de-Lis M, Jimenez I, Soto-Cardenas MJ, Gandia M, Diaz-Lagares C, Viñas O, Siso A, Perez-Alvarez R, Yague J, Ramos-Casals M. Anti-Ro52 antibody testing influences the classification and clinical characterisation of primary Sjögren's syndrome. Clin Exp Rheumatol 2012; 30:686-692. [PMID: 22704838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Accepted: 12/13/2011] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To evaluate how determination of antibodies against the Ro52 antigen influences the classification and clinical characterisation of patients with suspected primary Sjögren's syndrome (SS). METHODS The cohort study included 187 patients who fulfilled at least four of the six 1993 SS classification criteria, including positive autoantibodies (antinuclear antibodies [ANA], rheumatoid factor [RF], anti-Ro/SSA and/or anti-La/SS-B antibodies) as mandatory criterium. Anti-Ro/SSA antibodies were tested by qualitative ELISA using a commercial assay. Anti-Ro52 antibodies were detected by a semiquantitative ELISA. RESULTS Anti-Ro52 antibodies were found in 70/187 (37%) patients. A significant percentage of patients with anti-Ro/SSA antibodies were negative for anti-Ro52 antibodies (22%), while 13 patients (12%) were negative for anti-Ro/SSA antibodies but positive for anti-Ro52 antibodies, meaning that they fulfilled the 2002 SS criteria while avoiding the need for a salivary biopsy. Higher mean titers of anti-Ro52 antibodies were associated with severe scintigraphic involvement, positive salivary gland biopsy, parotid enlargement, anaemia, leukopenia and RF. A statistical correlation was found between anti-Ro52 titers and age, gammaglobulin levels, RF titers and serum IgA and IgG. Patients with positive anti-Ro/SSA and anti-Ro52 antibodies had a higher frequency of positive salivary gland biopsy, parotid enlargement and positive RF, and higher levels of serum IgG and IgA levels in comparison with patients with positive anti-Ro/SSA but negative anti-Ro52 antibodies. CONCLUSIONS Anti-Ro52 antibodies were closely associated with the main clinical, histopathological and immunological features of primary SS. Anti-Ro52 autoantibody testing may help to identify a specific subset of SS patients with more aggressive disease, in whom a closer follow-up and earlier, more robust therapeutic management may be necessary.
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Affiliation(s)
- Soledad Retamozo
- Department Autoimmune Diseases, Hospital Clinic, Barcelona, Spain.
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15
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Abstract
Sjögren Syndrome (SS) is a systemic, autoimmune disorder characterized by lymphocytic infiltration of the exocrine glands. Different clinical associations have been described for each of the diverse autoantibodies found in SS patients. Antibodies directed against the Ro/La ribonucleoprotein complexes have been correlated with younger age, more severe dysfunction of the exocrine glands and a higher prevalence of extraglandular manifestations. Anti-nuclear antibodies and rheumatoid factors have been associated to extraglandular manifestations and an active immunological profile, while cryoglobulins are markers of more severe disease and correlate to lymphoma development and death. Antibodies to cyclic citrullinated peptides are scarce in SS and have been linked in some cases to the development of non-erosive arthritis. Furthermore, the presence of anti-mitochondrial antibodies and anti-smooth muscle antibodies in the sera of primary SS patients is considered indicative of primary biliary cirrhosis and autoimmune hepatitis, respectively. In addition, anti-centromere antibodies have been associated with a clinical phenotype intermediate between primary SS and systemic sclerosis, while antibodies against carbonic anhydrase have been related to renal tubular acidosis. Finally, an association of anti-muscarinic antibodies with cytopenias and a higher disease activity has also been described in primary SS. In conclusion, although not all of the above mentioned antibodies are useful for predicting distinct patient subgroups in SS, knowledge of the clinical associations of the different autoantibody specificities encountered in SS can advance our understanding of the disease and improve patient management.
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Affiliation(s)
- Vasiliki-Kalliopi Bournia
- Department of Pathophysiology, Medical School, University of Athens, Mikras Asias 75, 115 27 Athens, Greece
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16
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Abstract
Diagnostic and classification criteria for Sjögren's syndrome (SS) continue to evolve as more is learned about SS and about autoimmune diseases in general. Among diagnostic or classification criteria for SS that are in current use, most include various and variable combinations of results from questions about symptoms and objective tests, many of which are not specific to SS. Given the rapid increase of genetic knowledge about other autoimmune diseases and the potential of finding and testing new biological agents to treat SS, selection of patients who have as uniform a disease process as possible becomes an important goal to better understand and treat this prevalent autoimmune disease. Such is the goal and promise of the latest entry into the SS classification criteria field.
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Affiliation(s)
- Troy E Daniels
- University of California, San Francisco, Schools of Dentistry and Medicine, San Francisco, CA 94143-0422, United States.
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17
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Shiboski SC, Shiboski CH, Criswell LA, Baer AN, Challacombe S, Lanfranchi H, Schiødt M, Umehara H, Vivino F, Zhao Y, Dong Y, Greenspan D, Heidenreich AM, Helin P, Kirkham B, Kitagawa K, Larkin G, Li M, Lietman T, Lindegaard J, McNamara N, Sack K, Shirlaw P, Sugai S, Vollenweider C, Whitcher J, Wu A, Zhang S, Zhang W, Greenspan JS, Daniels TE. American College of Rheumatology classification criteria for Sjögren's syndrome: A data-driven, expert consensus approach in the Sjögren's International Collaborative Clinical Alliance Cohort. Arthritis Care Res (Hoboken) 2012; 64:475-87. [PMID: 22563590 DOI: 10.1002/acr.21591] [Citation(s) in RCA: 917] [Impact Index Per Article: 76.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- S C Shiboski
- University of California, San Francisco, Department of Epidemiology and Biostatistics, Division of Biostatistics, 185 Berry Street, Lobby 5, Suite 5700, San Francisco, CA 94107, USA.
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18
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Johnson SR, Fransen J, Khanna D, Baron M, van den Hoogen F, Medsger TA, Peschken CA, Carreira PE, Riemekasten G, Tyndall A, Matucci-Cerinic M, Pope JE. Validation of potential classification criteria for systemic sclerosis. Arthritis Care Res (Hoboken) 2012; 64:358-67. [PMID: 22052658 PMCID: PMC3376721 DOI: 10.1002/acr.20684] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Classification criteria for systemic sclerosis (SSc; scleroderma) are being updated jointly by the American College of Rheumatology and European League Against Rheumatism. Potential items for classification were reduced to 23 using Delphi and nominal group techniques. We evaluated the face, discriminant, and construct validity of the items to be further studied as potential criteria. METHODS Face validity was evaluated using the frequency of items in patients sampled from the Canadian Scleroderma Research Group, 1000 Faces of Lupus, and the Pittsburgh, Toronto, Madrid, and Berlin connective tissue disease (CTD) databases. Patients with SSc (n = 783) were compared to 1,071 patients with diseases similar to SSc (mimickers): systemic lupus erythematosus (n = 499), myositis (n = 171), Sjögren's syndrome (n = 95), Raynaud's phenomenon (RP; n = 228), mixed CTD (n = 29), and idiopathic pulmonary arterial hypertension (PAH; n = 49). Discriminant validity was evaluated using odds ratios (ORs). For construct validity, empirical ranking was compared to expert ranking. RESULTS Compared to mimickers, patients with SSc were more likely to have skin thickening (OR 427); telangiectasias (OR 91); anti-RNA polymerase III antibody (OR 75); puffy fingers (OR 35); finger flexion contractures (OR 29); tendon/bursal friction rubs (OR 27); anti-topoisomerase I antibody (OR 25); RP (OR 24); fingertip ulcers/pitting scars (OR 19); anticentromere antibody (OR 14); abnormal nailfold capillaries (OR 10); gastroesophageal reflux disease symptoms (OR 8); antinuclear antibody, calcinosis, dysphagia, and esophageal dilation (all OR 6); interstitial lung disease/pulmonary fibrosis (OR 5); and anti-PM-Scl antibody (OR 2). Reduced carbon monoxide diffusing capacity, PAH, and reduced forced vital capacity had ORs of <2. Renal crisis and digital pulp loss/acroosteolysis did not occur in SSc mimickers (OR not estimated). Empirical and expert ranking were correlated (Spearman's ρ = 0.53, P = 0.01). CONCLUSION The candidate items have good face, discriminant, and construct validity. Further item reduction will be evaluated in prospective SSc and mimicker cases.
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Affiliation(s)
- Sindhu R Johnson
- Toronto Western Hospital, Mount Sinai Hospital, and University of Toronto, Toronto, Ontario, Canada.
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19
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Yan ZM, Wei P, Qiang L, Hua H. [Clinical assessment of oral diagnostic items in 2002 classification criteria for primary Sjogren's syndrome]. Beijing Da Xue Xue Bao Yi Xue Ban 2012; 44:51-54. [PMID: 22353900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To evaluate the diagnostic value of each item in 2002 international classification criteria for primary Sjogren's syndrome (pSS) in clinically diagnosed cases. METHODS All patients were from the Department of Oral Medicine of Peking University School of Stomatology from 2005 to 2010. Their clinical manifestations and lab testing results met the standard criteria and the diagnosis was established according to international classification criteria (2002). We retrospectively collected all of the clinical and information and did the data analysis. RESULTS A total of 148 pSS patients were included in the study. When the oral evaluations were performed, 98.0% of the patients complained dry mouth, 96.6% of them had decreased non-stimulated salivary flow rate, and 60.1% had positive parotid sialography results, which was consistent with diagnosis. It was found out in the lab testing that 79.7% of the patients had positive anti-SSA antibody, and 75.0% of them had elevated globulin level. 20.3% of the patients were finally diagnosed by performing the lower lip biopsy. CONCLUSION When applying 2002 international classification criteria for the diagnosis of pSS patients, oral symptoms and unstimulated salivary flow rate are feasible and sensitive, which play an important and indicative role in the diagnosis of pSS.
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Affiliation(s)
- Zhi-min Yan
- Department of Oral Medicine, Peking University School and Hospital of Stomatology, Beijing 100081, China
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20
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Fauchais AL, Gondran G, Martel C, Vidal E. [Evolutive forms of primary Sjögren's syndrome]. Rev Prat 2012; 62:229-231. [PMID: 22408871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Primary Sjogrën's syndrome (pSS) could be restricted in 50% of the cases to glandular involvement with a chronic sicca syndrome, with a considerable alteration of quality of life. It could be complicated by systemic involvements, which are responsible of the visceral severity. Thus systemic complications could appear many years after initial pSS diagnosis and justify long-term surveillance. Initial parotid gland enlargement, Raynaud phenomenon, cutaneous vasculitis and immunological abnormalities (anti-SSA and/or SSB positivity, hypergammaglobulinemia, and cryoglobulinemia) are also implicated in systemic complications.
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Affiliation(s)
- Anne-Laure Fauchais
- Service de médecine interne A, CHU de Limoges, hôpital Dupuytren, 87042 Limoges.
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21
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Nazmul-Hossain ANM, Morarasu GM, Schmidt SK, Walker AJ, Myers SL, Rhodus NL. A current perspective on Sjögren's syndrome. J Calif Dent Assoc 2011; 39:631-637. [PMID: 22034797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Sjögren's syndrome is a common autoimmune disorder characterized by dry mouth and dry eyes. Symptoms and signs are chronic and can be severe. The diagnosis of Sjögren's syndrome can be confusing and time-consuming. The management can also be a significant challenge for the clinicians. However, recent genomic and proteomic developments are unlocking the mystery of the disease process as well as contributing to our ability to define, diagnose, and develop new treatment modalities for patients with this complex disorder.
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22
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Lauritano D, Bussolati A, Baldoni M, Leonida A. Scleroderma and CREST syndrome: a case report in dentistry. Minerva Stomatol 2011; 60:443-465. [PMID: 21956352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
CREST syndrome is part of the heterogeneous scleroderma group of autoimmune diseases that cause thickening, hardening and tightening of the connective tissue in different parts of the body, and it may lead to complex disorders. CREST syndrome is characterized by the coexistence of calcinosis, Raynaud's phenomenon, esophageal hypomotility, sclerodactily and telangectasia. A 72-year-old caucasian woman is referred to the S. Gerardo Hospital of Monza, with a chief complaint of oral pain and difficulties in deglutition and eating, associated with denture instability and difficulties to fit it. She had been previously diagnosed with Raynaud's phenomenon, and afterwards with CREST syndrome. Extra-oral examination underlined taut, thickened and rigid skin, pallid-red irregular maculae all over the face, telangiectasias and acrocyanosis. Intra-oral examination showed no alteration of the mucosa, but we can observe tongue rigidity and some speckled red alternating with white spots on the hard palate and in the vestibule. We undermitted the patient the dental treatment of Sjogren's syndrome. The management of the Sjogren's syndrome is symptomatic and empirical, and involves the use of saliva secretion stimulators, salivary substitutes and coadjuvants. Dental treatment and prophylaxis are important to prevent the consequences of xerostomia, such as rampant caries, based on the administration of topical fluoride in toothpastes and rinses, and supplemented by fluoride gels and varnishes. Instruction and reinforcement of oral hygiene, along with frequent dental assessment and management by the dentist are essential measures to preserve the oral health of those affected with CREST syndrome in progression to SS, complicated with Sjogren's syndrome.
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Affiliation(s)
- D Lauritano
- Dental Clinic Neuroscience, Milano-Bicocca University, Monza, Monza e Brianza, Italy.
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23
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Pejda S, Alajbeg I, Alajbeg I. [Adherence to American European Consensus Group classification criteria for Sjögren's syndrome in differential diagnosis of xerostomia]. Lijec Vjesn 2011; 133:180-186. [PMID: 21888083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The aims were to obtain epidemiological and etiological data on xerostomia in cross section of Croatian population, and to evaluate adherence to "American European Consensus Group" (AECG) classification criteria for Sjögren's syndrome (SSj), in order to identify possible need for improvements in differential diagnosis of xerostomia. A retrospective study among patients seen at the Department of oral medicine for complaints of dry mouth was performed. Three hundred and ninety-five patients met inclusion criteria. A data base was formed, comprising epidemiological, clinical and sialometric data, immunological, scintigraphic, ultrasonographic and histopathological findings of salivary glands, coupled with drug intake listings. Descriptive statistics were used for data analysis. Objective salivary hypofunction was found in 74% of our patients. The most common probable cause of xerostomia was side effect of pharmacotherapy. SSj was diagnosed in 6.7% of patients with xerostomia, whereas in another 8% of patients Sjögren's syndrome was strongly suspected, but labial gland biopsy wasn't performed, indicating a lack of adherence to AECG criteria for SSj diagnosis. Application of AECG criteria in differential diagnosis of patients with dry mouth is mandatory, as well as educating general practitioners, dentists and patients on xerogenic side effects of pharmacotherapy.
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Affiliation(s)
- Slavica Pejda
- Zavod za oralnu medicinu, Stomatologki fakultet Sveunilita u Zagrebu
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24
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Whitcher JP, Shiboski CH, Shiboski SC, Heidenreich AM, Kitagawa K, Zhang S, Hamann S, Larkin G, McNamara NA, Greenspan JS, Daniels TE. A simplified quantitative method for assessing keratoconjunctivitis sicca from the Sjögren's Syndrome International Registry. Am J Ophthalmol 2010; 149:405-15. [PMID: 20035924 DOI: 10.1016/j.ajo.2009.09.013] [Citation(s) in RCA: 301] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2009] [Revised: 09/17/2009] [Accepted: 09/18/2009] [Indexed: 11/30/2022]
Abstract
PURPOSE To describe, apply, and test a new ocular grading system for assessing keratoconjunctivitis sicca (KCS) using lissamine green and fluorescein. DESIGN Prospective, observational, multicenter cohort study. METHODS The National Institutes of Health-funded Sjögren's Syndrome International Registry (called Sjögren's International Collaborative Clinical Alliance [SICCA]) is developing standardized classification criteria for Sjögren syndrome (SS) and is creating a biospecimen bank for future research. Eight SICCA ophthalmologists developed a new quantitative ocular grading system (SICCA ocular staining score [OSS]), and we analyzed OSS distribution among the SICCA cohort and its association with other phenotypic characteristics of SS. The SICCA cohort includes participants ranging from possibly early SS to advanced disease. Procedures include sequenced unanesthetized Schirmer test, tear break-up time, ocular surface staining, and external eye examination at the slit lamp. Using statistical analyses and proportional Venn diagrams, we examined interrelationships between abnormal OSS (>or=3) and other characteristics of SS (labial salivary gland [LSG] biopsy with focal lymphocytic sialadenitis and focus score >1 positive anti-SS A antibodies, anti-SS B antibodies, or both). RESULTS Among 1208 participants, we found strong associations between abnormal OSS, positive serologic results, and positive LSG focus scores (P < .0001). Analysis of the overlapping relationships of these 3 measures defined a large group of participants who had KCS without other components of SS, representing a clinical entity distinct from the KCS associated with SS. CONCLUSIONS This new method for assessing KCS will become the means for diagnosing the ocular component of SS in future classification criteria. We find 2 forms of KCS whose causes may differ.
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Affiliation(s)
- John P Whitcher
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California 94143-0422, USA
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Bookman AAM. Overlap syndromes: exploring the genetic underpinnings. J Rheumatol 2009; 36:1856-1857. [PMID: 19738205 DOI: 10.3899/jrheum.090733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Daniels TE, Criswell LA, Shiboski C, Shiboski S, Lanfranchi H, Dong Y, Schiødt M, Umehara H, Sugai S, Challacombe S, Greenspan JS. An early view of the international Sjögren's syndrome registry. Arthritis Rheum 2009; 61:711-4. [PMID: 19405009 PMCID: PMC2819471 DOI: 10.1002/art.24397] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Troy E Daniels
- Oral Pathology, University of California at San Francisco, Box 0422, San Francisco, California 94143, USA.
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Baldini C, Giusti L, Bazzichi L, Lucacchini A, Bombardieri S. Proteomic analysis of the saliva: a clue for understanding primary from secondary Sjögren's syndrome? Autoimmun Rev 2007; 7:185-91. [PMID: 18190876 DOI: 10.1016/j.autrev.2007.11.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The clinical entity of secondary Sjögren's syndrome (SS) is controversial and the relationship with primary SS and other systemic autoimmune diseases is still far from being completely understood. In the last few years, proteomic approaches have been applied with a growing interest in the search for diagnostic biomarkers for many rheumatic diseases and it is possible that, in the near future, proteomic analysis of human saliva could help in distinguishing also primary from secondary SS. This review summarizes the state of the art of proteomic analysis of human saliva in the diagnosis of connective diseases focusing its advantages, limits and future perspectives.
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Affiliation(s)
- Chiara Baldini
- Department of Internal Medicine, Rheumatology Unit, University of Pisa, Via Roma 67, 56126 Pisa, Italy
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Abstract
The cause of interstitial cystitis, a chronic disease that affects the bladder, is unknown. Autoantibodies, such as those against nuclear and bladder epithelium antigens, have been found in patients with interstitial cystitis, but these are likely to be secondary to the disease. No data support a direct causal role of autoimmune reactivity in the pathogenesis of interstitial cystitis. Indirect evidence, however, does support a possible autoimmune nature of interstitial cystitis, such as the strong female preponderance and the clinical association between interstitial cystitis and other known autoimmune diseases within patients and families. The strongest association occurs between interstitial cystitis and Sjögren's syndrome. Increasing evidence suggests a possible role of autoantibodies to the muscarinic M3 receptor in Sjögren's syndrome. The M3 receptor is also located on the detrusor muscle cells of the bladder and mediates cholinergic contraction of the urinary bladder and other smooth muscle tissues. Autoantibodies to the M3 receptor might be important in both the early noninflammatory and the late inflammatory features of interstitial cystitis.
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Affiliation(s)
- Joop P van de Merwe
- Erasmus MC, University Medical Center Rotterdam, Departments of Immunology and Internal Medicine, Dr Molewaterplein 50, Rotterdam, The Netherlands.
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Zhang HF, Hou P, Xiao WG. [Clinical observation on effect of total glucosides of paeony in treating patients with non-systemic involved Sjögren syndrome]. Zhongguo Zhong Xi Yi Jie He Za Zhi 2007; 27:596-8. [PMID: 17717915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
OBJECTIVE To investigate the efficacy and adverse reaction of total glucosides of paeony (TGP) in treating patients with non-systemic involved Sjögren syndrom (NSI-SS). METHODS Retrospective study was conducted on 27 patients with NSI-SS who received TGP treatment for over two years as the TGP group, and 20 patients received hydroxychloroquine sulfate (HCQs) for over two years in the HCQs group for positive control. Salivary flow, Schirmer's test and serum gamma-globulin at different time points, i.e. before treatment, and at the end of 1st, 3rd, 6th, 12th and 24th month respectively, were compared between groups, and adverse reactions associated with TGP and HCQ were also observed. RESULTS In the TGP group, saliva secretion was significantly increased and serum gamma-globulin decreased significantly from the 6th month (P <0.01), Schirmer's test improved significantly after 12 months (P< 0.01). While in the HCQs group serum gamma-globulin was significantly decreased from the 3rd month (P <0.01), saliva secretion and Schirmer's test improved significantly after six months (P<0.01). However, the 3 indexes determined at the end of the 3rd month were insignificantly different from those before treatment. Mild diarrhea occurred in 4 cases in the TGP group, they were improved two weeks later, but one case with severe diarrhea was dropped. While in the HCQs group, 2 patients were dropped, one for the raising of alanine aminotransferase at the 6th month and the other for decreased vision at the 9th month. CONCLUSION Efficacy of TGP is equivalent to that of HCQs in treating NSI-SS, but with higher safety and the effect initiating time being about 6 - 12 months.
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Affiliation(s)
- Hong-feng Zhang
- Department ofRheumatology & Immunology, The First Affiliated Hospital of China Medical University, Shenyang.
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Novljan MP, Rozman B, Jerse M, Rotar Z, Vidmar G, Kveder T, Tomsic M. Comparison of the different classification criteria sets for primary Sjögren's syndrome. Scand J Rheumatol 2007; 35:463-7. [PMID: 17343255 DOI: 10.1080/03009740600759860] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To assess the comparability of different classification criteria sets for primary Sjögren's syndrome (pSS). METHODS In a prospective study we examined all patients with suspected pSS who were admitted to our Department of Rheumatology or referred to our outpatient clinic between 1 January 2001 and 31 December 2002. The Copenhagen, Californian, 1996 European, and American-European consensus group (US-EU) criteria sets were used to assess each patient. RESULTS Ninety out of 222 patients (41%) were diagnosed with pSS by fulfilling at least one classification criteria set. The highest number of patients who were diagnosed with pSS fulfilled the European criteria set (36%), followed by the Copenhagen (28%), the US-EU (26%), and the Californian (9%) criteria sets. On average, the group of patients fulfilling the Californian criteria set were 5.6 years older than the patients in the other three groups (p < 0.05). In addition, the disease duration before diagnosis was 2.6 years longer than in the other three groups. The groups of patients fulfilling either the Californian or the US-EU criteria sets had a higher prevalence of leucopaenia (p < 0.05). Those fulfilling the US-EU criteria set also had a higher prevalence of arthritis (p < 0.05). No significant differences were found in the prevalence of the other clinical and laboratory parameters studied. CONCLUSIONS Different patients are diagnosed with pSS if different classification criteria sets are used. Therefore, studies based on different classification criteria sets for diagnosing pSS are not directly comparable.
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Affiliation(s)
- M P Novljan
- Department of Rheumatology, University Medical Centre, Ljubljana, Slovenia
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Versura P, Frigato M, Mulé R, Malavolta N, Campos EC. A proposal of new ocular items in Sjögren's syndrome classification criteria. Clin Exp Rheumatol 2006; 24:567-72. [PMID: 17181927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
OBJECTIVE To verify whether ocular surface tests other than those included in primary Sjögren's syndrome (SS-I) classification criteria (Schirmer I, Break up Time, vital dye staining) may contribute to SS I diagnosis. METHODS Two hundred and sixty-two patients (78 SS-1, 91 non-SS autoimmune diseases, 93 Sicca syndrome) filled a validated questionnaire on symptoms and were evaluated by Schirmer test without (Schirmer I) and with (Jones test) topical anaesthesia, Break Up Time (BUT), corneal aesthesiometry, tear clearance rate, vital dye (lissamine green) staining, impression conjunctival cytology, concentration of tear lysozyme and lactoferrin. Thresholds were selected from Receiver Operating Curves; sensitivity, specificity, likelihood ratio (LR+), predictive values were calculated for each test. A logistic regression model was constructed representing the best diagnostic index for SS. RESULTS Data showed a poor diagnostic performance of Schirmer test I (LR+ 1.38) and BUT (LR+ 1.05); results from lissamine green staining may be unreliable due to incorporation bias. Tear lactoferrin (LR+ 4.52), Jones test (LR+ 6.24), tear lysozyme (LR+ 8.0), symptom questionnaire (LR+ 8.62), tear clearance rate (LR+ 18.73) and corneal aesthesiometry (LR+ 20.96) exhibited high diagnostic performance also taken together in the regression model. CONCLUSION Because many of the tests we have screened in this study can be carried out by a trained ophthalmologist in any clinical setting, we recommend that ocular surface impairment is studied with the combination of tests proved to be helpful for the SS I diagnosis.
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Affiliation(s)
- P Versura
- Dept. of Surgical Science and Transplants, Ophthalmology Section, Alma Mater Studiorum Università di Bologna, Italy.
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Shiari R, Kobayashi I, Toita N, Hatano N, Kawamura N, Okano M, Hayashi Y, Kobayashi K, Ariga T. Epitope mapping of anti-alpha-fodrin autoantibody in juvenile Sjögren's syndrome: difference in major epitopes between primary and secondary cases. J Rheumatol 2006; 33:1395-400. [PMID: 16821274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
OBJECTIVE Juvenile Sjögren's syndrome (SS) is an early-onset type of SS. Autoantibody against the N-terminal 120 kDa form of a-fodrin is a specific and sensitive disease marker for both juvenile and adult SS. We investigated the initial and major determinants of a-fodrin in SS. METHODS Sera were obtained from patients with juvenile SS, 10 with primary SS and 10 with secondary SS. Epitope specificities of IgG antibodies were examined by dot-blot analyses using overlapping fusion proteins of the N-terminal part (561 amino acid residues) of a-fodrin as antigens. RESULTS All sera from patients with primary SS reacted with amino acid residues 1 to 98 and 36 to 150, but not with 91 to 199. Epitope mapping using fusion proteins with subfragments, each consisting of about 50 amino acid residues, showed reactivity with amino acid residues 27-80 and 79-132, suggesting that at least 2 epitopes are contained in the first 150 amino acid residues. All 3 cases with neurological complications had additional epitope specificities. Sera from patients with secondary SS showed more diversified specificities and strongly reacted with amino acid residues 1-98 and 334-432, whereas the reactivities to 36-150, a major epitope in primary SS, were minimal. CONCLUSION Major and initial B cell epitopes specifically reside in N-terminal amino acids 36-132 and could be used as a diagnostic tool for primary SS. The epitope subsequently expands to other regions of a-fodrin in association with the development of neurological complications or disease progression. Secondary SS has distinct epitope specificities.
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Affiliation(s)
- Reza Shiari
- Department of Pediatrics, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Guobis Z, Baseviciene N, Paipaliene P, Sabalys G, Kubilius R. [Xerostomia: clinic, etiology, diagnosis and treatment]. Medicina (Kaunas) 2006; 42:171-9. [PMID: 16528134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
The aim of this article is to review the problem of xerostomia considering its clinical, etiological, diagnostic and treatment features, basing on the today's tutorials and scientific articles found in databases on the Internet. Recent epidemiologic data on the prevalence of xerostomia in different countries are introduced. There are analyzed the main aspects of clinical manifestations of xerostomia, according to the different etiology analyzed. The most common etiological factors causing xerostomia, especially the main three of them: radiation therapy, Sjögren's syndrome, and drugs, are pointed out. The most popular and accepted clinical and laboratory assays for measuring and evaluating the function of salivary glands are represented. Attention is paid to xerostomia as substantiation of the separate diagnosis and its role in diagnosing other diseases. The concept of possible treatment modalities and prognosis are discussed. The main and most common problems concerning xerostomia are revealed.
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Affiliation(s)
- Zygimantas Guobis
- Clinic of Dental and Oral Diseases, Kaunas University of Medicine, Kaunas, Lithuania.
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Houghton K, Malleson P, Cabral D, Petty R, Tucker L. Primary Sjögren's syndrome in children and adolescents: are proposed diagnostic criteria applicable? J Rheumatol 2005; 32:2225-32. [PMID: 16265707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVE To compare the proposed criteria for the diagnosis of primary Sjögren's syndrome (pSS) in childhood to the validated American-European Consensus Group (AECG) classification criteria for pSS in adults. METHODS Charts of 7 children with pSS seen at British Columbia's Children's Hospital (BCCH) and data on 128 children identified through Medline in the English language literature between 1963 and 2003 were reviewed for pediatric and AECG criteria for pSS. The presence of > or = 4 criteria was required to satisfy the respective classification criteria. The expert clinical opinion of pediatric rheumatologists was considered the gold standard for diagnosis. RESULTS A total of 24/62 (39%) cases satisfied the AECG criteria; 47/62 (76%) satisfied the proposed pediatric criteria. Inclusion of recurrent parotitis increased the sensitivity of the pediatric clinical criteria. From the cases, 78/133 (59%) satisfied the pediatric oral symptom criteria; only 6/78 (8%) had xerostomia in the absence of recurrent parotitis. There was no reported case of recurrent conjunctivitis in the absence of keratoconjunctivitis sicca. We found 101/130 (78%) cases had at least one positive autoantibody test result [antinuclear antibodies (ANA), rheumatoid factor (RF), SSA, SSB]; 78/123 (63%) had autoantibodies to SSA or SSB. CONCLUSION The AECG adult criteria for pSS should not be applied to children as the sensitivity is unacceptably low. The inclusion of recurrent parotitis increases the sensitivity of the pediatric criteria, and recurrent parotitis should alert the clinician to the possibility of pSS. The inclusion of recurrent conjunctivitis did not improve the sensitivity over the AECG ocular criteria. The addition of ANA and RF to the AECG criteria did not change the number of patients satisfying the criteria for pediatric pSS.
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Affiliation(s)
- Kristin Houghton
- Division of Rheumatology, Department of Pediatrics, University of British Columbia, British Columbia's Children's Hospital, Vancouver, Canada.
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Zhao Y, Kang J, Zheng WJ, Zhou W, Guo XP, Gao Y, Dong Y. Evaluation of international classification criteria (2002) for primary Sjögren's syndrome in Chinese patients. Chin Med Sci J 2005; 20:190-3. [PMID: 16261891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVE To evaluate the sensitivity and specificity of international classification criteria (2002) for primary Sjögren's syndrome (pSS) and the role of lower lip biopsy in diagnosis of pSS in Chinese patients. METHODS Patients who were diagnosed by the experts/rheumatologists as pSS during 1990-2002 from the Department of Rheumatology, Peking Union Medical College Hospital were retrospectively collected as experimental group. Patients who were diagnosed as non-pSS connective tissue diseases or non-connective tissue diseases served as control group. Those with a history of head-neck radiation, hepatitis C virus infection, AIDS, lymphoma, sarcoidosis, graft versus host disease (GVHD), and anti-acetylcholine drug use were exempted. Both groups were required to complete questionnaires about symptoms such as dry eyes and dry mouth, and complete the objective tests of keratoconjunctivitis and xerostomia including Schirmer test, corneal staining, unstimulated salivary flow, sialography, lower lip biopsy, and antinuclear antibodies (including anti-SSA/SSB antibodies) test. RESULTS A total of 330 pSS patients were included in experimental group and 185 non-pSS patients in control group. The mean age of both groups matched (47.8 +/- 10.9 years vs. 46.2 +/- 13.6 years, P > 0.05). The sensitivities of the criteria in pSS patients with lower lip biopsy and in pSS patients without lower lip biopsy were 89.2% and 87.2%, respectively; the overall sensitivity was 88.5%. The specificity was 97.3%. A total of 11.3% pSS patients with negative anti-SSA/SSB anti- bodies were diagnosed as pSS by lower lip biopsy. CONCLUSION The international classification criteria (2002) for pSS is feasible in Chinese patients. It has high sensitivity and specificity, and may serve as diagnosis criteria in routine clinical practice.
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Affiliation(s)
- Yan Zhao
- Department of Rheumatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730
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Azuma N, Katada Y, Harada Y, Arimoto H, Kimura Y, Terada H, Tsujino K, Kida H, Yamamoto S, Kudo E, Umeshita M, Mima T, Saeki Y. [Case of primary Sjögren's syndrome with hypereosinophilia and elevation of serum IgE: measurements of serum IL-4, IL-5 and the IgG subclass]. Arerugi 2005; 54:646-51. [PMID: 16229365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
A 62-year-old man admitted to our hospital because of dry eyes and thirst. On admission, his bilateral parotid and submandibular glands were swelling. Laboratory data revealed severe eosinophilia (3309/microl), elevated serum IgE (1821IU/dl) and hypergammaglobulinemia (IgG 6049 mg/dl). Interstitial pneumonia and renal dysfunction were present. He was diagnosed with Sjögren's syndrome (SjS) according to the European criteria. After the initiation of the therapy with 30 mg of prednisolone, all abnormal findings including salivation ameliorated promptly. In the absence of any other obvious causes of eosinophilia and elevation of serum IgE, these findings might be associated with SjS itself. Moreover, both serum IL-5 and IgG4 levels were elevated in this patient, suggesting that Th2 type cytokines were dominant. Elevation of serum IgE and IgG4, and hypereosinophilia were likely to be reactive. To our knowledge, there have been no reports of these cytokines and of IgG subclass in such patients. We propose the existence of Th2-type-cytokine-dominant subtype of SjS.
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Affiliation(s)
- Naoto Azuma
- Division of Allergy and Clinical Immunology, National Hospital Organization Osaka-Minami Medical Center.
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Locht H, Pelck R, Manthorpe R. Clinical manifestations correlated to the prevalence of autoantibodies in a large (n=321) cohort of patients with primary Sjögren's syndrome. Autoimmun Rev 2005; 4:276-81. [PMID: 15990074 DOI: 10.1016/j.autrev.2004.12.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2004] [Accepted: 12/06/2004] [Indexed: 11/22/2022]
Abstract
In this study we imposed the recently described American-European consensus criteria for primary Sjögren's syndrome (pSS) on a large cohort of patients originally classified according to the Copenhagen set of criteria. Of the 321 patients fulfilling the Copenhagen criteria, 205 conformed to the Consensus criteria. When comparing clinical manifestations and laboratory findings between the two groups defined by different standards we found only small variations. Thus, the consequence of using the Consensus criteria in daily clinical practice will lead to the exclusion of a considerable proportion of patients with classical features of pSS. The main reason for this discrepancy is probably the absolute requirement of a positive test for anti-Ro/La or a characteristic lymphocytic infiltration in the labial gland biopsy. The sensitivity and specificity of testing for autoantibodies to Ro-52, Ro-60, and La were calculated for each set of criteria. Antibodies to La but not to Ro-52 or Ro-60 were strongly correlated to internal organ (kidney, lung, liver) dysfunction in pSS (OR 6; 95% CI 3-12), p<0.0001. Although presence of ANA was slightly more prevalent among patients with internal organ involvement it did not reach statistical significance. The fine speckled ANA pattern was most often found followed by the homogeneous and centromere pattern. Individual ANA patterns did not correlate with any particular organ manifestation.
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Affiliation(s)
- Henning Locht
- Department of Autoimmunology, Bldg 81/5, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen S, Denmark.
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Ruiz-Tíscar JL, López-Longo FJ, Sánchez-Ramón S, Santamaría B, Urrea R, Carreño L, Estecha A, Vigil D, Fernández-Cruz E, Rodríguez-Mahou M. Prevalence of IgG anti-{alpha}-fodrin antibodies in Sjogren's syndrome. Ann N Y Acad Sci 2005; 1050:210-6. [PMID: 16014536 DOI: 10.1196/annals.1313.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The objective of this study was to determine the prevalence of antibodies against alpha-fodrin (alpha-fodrin) of the immunoglobulin G (IgG) isotype in Sjögren's syndrome (SS), as defined by European Community Study Group (ESG) and ESG-modified criteria. We arrived at the prevalence and mean concentrations of IgG anti-alpha-fodrin antibodies using enzyme-linked immunosorbent assay (ELISA) in 507 patients with SS, primary SS (pSS), and secondary SS (sSS), classified according to either the ESG or the ESG-modified criteria. IgG anti-alpha-fodrin antibodies were detected in 6/507 (1.2%) and 4/228 (1.7%) of the SS group, according to the ESG or ESG-modified criteria, respectively. Similar prevalence was found for patients with pSS or sSS. Anti-Ro/SSA antibodies were present in 151/409 (36.9%) vs. 149/213 (70.0%) of the SS group, 85/195 (43.6%) vs. 83/101 (82.2%) of the pSS group, and 66/214 (30.8%) vs. 66/112 (58.9%) of the sSS group. Anti-La/SSB antibodies were detected in 77/403 (19.1%) vs. 73/212 (34.4%) of the SS group, 47/194 (24.2%) vs. 45/101 (44.5%) of the pSS group, and 30/209 (14.3%) vs. 28/111 (25.2%) of the sSS group. No clinical associations were found. Only two IgG anti-alpha-fodrin-positive sera were anti-Ro/SSA-negative. We conclude that IgG antibodies against alpha-fodrin are present in a small percentage of people with SS, pSS, and sSS. The lower prevalence in patients classified according to the ESG criteria reflects the lower specificity of these criteria. IgG anti-alpha-fodrin antibodies can be detected in some SS patients whose sera do not contain anti-Ro/SSA antibodies.
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Affiliation(s)
- J L Ruiz-Tíscar
- Department of Clinical Immunology, Gregorio Marañón Hospital, 28009 Madrid, Spain
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Dubucquoi S. Anticorps anti-alpha fodrine : place dans le diagnostic des syndromes de Sjögren. Rev Med Interne 2005; 26:85-7. [PMID: 15710253 DOI: 10.1016/j.revmed.2004.09.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2004] [Accepted: 09/27/2004] [Indexed: 11/15/2022]
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Morbini P, Manzo A, Caporali R, Epis O, Villa C, Tinelli C, Solcia E, Montecucco C. Multilevel examination of minor salivary gland biopsy for Sjogren's syndrome significantly improves diagnostic performance of AECG classification criteria. Arthritis Res Ther 2005; 7:R343-8. [PMID: 15743482 PMCID: PMC1065324 DOI: 10.1186/ar1486] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2004] [Revised: 11/15/2004] [Accepted: 12/01/2004] [Indexed: 11/23/2022] Open
Abstract
The recently observed low reproducibility of focus score (FS) assessment at different section depths in a series of single minor salivary gland biopsies highlighted the need for a standardized protocol of extensive histopathological examination of such biopsies in Sjögren's syndrome. For this purpose, a cumulative focus score (cFS) was evaluated on three slides cut at 200-μm intervals from each of a series of 120 salivary biopsies. The cFS was substituted for the baseline FS in the American–European Consensus Group (AECG) criteria set for Sjögren's syndrome classification, and then test specificity and sensitivity were assessed against clinical patient re-evaluation. Test performances of the AECG classification with the original FS and the score obtained after multilevel examination were statistically compared using receiver operating characteristic (ROC) curve analysis. The diagnostic performance of AECG classification significantly improved when the cFS was entered in the AECG classification; the improvement was mostly due to increased specificity in biopsies with a baseline FS ≥ 1 but <2. The assessment of a cFS obtained at three different section levels on minor salivary gland biopsies can be useful especially in biopsies with baseline FSs between 1 and 2.
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Affiliation(s)
- Patrizia Morbini
- Department of Pathology, IRCCS Policlinico S Matteo, Pavia, Italy
| | - Antonio Manzo
- Department of Rheumatology, IRCCS Policlinico S Matteo, Pavia, Italy
| | - Roberto Caporali
- Department of Rheumatology, IRCCS Policlinico S Matteo, Pavia, Italy
| | - Oscar Epis
- Department of Rheumatology, IRCCS Policlinico S Matteo, Pavia, Italy
| | - Chiara Villa
- Department of Pathology, IRCCS Policlinico S Matteo, Pavia, Italy
| | | | - Enrico Solcia
- Department of Pathology, IRCCS Policlinico S Matteo, Pavia, Italy
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Bizzaro N, Villalta D, Tonutti E. Low sensitivity of anti-alpha-fodrin antibodies in patients with primary Sjögren's syndrome. J Rheumatol 2004; 31:2310-1; author reply 2311. [PMID: 15517652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
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Taiym S, Haghighat N, Al-Hashimi I. A comparison of the hormone levels in patients with Sjogren's syndrome and healthy controls. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004; 97:579-83. [PMID: 15153869 DOI: 10.1016/s107921040400068x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The purpose of this study was to compare the level and relative ratio of estrogen, progesterone, and prolactin in patients with Sjögren's syndrome and healthy controls. STUDY DESIGN Serum samples were collected from 17 SS patients and 19 age-, sex- and race-matched controls. All subjects were postmenopausal females who were not currently on hormone replacement therapy. Prolactin levels were measured using ELISA and progesterone and estrogen were measured using EIA. RESULTS Mann-Whitney U test revealed a significantly higher levels of prolactin among patients than controls (11.41 ng/ml vs. 6.74 ng/ml, p=0.003) with significantly higher prolactin/ progesterone (18.88 vs. 8.14, p=0.02) and estrogen/ progesterone (71.51 vs. 42.02, p=0.05) ratios. No significant differences were observed in the levels of estrogen and progesterone between patients and controls. CONCLUSION Abnormal levels and relative ratios of hormones may play a role in the pathogenesis of Sjögren's syndrome.
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Affiliation(s)
- S Taiym
- Department of Periodontics, Baylor College of Dentistry, Texas A&M University System, Dallas, 75246, USA
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Negoro A, Umemoto M, Fujii M, Kakibuchi M, Terada T, Hashimoto N, Sakagami M. Taste function in Sjögren’s syndrome patients with special reference to clinical tests. Auris Nasus Larynx 2004; 31:141-7. [PMID: 15121223 DOI: 10.1016/j.anl.2004.01.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2003] [Accepted: 01/16/2004] [Indexed: 11/27/2022]
Abstract
OBJECTIVE We analyzed the correlation between taste functions and clinical features in patients with Sjögren's syndrome (SS). METHODS Sixty-three patients were divided into two groups: group A consisting of patients with primary or secondary SS of the European classification, and group B consisting of non-SS complaining of dry eye and mouth. RESULTS Eighteen percent of the group A patients and 11% of the group B patients complained of taste disorders. Electrogustometric examination detected taste disorders in 27% of the group A patients and 38% of the group B patients, while the filter paper disc method showed taste disorders in 30% of group A and 40% of group B. In group A, unstimulated and stimulated salivary flows were correlated with the ability to discriminate taste analyzed by the filter paper disc method, but not with the taste electrogustometric threshold. Serum zinc concentration was not significantly correlated with taste disorders in either group. CONCLUSION Our findings showed that SS patients presented taste disorders less frequently than previously reported, and we speculated that taste disorder found in SS patients were due to the salivary flow deficiency that might prevent substances from reaching the taste buds.
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Affiliation(s)
- Atsushi Negoro
- Department of Otolaryngology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya City, Hyogo 663-8501, Japan.
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Lamey PJ, Lundy FT, Al-Hashimi I. Sjögren’s syndrome: a condition with features of chronic graft-versus-host disease: does duct cell adhesion or permeability play a role in pathogenesis? Med Hypotheses 2004; 62:825-9. [PMID: 15082115 DOI: 10.1016/j.mehy.2003.12.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2003] [Accepted: 12/04/2003] [Indexed: 11/25/2022]
Abstract
Primary and Secondary Sjögren's syndrome are disease complexes characterized by periductal inflammatory cell infiltration of the salivary and lacrimal glands and manifest as dry mouth and dry eyes. Secondary Sjögren's syndrome may be associated with a connective tissue disorder. Additional extraglandular features in Sjögren's syndrome include a generalized inflammatory exocrinopathy that might be associated with abnormalities of both humoral and cellular mediated immunity. Similar inflammatory changes and extraglandular features, including an altered immune response, have been reported in patients developing graft-versus-host disease after bone-marrow transplantation and in patients with primary biliary cirrhosis. The periductal nature of the inflammatory response involving minor salivary and other glands raises the possibility of altered duct cell adhesion or permeability in playing a role in the aetiopathogenesis of Sjögren's syndrome. The paper pulls together evidence that could be interpreted in this light. Evidence for bacterial or viral factor(s) altering the antigenicity of the histocompartibility (HC) complex on ductal cells in Sjögren's syndrome patients is also described. A hypothesis is proposed for Sjögren's syndrome in which the principal feature is an alteration in salivary gland duct cell adhesion or permeability. A re-evaluation of current knowledge of these two conditions from a clinical and experimental context are interpreted in this light.
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Affiliation(s)
- P-J Lamey
- Oral Science Research Centre, School of Dentistry, Queen's University Belfast, Grosvenor Road, Northern Ireland, Belfast BT12 6BP, UK.
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Shizukuishi K, Nagaoka S, Kinno Y, Saito M, Takahashi N, Kawamoto M, Abe A, Jin L, Inoue T. Scoring analysis of salivary gland scintigraphy in patients with Sjögren’s syndrome. Ann Nucl Med 2003; 17:627-31. [PMID: 14971603 DOI: 10.1007/bf02984967] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The purpose of the present study was to evaluate the validity of a scoring system based on excretion rate of salivary gland scintigraphy in patients with Sjögren's syndrome (SjS). Total scintigraphic scores were compared with the results of the Saxon test. One hundred and twenty-four subjects who were clinically diagnosed with SjS and 11 normal ones underwent salivary gland scintigraphy and the Saxon test. In salivary gland scintigraphy, the difference between maximum and minimum counts after stimulation using vitamin C divided by maximum counts was defined as the excretion rate. We then defined a scoring system with 4 grades: severe dysfunction = 3 (excretion rate < 25%), moderate dysfunction = 2 (25% < or = excretion rate < 40%), mild dysfunction = 1 (40% < or = excretion rate < 50%) and normal function = 0 (50% < or = excretion rate). The summation of the total scintigraphic score (0-12) of all 4 salivary glands was used as a semi-quantitative index indicating total salivary gland function, and total scintigraphic scores were compared with the results of the Saxon test. A significant inverse linear correlation (R2 = 0.95) was observed between total scintigraphic scores and mean values of the Saxon test within a range of abnormal scintigraphic scores (> or = 4). The scoring system developed in the present study is a clinically available, objective, and reproducible method for evaluation of salivary gland function in patients with SjS.
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Affiliation(s)
- Kazuya Shizukuishi
- Department of Radiology, Yokohama City University, School of Medicine, Yokohama, Japan.
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Witte T, Matthias T, Oppermann M, Helmke K, Peter HH, Schmidt RE, Tishler M. Prevalence of antibodies against alpha-fodrin in Sjögren's syndrome: comparison of 2 sets of classification criteria. J Rheumatol 2003; 30:2157-9. [PMID: 14528510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
OBJECTIVE To compare the prevalence of antibodies against alpha-fodrin in Sjögren's syndrome (SS) classified according to San Diego and European Community Study Group (ESG) criteria. METHODS The prevalence and mean concentrations of IgA and IgG autoantibodies against alpha-fodrin were determined and compared in patients with SS classified either according to San Diego criteria or to criteria of the ESG by ELISA. RESULTS IgA antibodies against alpha-fodrin were detected in 88% and IgG antibodies against alpha-fodrin in 64% and either of these antibodies in 93% of 85 patients classified according to San Diego criteria. Antibodies against Ro were present in 38% of these sera. IgA antibodies against alpha-fodrin were detected in 61%, IgG antibodies against alpha-fodrin in 51%, and any of these antibodies in 73% of 51 patients classified according to the ESG criteria. The mean concentrations of both IgA and IgG antibodies against alpha-fodrin that seem to correlate with disease activity were higher in patients classified according to the San Diego criteria. CONCLUSION Antibodies against alpha-fodrin are detectable in almost all sera obtained from patients with SS classified according to the San Diego criteria and are significantly more prevalent than antibodies against Ro. The lower prevalence of the autoantibodies in patients classified according to the ESG criteria reflects the lower specificity of these criteria for SS.
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Affiliation(s)
- Torsten Witte
- Abteilung Klinische Immunologie, Medizinische Hochschule, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany.
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Abstract
We evaluated the role of quantitative indices derived from dynamic 99mTc-pertechnetate salivary scintigraphy in the differentiation between a group of patients with Sjögren's syndrome (SS), a group of patients without xerostomia, but with underlying autoimmune disorders, and a group of controls. Seventeen patients with SS (group A), 18 patients with autoimmune disorders (group B) and 15 controls (group C) underwent dynamic salivary gland scintigraphy. Functional indices for the parotid and submandibular glands were calculated and comparisons were made between the groups. There were no significant differences between the three groups in terms of the maximum accumulation (MA), maximum secretion (MS) and pre-stimulatory oral index (PRI). The uptake ratios (URs) for both the right and left parotid glands and the left submandibular gland in group A were significantly lower than those in group C, but no different from those in group B. The URs for the parotid glands in group B were significantly less than those in group C. The percentage uptake by the right parotid gland at 4 min (U4) was significantly lower in group A than in groups B or C, and lower than the percentage uptake by the left parotid gland at 4 min in group A. The rest of the U4 values and all of the uptakes at 14 min (U14) were not significantly different between the three groups. The time taken for the right parotid gland to reach peak activity (Tmax) was significantly less in group A than in the other groups, but other glands showed no significant differences. It can be concluded that MA, MS and PRI cannot be used to differentiate between the three groups. The URs in groups A and B were no different, but were significantly lower than those in group C. However, the extensive overlap between xerostomic patients and normal controls for all the quantitative indices calculated imposes a severe limitation on their discriminatory power.
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Affiliation(s)
- B K Adams
- Department of Nuclear Medicine, Mafraq Hospital, Abu Dhabi, United Arab Emirates.
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Mariette X, Caudmont C, Berge E, Desmoulins F, Pinabel F. Dry eyes and mouth syndrome or sicca, asthenia and polyalgia syndrome? Rheumatology (Oxford) 2003; 42:914-5; author reply 913-4. [PMID: 12826718 DOI: 10.1093/rheumatology/keg226] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Field EA, Rostron JL, Longman LP, Bowman SJ, Lowe D, Rogers SN. The development and initial validation of the Liverpool sicca index to assess symptoms and dysfunction in patients with primary Sjögren's syndrome. J Oral Pathol Med 2003; 32:154-62. [PMID: 12581385 DOI: 10.1034/j.1600-0714.2003.t01-1-00109.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND A validated measure to assess sicca-related symptoms in patients with primary Sjögren's syndrome (1 degrees SS) is required for clinical studies. METHODS A self-administered questionnaire was developed to assess sicca-related symptoms and dysfunction in 1 degrees SS. This was administered to three groups of 40 respondents to measure construct validity: 1 degrees SS patients, non-SS patients reporting xerostomia and a non-patient group. The frequency of scores and the mean score for each question were calculated for each group. Reliability was assessed by test/retest. RESULTS The measure consisted of 28 items divided into five domains. Scores for questions in domains were generally worse (higher) for 1 degrees SS patients than for patients with xerostomia. The non-patient group reported the best (lowest) scores for all questions. The Kappa statistic for all but four questions was greater than 0.6, suggesting good reliability. CONCLUSION Questionnaire showed good construct validity and reliability. The Liverpool sicca index needs to be further validated in larger, multicentre studies.
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Affiliation(s)
- E Anne Field
- Sjögren's Syndrome Research Group, Department of Clinical Dental Sciences, University of Liverpool, UK.
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