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Hou L, Wang N, Zhao C, Wang X, Du Y. A single-center study of clinical features of pediatric Sjögren's syndrome. Pediatr Rheumatol Online J 2023; 21:119. [PMID: 37833819 PMCID: PMC10571342 DOI: 10.1186/s12969-023-00902-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 09/30/2023] [Indexed: 10/15/2023] Open
Abstract
OBJECTIVE Sjögren's syndrome (SS) is a rare disease with unclear diagnostic criteria among the children and adolescents. The purpose of this study is to describe the clinical features of pediatric Sjögren's syndrome and validate with Japanese diagnostic guidelines criteria of 2018. METHODS We conducted a retrospective analysis of the clinical data of a cohort of 54 patients with pediatric Sjögren's syndrome admitted to our hospital over a total of 10 years from September 2013 to September 2022. RESULTS The ratio of females to males was 49:5 among the 54 children (34 cases of primary SS and 20 cases of secondary SS), the average age of onset of symptoms for the first time was 9.9 years, and the average age at diagnosis was 10.2 years. In terms of subjective symptoms, 7 cases (13.0%) presented with dry mouth and 5 cases (9.3%) reported dry eyes. The positive rates were 9.3% for Schirmer I test, 70.4% for salivary gland function test, and 55.6% for salivary gland ultrasonography. The positive rates were 94.4% for Anti-Ro/SSA antibodies, 66.7% for Anti-La/SSB antibodies, 88.9% for ANA, 59.3% for RF, and the elevation rate of IgG was 63.0%. Among the EULAR Sjögren's syndrome disease activity index (ESSDAI) domains, the biological, constitutional, glandular, cutaneous, and lymphadenopathy domains were most involved. Treatment consisted of glucocorticoids in 88.9% of the patients in our study and hydroxychloroquine in 92.6%. As per the Japanese version of the clinical practice guidance for Sjögren's Syndrome in pediatric patients (2018), 5 cases were identified as Definite SS, 35 cases as Probable SS, and 14 cases as Possible SS. With respect to primary and secondary SS, there was essentially no significant difference between the groups in any of the above aspects. CONCLUSIONS Patients with pediatric SS presented with a wide spectrum of clinical features, a low prevalence of reported symptoms of dry mouth and dry eyes, and various clinical manifestations with multi-system involvement. These are similar to other pediatric study cohorts in terms of epidemiology, auxiliary investigation results, disease activity scores, and treatment. The coincidence between our study and the Japanese version of the clinical practice guidance for Sjögren's Syndrome in pediatric patients (2018) is good for the diagnosis of pediatric SS.
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Affiliation(s)
- Ling Hou
- Department of Pediatrics, Shengjing Hospital of China Medical University, No.36 of Sanhao Street, Heping District, Shenyang, 110004, China
| | - Ningning Wang
- Department of Pediatrics, Shengjing Hospital of China Medical University, No.36 of Sanhao Street, Heping District, Shenyang, 110004, China
| | - Chengguang Zhao
- Department of Pediatrics, Shengjing Hospital of China Medical University, No.36 of Sanhao Street, Heping District, Shenyang, 110004, China
| | - Xiuli Wang
- Department of Pediatrics, Shengjing Hospital of China Medical University, No.36 of Sanhao Street, Heping District, Shenyang, 110004, China
| | - Yue Du
- Department of Pediatrics, Shengjing Hospital of China Medical University, No.36 of Sanhao Street, Heping District, Shenyang, 110004, China.
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Abstract
Sjögren disease increasingly is recognized in pediatric patients. Clinical features, primarily parotitis and sicca symptoms, and results of diagnostic tests may be different from those in adult disease. Adult criteria fail to capture most pediatric patients. Pediatric-specific criteria are urgently needed to define the natural history of the disease, identify risk and prognostic factors, and evaluate the impact of therapeutics and other interventions on disease course in young patients.
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Affiliation(s)
- Rachel L Randell
- Department of Pediatrics, Duke University School of Medicine, 2301 Erwin Road Box #3212, Durham, NC 27705, USA.
| | - Scott M Lieberman
- Division of Rheumatology, Allergy, and Immunology, Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, 500 Newton Road, 2191 ML, Iowa City, IA 52242, USA
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3
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McDonald J, Vega-Fernandez P, Ting T. Findings and feasibility of major salivary gland ultrasound in childhood-onset systemic lupus erythematosus: a pilot study. Pediatr Rheumatol Online J 2021; 19:73. [PMID: 34001167 PMCID: PMC8130521 DOI: 10.1186/s12969-021-00561-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 05/05/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Childhood-onset systemic lupus erythematosus (cSLE) is a complex autoimmune disorder with multi-organ manifestations and can be associated with other rheumatic diseases including Sjögren's syndrome (SS). Salivary gland ultrasound (SGUS) represents a noninvasive tool to screen for salivary gland disease in rheumatic disease patients. The aims of this cross-sectional study were to determine feasibility of major SGUS in a clinic setting and to identify characteristics in a cohort of cSLE patients (without confirmed SS) that may be associated with salivary gland abnormalities consistent with secondary SS. METHODS Patients with SLE onset prior to age 18 were recruited. Patients completed questionnaires rating symptoms and underwent major SGUS examination. Disease and demographic differences were compared between cSLE patients with abnormal SGUS vs. cSLE patients with normal SGUS using t-tests and Fisher's exact tests. RESULTS Thirty-one cSLE patients were recruited, 84% were female, 55% were Caucasian. The average disease duration among all patients was 5 years. Average time to complete the SGUS examination and scoring protocol was 7 min. 35% of SGUS scores were abnormal and significantly associated with IgG level at diagnosis, and anti-Ro and anti-La antibodies. CONCLUSIONS This is one of the first studies to our knowledge that assesses major SGUS in a cohort of patients with cSLE without prior diagnoses of SS. The SGUS protocol was feasible to perform by rheumatologists in a clinic setting. Although the sample size was small, SGUS abnormalities were identified in one-third of patients. IgG level at diagnosis and anti-Ro and anti-La antibodies may be associated with SGUS abnormalities.
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Affiliation(s)
- Joseph McDonald
- Division of Pediatric Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | - Patricia Vega-Fernandez
- grid.239573.90000 0000 9025 8099Division of Pediatric Rheumatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA
| | - Tracy Ting
- grid.239573.90000 0000 9025 8099Division of Pediatric Rheumatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA
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Ramos-Casals M, Acar-Denizli N, Vissink A, Brito-Zerón P, Li X, Carubbi F, Priori R, Toplak N, Baldini C, Faugier-Fuentes E, Kruize AA, Mandl T, Tomiita M, Gandolfo S, Hashimoto K, Hernandez-Molina G, Hofauer B, Mendieta-Zerón S, Rasmussen A, Sandhya P, Sene D, Trevisani VFM, Isenberg D, Sundberg E, Pasoto SG, Sebastian A, Suzuki Y, Retamozo S, Xu B, Giacomelli R, Gattamelata A, Bizjak M, Bombardieri S, Loor-Chavez RE, Hinrichs A, Olsson P, Bootsma H, Lieberman SM. Childhood-onset of primary Sjögren's syndrome: phenotypic characterization at diagnosis of 158 children. Rheumatology (Oxford) 2021; 60:4558-4567. [PMID: 33493333 DOI: 10.1093/rheumatology/keab032] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/12/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES To characterize the phenotypic presentation at diagnosis of childhood-onset primary Sjögren syndrome (SjS). METHODS The Big Data Sjögren Project Consortium is an international, multicentre registry using worldwide data-sharing cooperative merging of pre-existing clinical SjS databases from the five continents. For this study, we selected those patients in whom the disease was diagnosed below the age of 19 according to the fulfilment of the 2002/2016 classification criteria. RESULTS Among the 12 083 patients included in the Sjögren Big Data Registry, 158 (1.3%) patients had a childhood-onset diagnosis (136 girls, mean age of 14.2 years): 126 (80%) reported dry mouth, 111 (70%) dry eyes, 52 (33%) parotid enlargement, 118/122 (97%) positive minor salivary gland biopsy and 60/64 (94%) abnormal salivary ultrasound study, 140/155 (90%) positive antinuclear antibody, 138/156 (89%) anti-Ro/La antibodies and 86/142 (68%) positive rheumatoid factor. The systemic ESSDAI domains containing the highest frequencies of active patients included the glandular (47%), articular (26%) and lymphadenopathy (25%) domains. Patients with childhood-onset primary SjS showed the highest mean ESSDAI score and the highest frequencies of systemic disease in 5 (constitutional, lymphadenopathy, glandular, cutaneous and haematological) of the 12 ESSDAI domains, and the lowest frequencies in 4 (articular, pulmonary, peripheral nerve and central nervous system) in comparison with patients with adult-onset disease. CONCLUSIONS Childhood-onset primary SjS involves around 1% of patients with primary SjS, with a clinical phenotype dominated by sicca features, parotid enlargement and systemic disease. Age at diagnosis plays a key role on modulating the phenotypic expression of the disease.
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Affiliation(s)
- Manuel Ramos-Casals
- Department of Autoimmune Diseases, ICMiD, Hospital Clínic, Barcelona, Spain.,Sjögren Syndrome Research Group (AGAUR), Laboratory of Autoimmune Diseases Josep Font, IDIBAPS-CELLEX, Barcelona, Spain.,Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Nihan Acar-Denizli
- Department of Statistics and Operations Research, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Arjan Vissink
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Pilar Brito-Zerón
- Sjögren Syndrome Research Group (AGAUR), Laboratory of Autoimmune Diseases Josep Font, IDIBAPS-CELLEX, Barcelona, Spain.,Autoimmune Diseases Unit, Department of Medicine, Hospital CIMA- Sanitas, Barcelona, Spain
| | - Xiaomei Li
- Department of Rheumatology and Immunology, Anhui Provincial Hospital, Hefei, China
| | - Francesco Carubbi
- Clinical Unit of Rheumatology, University of l'Aquila, School of Medicine, L'Aquila, Italy
| | - Roberta Priori
- Department of Internal Medicine and Medical Specialties, Rheumatology Clinic, Sapienza University of Rome, Rome, Italy
| | - Nataša Toplak
- University Children's Hospital Ljubljana, University Medical center Ljubljana, Medical faculty of Ljubljana, Slovenia
| | | | | | - Aike A Kruize
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Thomas Mandl
- Department of Rheumatology, Skane University Hospital Malmö, Lund University, Lund, Sweden
| | - Minako Tomiita
- Department of Pediatrics, National Hospital Organization, Shimoshizu National Hospital, Yotsukaido, Japan
| | - Saviana Gandolfo
- Clinic of Rheumatology, Department of Medical and Biological Sciences, University Hospital "Santa Maria della Misericordia", Udine, Italy
| | - Kunio Hashimoto
- Department of Pediatrics (Pediatric Allergy and Rheumatology), Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Gabriela Hernandez-Molina
- Immunology and Rheumatology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, Mexico
| | - Benedikt Hofauer
- Otorhinolaryngology, Head and Neck Surgery, Technical University Munich, Munich, Germany
| | | | - Astrid Rasmussen
- Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - Pulukool Sandhya
- Department of Clinical Immunology & Rheumatology, Christian Medical College & Hospital, Vellore, India
| | - Damien Sene
- Service de Médecine Interne 2, Hôpital Lariboisière, Université Paris VII, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - David Isenberg
- Centre for Rheumatology, Division of Medicine, University College London, London, UK
| | - Erik Sundberg
- Pediatric Rheumatology, Astrid Lindgreńs Children Hospital, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden
| | - Sandra G Pasoto
- Rheumatology Division, Hospital das Clinicas, Faculdade de Medicina da Universidade de Sao Paulo (HCFMUSP), Sao Paulo, Brazil
| | - Agata Sebastian
- Department of Rheumatology and Internal Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Yasunori Suzuki
- Division of Rheumatology, Kanazawa University Hospital, Kanazawa, Japan
| | - Soledad Retamozo
- Sjögren Syndrome Research Group (AGAUR), Laboratory of Autoimmune Diseases Josep Font, IDIBAPS-CELLEX, Barcelona, Spain.,Instituto De Investigaciones En Ciencias De La Salud (INICSA), Universidad Nacional de Córdoba (UNC), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Córdoba, Argentina.,Instituto Universitario de Ciencias Biomédicas de Córdoba (IUCBC), Córdoba, Argentina
| | - Bei Xu
- Department of Rheumatology and Immunology, Anhui Provincial Hospital, Hefei, China
| | - Roberto Giacomelli
- Clinical Unit of Rheumatology, University of l'Aquila, School of Medicine, L'Aquila, Italy
| | - Angelica Gattamelata
- Department of Internal Medicine and Medical Specialties, Rheumatology Clinic, Sapienza University of Rome, Rome, Italy
| | - Masa Bizjak
- University Children's Hospital Ljubljana, University Medical center Ljubljana, Medical faculty of Ljubljana, Slovenia
| | | | | | - Anneline Hinrichs
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Peter Olsson
- Department of Rheumatology, Skane University Hospital Malmö, Lund University, Lund, Sweden
| | - Hendrika Bootsma
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Scott M Lieberman
- Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
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Sjögren's syndrome in children with recurrent parotitis. Int J Pediatr Otorhinolaryngol 2020; 129:109768. [PMID: 31731017 DOI: 10.1016/j.ijporl.2019.109768] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 10/09/2019] [Accepted: 11/02/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Optimize the diagnosis of pediatric Sjögren's syndrome in children who present with parotitis. METHODS Twenty children presented to a pediatric otolaryngology or rheumatology clinic with recurrent parotitis. Presenting symptoms, serologies, sialendoscopy findings, and minor salivary gland biopsy pathology results were reviewed. RESULTS Twenty patients aged 3-17 years presented with recurrent parotitis. Ten percent of this cohort met the American-European Consensus Group adult diagnostic criteria for Sjögren's syndrome. Forty percent of this cohort met diagnosis of Sjögren's syndrome when utilizing Bartunkova's proposed pediatric criteria for diagnosis of Sjögren's syndrome. CONCLUSION Sjögren's syndrome is surprisingly common in pediatric patients who present with recurrent parotitis. Otolaryngologists who treat pediatric parotitis should have a high index of suspicion for Sjögren's syndrome. LEVEL OF EVIDENCE 4.
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6
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Kaleda MI, Nikishina IP, Latypova AN. [Sjögren's syndrome with juvenile onset]. TERAPEVT ARKH 2019; 91:54-60. [PMID: 32598677 DOI: 10.26442/00403660.2019.05.000189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Indexed: 02/03/2023]
Abstract
Aim to analyze demographic data, clinical features and results of laboratory and instrumental examinations in children with primary and secondary Sjögren syndrome (SS). MATERIALS AND METHODS The study included all consequently patients, who hospitalized to the pediatric department of V.A. Nasonova Scientific and Research Institute of Rheumatology from January 2013 to December 2018, which verified the diagnosis of the SS. RESULTS The diagnosis of SS was established in 30 patients, among whom there were only 5 (16.7%) boys, the ratio of boys and girls was 1:5. According to the results of the examination, the following diagnoses were verified: 4 - primary SS, 9 - systemic lupus erythematosus with SS, 10 - juvenile rheumatoid arthritis with SS, 3 - mixed connective tissue disease, 3 - overlap syndrome, 1 - systemic sclerosis with SS. The median age of rheumatic disease onset was 10.4 (7.0; 13.75) years. The median of disease duration at the time of SS verification - 3.0 (0.85; 4.4) years. Recurrent parotitis were observed in 8 patients. 24 pts had isolated involvement of salivary glands, 6 - combined with lacrimal glands. Sicca syndrome was occurred in 8 patients. All patients had systemic manifestations: constitutional abnormalities - 50%, polyarthritis - 83.3%, lymphadenopathy - 73.3%, cutaneous involvement - 60%, pulmonary involvement - 23.3%. Of the hematological disorders, leuko/lymphopenia was more often recorded - in 30%, polyclonal hypergammaglobulinemia - in 26.7% of patients. ANA were detected in all cases, anti-Ro antibodies - 60%, a positive rheumatoid factor - 56.7% of patients. The most common combination of immunological disorders was the presence of ANA, RF and anti-Ro antibodies (40% of patients). The treatment for each patient was justified by the main manifestations and activity of rheumatic disease: 66.7% received nonsteroidal anti - inflammatory drugs, 80% - glucocorticoids, 46.7% - methotrexate, 20% - azathioprine, 43.3% - hydroxychloroquine, 10% - mycophenolatis mofetilum, 3.4% - cyclophosphamide. 66.7% of patients received the treatment of Biologics. CONCLUSIONS Early diagnosis of SS in children with rheumatic diseases significantly affects to the choice of treatment and prognosis. In children the SS has no clinical manifestations for a long time. Such symptoms as a hypergammaglobulinemia, positive RF without persistant arthritis, nonspecific skin lesions, recurrent parotid swelling may help to diagnosis of SS.
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Affiliation(s)
- M I Kaleda
- V.A. Nasonova Scientific and Research Institute of Rheumatology, Pediatric Department
| | - I P Nikishina
- V.A. Nasonova Scientific and Research Institute of Rheumatology, Pediatric Department
| | - A N Latypova
- V.A. Nasonova Scientific and Research Institute of Rheumatology, Pediatric Department
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Hinze C, Wagner N, Tenbrock K. Kollagenosen im Kindes- und Jugendalter. Monatsschr Kinderheilkd 2018. [DOI: 10.1007/s00112-018-0498-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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8
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Extranodal marginal zone B cell lymphoma: An unexpected complication in children with Sjögren's syndrome. ACTA ACUST UNITED AC 2018; 14:227-229. [DOI: 10.1016/j.reuma.2017.01.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 12/21/2016] [Accepted: 01/26/2017] [Indexed: 12/15/2022]
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9
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Maciel G, Crowson CS, Matteson EL, Cornec D. Reply. Arthritis Care Res (Hoboken) 2018; 70:953-954. [DOI: 10.1002/acr.23222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Gabriel Maciel
- Mayo Clinic College of Medicine; Rochester Minnesota
- Hospital Maciel, Montevideo; Montevideo Uruguay
| | | | | | - Divi Cornec
- Mayo Clinic College of Medicine; Rochester Minnesota
- Brest Teaching Hospital; Brest France
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10
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Sumida T, Azuma N, Moriyama M, Takahashi H, Asashima H, Honda F, Abe S, Ono Y, Hirota T, Hirata S, Tanaka Y, Shimizu T, Nakamura H, Kawakami A, Sano H, Ogawa Y, Tsubota K, Ryo K, Saito I, Tanaka A, Nakamura S, Takamura E, Tanaka M, Suzuki K, Takeuchi T, Yamakawa N, Mimori T, Ohta A, Nishiyama S, Yoshihara T, Suzuki Y, Kawano M, Tomiita M, Tsuboi H. Clinical practice guideline for Sjögren's syndrome 2017. Mod Rheumatol 2018; 28:383-408. [PMID: 29409370 DOI: 10.1080/14397595.2018.1438093] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The objective of this study is to develop clinical practice guideline (CPG) for Sjögren's syndrome (SS) based on recently available clinical and therapeutic evidences. METHODS The CPG committee for SS was organized by the Research Team for Autoimmune Diseases, Research Program for Intractable Disease of the Ministry of Health, Labor and Welfare (MHLW), Japan. The committee completed a systematic review of evidences for several clinical questions and developed CPG for SS 2017 according to the procedure proposed by the Medical Information Network Distribution Service (Minds). The recommendations and their strength were checked by the modified Delphi method. The CPG for SS 2017 has been officially approved by both Japan College of Rheumatology and the Japanese Society for SS. RESULTS The CPG committee set 38 clinical questions for clinical symptoms, signs, treatment, and management of SS in pediatric, adult and pregnant patients, using the PICO (P: patients, problem, population, I: interventions, C: comparisons, controls, comparators, O: outcomes) format. A summary of evidence, development of recommendation, recommendation, and strength for these 38 clinical questions are presented in the CPG. CONCLUSION The CPG for SS 2017 should contribute to improvement and standardization of diagnosis and treatment of SS.
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Affiliation(s)
- Takayuki Sumida
- a Department of Internal Medicine , University of Tsukuba , Ibaraki , Japan.,b Clinical Practice Guideline Committee for Sjögren's Syndrome, The Research Team for Autoimmune Diseases, The Research Program for Intractable Disease of the Ministry of Health, Labor and Welfare (MHLW) , Tokyo , Japan
| | - Naoto Azuma
- b Clinical Practice Guideline Committee for Sjögren's Syndrome, The Research Team for Autoimmune Diseases, The Research Program for Intractable Disease of the Ministry of Health, Labor and Welfare (MHLW) , Tokyo , Japan.,c Division of Rheumatology, Department of Internal Medicine , Hyogo College of Medicine , Hyogo , Japan
| | - Masafumi Moriyama
- b Clinical Practice Guideline Committee for Sjögren's Syndrome, The Research Team for Autoimmune Diseases, The Research Program for Intractable Disease of the Ministry of Health, Labor and Welfare (MHLW) , Tokyo , Japan.,d Section of Oral and Maxillofacial Oncology, Division of Maxillofacial Diagnostic and Surgical Sciences , Kyushu University , Fukuoka , Japan
| | - Hiroyuki Takahashi
- a Department of Internal Medicine , University of Tsukuba , Ibaraki , Japan.,b Clinical Practice Guideline Committee for Sjögren's Syndrome, The Research Team for Autoimmune Diseases, The Research Program for Intractable Disease of the Ministry of Health, Labor and Welfare (MHLW) , Tokyo , Japan
| | - Hiromitsu Asashima
- a Department of Internal Medicine , University of Tsukuba , Ibaraki , Japan.,b Clinical Practice Guideline Committee for Sjögren's Syndrome, The Research Team for Autoimmune Diseases, The Research Program for Intractable Disease of the Ministry of Health, Labor and Welfare (MHLW) , Tokyo , Japan
| | - Fumika Honda
- a Department of Internal Medicine , University of Tsukuba , Ibaraki , Japan
| | - Saori Abe
- a Department of Internal Medicine , University of Tsukuba , Ibaraki , Japan
| | - Yuko Ono
- a Department of Internal Medicine , University of Tsukuba , Ibaraki , Japan.,d Section of Oral and Maxillofacial Oncology, Division of Maxillofacial Diagnostic and Surgical Sciences , Kyushu University , Fukuoka , Japan
| | - Tomoya Hirota
- a Department of Internal Medicine , University of Tsukuba , Ibaraki , Japan.,b Clinical Practice Guideline Committee for Sjögren's Syndrome, The Research Team for Autoimmune Diseases, The Research Program for Intractable Disease of the Ministry of Health, Labor and Welfare (MHLW) , Tokyo , Japan
| | - Shintaro Hirata
- b Clinical Practice Guideline Committee for Sjögren's Syndrome, The Research Team for Autoimmune Diseases, The Research Program for Intractable Disease of the Ministry of Health, Labor and Welfare (MHLW) , Tokyo , Japan.,e The First Department of Internal Medicine , School of Medicine, University of Occupational and Environmental Health, Japan , Fukuoka , Japan.,f Department of Clinical Immunology and Rheumatology , Hiroshima University Hospital , Hiroshima , Japan
| | - Yoshiya Tanaka
- b Clinical Practice Guideline Committee for Sjögren's Syndrome, The Research Team for Autoimmune Diseases, The Research Program for Intractable Disease of the Ministry of Health, Labor and Welfare (MHLW) , Tokyo , Japan.,e The First Department of Internal Medicine , School of Medicine, University of Occupational and Environmental Health, Japan , Fukuoka , Japan
| | - Toshimasa Shimizu
- b Clinical Practice Guideline Committee for Sjögren's Syndrome, The Research Team for Autoimmune Diseases, The Research Program for Intractable Disease of the Ministry of Health, Labor and Welfare (MHLW) , Tokyo , Japan.,g Unit of Translational Medicine, Department of Immunology and Rheumatology , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Hideki Nakamura
- b Clinical Practice Guideline Committee for Sjögren's Syndrome, The Research Team for Autoimmune Diseases, The Research Program for Intractable Disease of the Ministry of Health, Labor and Welfare (MHLW) , Tokyo , Japan.,g Unit of Translational Medicine, Department of Immunology and Rheumatology , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Atsushi Kawakami
- b Clinical Practice Guideline Committee for Sjögren's Syndrome, The Research Team for Autoimmune Diseases, The Research Program for Intractable Disease of the Ministry of Health, Labor and Welfare (MHLW) , Tokyo , Japan.,g Unit of Translational Medicine, Department of Immunology and Rheumatology , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Hajime Sano
- b Clinical Practice Guideline Committee for Sjögren's Syndrome, The Research Team for Autoimmune Diseases, The Research Program for Intractable Disease of the Ministry of Health, Labor and Welfare (MHLW) , Tokyo , Japan.,c Division of Rheumatology, Department of Internal Medicine , Hyogo College of Medicine , Hyogo , Japan
| | - Yoko Ogawa
- b Clinical Practice Guideline Committee for Sjögren's Syndrome, The Research Team for Autoimmune Diseases, The Research Program for Intractable Disease of the Ministry of Health, Labor and Welfare (MHLW) , Tokyo , Japan.,h Department of Ophthalmology , School of Medicine, Keio University , Tokyo , Japan
| | - Kazuo Tsubota
- b Clinical Practice Guideline Committee for Sjögren's Syndrome, The Research Team for Autoimmune Diseases, The Research Program for Intractable Disease of the Ministry of Health, Labor and Welfare (MHLW) , Tokyo , Japan.,h Department of Ophthalmology , School of Medicine, Keio University , Tokyo , Japan
| | - Koufuchi Ryo
- b Clinical Practice Guideline Committee for Sjögren's Syndrome, The Research Team for Autoimmune Diseases, The Research Program for Intractable Disease of the Ministry of Health, Labor and Welfare (MHLW) , Tokyo , Japan.,i Department of Pathology , Tsurumi University School of Dental Medicine , Kanagawa , Japan
| | - Ichiro Saito
- b Clinical Practice Guideline Committee for Sjögren's Syndrome, The Research Team for Autoimmune Diseases, The Research Program for Intractable Disease of the Ministry of Health, Labor and Welfare (MHLW) , Tokyo , Japan.,i Department of Pathology , Tsurumi University School of Dental Medicine , Kanagawa , Japan
| | - Akihiko Tanaka
- b Clinical Practice Guideline Committee for Sjögren's Syndrome, The Research Team for Autoimmune Diseases, The Research Program for Intractable Disease of the Ministry of Health, Labor and Welfare (MHLW) , Tokyo , Japan.,d Section of Oral and Maxillofacial Oncology, Division of Maxillofacial Diagnostic and Surgical Sciences , Kyushu University , Fukuoka , Japan
| | - Seiji Nakamura
- b Clinical Practice Guideline Committee for Sjögren's Syndrome, The Research Team for Autoimmune Diseases, The Research Program for Intractable Disease of the Ministry of Health, Labor and Welfare (MHLW) , Tokyo , Japan.,d Section of Oral and Maxillofacial Oncology, Division of Maxillofacial Diagnostic and Surgical Sciences , Kyushu University , Fukuoka , Japan
| | - Etsuko Takamura
- b Clinical Practice Guideline Committee for Sjögren's Syndrome, The Research Team for Autoimmune Diseases, The Research Program for Intractable Disease of the Ministry of Health, Labor and Welfare (MHLW) , Tokyo , Japan.,j Department of Ophthalmology , Tokyo Women's Medical University, School of Medicine , Tokyo , Japan
| | - Masao Tanaka
- b Clinical Practice Guideline Committee for Sjögren's Syndrome, The Research Team for Autoimmune Diseases, The Research Program for Intractable Disease of the Ministry of Health, Labor and Welfare (MHLW) , Tokyo , Japan.,k Department of Advanced Medicine for Rheumatic Diseases , Kyoto University Graduate School of Medicine , Kyoto , Japan
| | - Katsuya Suzuki
- b Clinical Practice Guideline Committee for Sjögren's Syndrome, The Research Team for Autoimmune Diseases, The Research Program for Intractable Disease of the Ministry of Health, Labor and Welfare (MHLW) , Tokyo , Japan.,l Division of Rheumatology, Department of Internal Medicine , School of Medicine, Keio University , Tokyo , Japan
| | - Tsutomu Takeuchi
- b Clinical Practice Guideline Committee for Sjögren's Syndrome, The Research Team for Autoimmune Diseases, The Research Program for Intractable Disease of the Ministry of Health, Labor and Welfare (MHLW) , Tokyo , Japan.,l Division of Rheumatology, Department of Internal Medicine , School of Medicine, Keio University , Tokyo , Japan
| | - Noriyuki Yamakawa
- b Clinical Practice Guideline Committee for Sjögren's Syndrome, The Research Team for Autoimmune Diseases, The Research Program for Intractable Disease of the Ministry of Health, Labor and Welfare (MHLW) , Tokyo , Japan.,m Department of Rheumatology and Clinical Immunology , Kyoto University Graduate School of Medicine , Kyoto , Japan.,n Department of Rheumatology , Kyoto-Katsura Hospital , Kyoto , Japan
| | - Tsuneyo Mimori
- b Clinical Practice Guideline Committee for Sjögren's Syndrome, The Research Team for Autoimmune Diseases, The Research Program for Intractable Disease of the Ministry of Health, Labor and Welfare (MHLW) , Tokyo , Japan.,m Department of Rheumatology and Clinical Immunology , Kyoto University Graduate School of Medicine , Kyoto , Japan
| | - Akiko Ohta
- b Clinical Practice Guideline Committee for Sjögren's Syndrome, The Research Team for Autoimmune Diseases, The Research Program for Intractable Disease of the Ministry of Health, Labor and Welfare (MHLW) , Tokyo , Japan.,o Division of Public Health, Department of Social Medicine , Saitama Medical University , Saitama , Japan
| | - Susumu Nishiyama
- b Clinical Practice Guideline Committee for Sjögren's Syndrome, The Research Team for Autoimmune Diseases, The Research Program for Intractable Disease of the Ministry of Health, Labor and Welfare (MHLW) , Tokyo , Japan.,p Kurashiki Medical Center , Okayama , Japan
| | - Toshio Yoshihara
- b Clinical Practice Guideline Committee for Sjögren's Syndrome, The Research Team for Autoimmune Diseases, The Research Program for Intractable Disease of the Ministry of Health, Labor and Welfare (MHLW) , Tokyo , Japan.,q Department of Otorhinolaryngology , Tokyo Women's Medical University , Tokyo , Japan
| | - Yasunori Suzuki
- b Clinical Practice Guideline Committee for Sjögren's Syndrome, The Research Team for Autoimmune Diseases, The Research Program for Intractable Disease of the Ministry of Health, Labor and Welfare (MHLW) , Tokyo , Japan.,r Division of Rheumatology, Department of Cardiovascular and Internal Medicine , Kanazawa University Graduate School of Medicine , Ishikawa , Japan
| | - Mitsuhiro Kawano
- b Clinical Practice Guideline Committee for Sjögren's Syndrome, The Research Team for Autoimmune Diseases, The Research Program for Intractable Disease of the Ministry of Health, Labor and Welfare (MHLW) , Tokyo , Japan.,r Division of Rheumatology, Department of Cardiovascular and Internal Medicine , Kanazawa University Graduate School of Medicine , Ishikawa , Japan
| | - Minako Tomiita
- b Clinical Practice Guideline Committee for Sjögren's Syndrome, The Research Team for Autoimmune Diseases, The Research Program for Intractable Disease of the Ministry of Health, Labor and Welfare (MHLW) , Tokyo , Japan.,s Department of Allergy and Rheumatology , Chiba Children's Hospital , Chiba , Japan
| | - Hiroto Tsuboi
- a Department of Internal Medicine , University of Tsukuba , Ibaraki , Japan.,b Clinical Practice Guideline Committee for Sjögren's Syndrome, The Research Team for Autoimmune Diseases, The Research Program for Intractable Disease of the Ministry of Health, Labor and Welfare (MHLW) , Tokyo , Japan
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Means C, Aldape MA, King E. Pediatric primary Sjögren syndrome presenting with bilateral ranulas: A case report and systematic review of the literature. Int J Pediatr Otorhinolaryngol 2017; 101:11-19. [PMID: 28964279 DOI: 10.1016/j.ijporl.2017.07.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Revised: 07/13/2017] [Accepted: 07/16/2017] [Indexed: 01/01/2023]
Abstract
CONTEXT Primary Sjögren syndrome is uncommon in children, and the standard clinical criteria used in diagnosis of adult Sjögren syndrome will miss many children with the disease. Floor of mouth ranulas have not been described in Sjögren syndrome. OBJECTIVE This study aims to describe a novel presentation of juvenile primary Sjögren syndrome, and to present a comprehensive systematic review of the literature regarding the presentation and diagnosis of Sjögren syndrome in children. DATA SOURCES Ovid MEDLINE. STUDY SELECTION A MEDLINE literature search was performed using the following search terms: primary, Sjögren, disease, and children. Results were limited to human subjects and articles written in English between 1981 and 2014. Applicable articles were reviewed and qualitatively summarized. DATA EXTRACTION Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRIMA). RESULTS Initial MEDLINE search yielded 146 articles, 80 of which were excluded as not clinically pertaining to Sjögren syndrome. An additional 25 were excluded due to lack of pediatric-specific data. Systematic review of the literature revealed no reports of ranula in association with Sjögren syndrome. 6 papers were manually included from review of reference lists of included articles. Our review indicated that recurrent parotitis is the most commonly reported presenting symptom in children, followed by ocular and oral symptoms, musculoskeletal, and renal symptoms. Compared to adults, children are less likely to present with dry eyes and mouth. LIMITATIONS All studies were retrospective chart reviews, case series or case reports. CONCLUSION This is the first report of a child presenting with floor of mouth ranulas in association with Sjögren syndrome. While recurrent parotitis is the most common presentation in children, other salivary gland and extra-salivary manifestations may be seen, and the clinician must maintain a high index of suspicion for underlying Sjögren syndrome.
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Affiliation(s)
- Casey Means
- Department of Otolaryngology/Head and Neck Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, PV01, Portland, OR 97239, United States.
| | - Mark A Aldape
- Department of Pathology, Kaiser Permanente Northwest, United States.
| | - Ericka King
- Department of Otolaryngology/Head and Neck Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, PV01, Portland, OR 97239, United States.
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Virdee S, Greenan-Barrett J, Ciurtin C. A systematic review of primary Sjögren's syndrome in male and paediatric populations. Clin Rheumatol 2017; 36:2225-2236. [PMID: 28735431 PMCID: PMC5596040 DOI: 10.1007/s10067-017-3745-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 06/26/2017] [Accepted: 06/28/2017] [Indexed: 11/28/2022]
Abstract
Primary Sjögren's syndrome (pSS) is a chronic multisystem autoimmune rheumatic disease characterised by female predominance. Although the disease is rare in the male and paediatric populations, it has been suggested that it may have a different disease phenotype, which has not been investigated before using a systematic approach. A systematic literature search of PubMed databases (updated to December 2016) was performed to identify all published data on the epidemiological, clinical and laboratory manifestations of pSS in the male and paediatric populations. The literature search of the male and paediatric pSS studies identified 2025 and 186 citations, respectively, out of which 7 and 5 fulfilled our inclusion criteria and were analysed further. The range of age at disease onset was 9.4-10.7 years for children and 39.4-56.9 years at diagnosis for male patients. We identified a prevalence of extra-glandular manifestations between 52.6-92.3% in the male population and 50.0-84.6% in children, while abnormal sialometry was only reported in the paediatric population, with a prevalence between 71.4 and 81.8%. There was a significant variation of positive serological markers, with anti-Ro antibodies reported between 15.7-75.0% and 36.4-84.6%, and anti-La antibodies between 5.6-51.7% and 27.3-65.4%, in the male and paediatric populations, respectively. The characteristics of pSS in the male and paediatric populations varied according to different studies. When compared to data available from pSS adult populations, children diagnosed with pSS reported less dryness and had a higher prevalence of parotitis, lymphadenopathy and systemic symptoms and male patients were younger at the time of diagnosis. This systematic review contributes to a better understanding of the epidemiology of pSS in rare populations. Large longitudinal cohort studies comparing male with female patients and adult with paediatric patients are needed.
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Affiliation(s)
- Simrun Virdee
- University College London Medical School, London, UK
| | | | - Coziana Ciurtin
- Department of Rheumatology, University College London, 250 Euston Road, London, NW1 2PG, UK.
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13
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A review of the role and clinical utility of anti-Ro52/TRIM21 in systemic autoimmunity. Rheumatol Int 2017; 37:1323-1333. [DOI: 10.1007/s00296-017-3718-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 04/06/2017] [Indexed: 01/23/2023]
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Abstract
INTRODUCTION Sjögren's syndrome (SS) is a chronic autoimmune disease that primarily affects the lacrimal and salivary exocrine glands. In children, it is a rare condition. OBJECTIVE To present the case of an adolescent with non-specific symptoms, but with a clinical suspicion of SS. CASE REPORT A male 12-year old patient, with history of arthralgias for 3 years and suspicion of xerophthalmia. Physical examination showed mild conjunctival congestion, dry mouth and hypermobility of the knees. Laboratory work: blood count and ESR were normal, antinuclear antibodies (+) > 60, Ro (+) > 60 U, and rheumatoid factor concentration (+) 160 IU / ml. SS was suspected, and a study was carried out: Schirmer test determined mild dry eye, salivary gland scintigraphy showed parotid and submandibular gland dysfunction, and salivary gland biopsy reported focal lymphocytic acinar and periductal infiltration. SS was confirmed and treated with prednisone 7.5mg/day and hydroxychloroquine 200mg/day, and local treatment, with good response. CONCLUSIONS The diagnostic criteria for SS in adults identified only 39% of pediatric patients, due to the low frequency of sicca symptoms. Still there are no validated diagnostic criteria for children. A good diagnosis will alleviate symptoms, prevent complications and detect associated diseases.
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Affiliation(s)
- R Mabel Ladino
- Reumatología Pediátrica, Hospital San Juan de Dios, Universidad de Chile, Chile..
| | | | - M Ximena Campos
- Residente de Pediatría, Hospital San Juan de Dios, Universidad de Chile, Chile
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Kumar KJ, Kudakesseril AS, Sheeladevi CS, Sowmya HV. Primary Sjogrens Syndrome in a Child. IRANIAN JOURNAL OF PEDIATRICS 2015. [PMID: 26195996 PMCID: PMC4506000 DOI: 10.5812/ijp.254] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- K. Jagadish Kumar
- Department of Pediatrics, JSS Medical College, JSS University, Mysore, India
- Corresponding Author: K. Jagadish Kumar, Department of Pediatrics, JSS medical College, JSS University, Mysore, Karnataka, India. E-mail:
| | | | - CS Sheeladevi
- Department of Pathology, JSS Medical College, JSS University, Mysore, India
| | - HV Sowmya
- Department of Ophthamology, JSS Medical College, JSS University, Mysore, India
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16
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Moy MM, Mandel L. Identifying Primary Sjögren Syndrome in Children: Case Report. J Oral Maxillofac Surg 2014; 72:2485-90. [DOI: 10.1016/j.joms.2014.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 07/01/2014] [Indexed: 11/16/2022]
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17
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Yokogawa N, Lieberman SM, Alawi F, Bout-Tabaku S, Guttenberg M, Sherry DD, Vivino FB. Comparison of Labial Minor Salivary Gland Biopsies from Childhood Sjögren Syndrome and Age-matched Controls. J Rheumatol 2014; 41:1178-82. [DOI: 10.3899/jrheum.131511] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective.To determine an appropriate focus score cutoff for childhood Sjögren syndrome (SS).Methods.Labial salivary gland tissue from specimens from children with SS and age-matched controls was retrospectively identified and reviewed by a blinded oral pathologist.Results.The presence of any focal sialadenitis (focus score > 0 foci/4 mm2) was common among childhood SS samples but present in only 1 of 8 control samples.Conclusion.The presence of any focal lymphocytic sialadenitis in minor labial salivary gland tissue is suggestive of childhood SS and should be included in future childhood SS-specific diagnostic or classification criteria.
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18
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Palejwala NV, Yeh S, Angeles-Han ST. Current perspectives on ophthalmic manifestations of childhood rheumatic diseases. Curr Rheumatol Rep 2013; 15:341. [PMID: 23686303 DOI: 10.1007/s11926-013-0341-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Inflammatory eye diseases are an important manifestation of many pediatric rheumatologic conditions. Early screening and diagnosis are imperative as these illnesses can not only result in significant visual morbidity but are also an indicator of systemic inflammation. Time to presentation of ocular inflammation varies significantly and can range from many years prior to the onset of systemic symptoms to well after the diagnosis of the rheumatologic disorder. Due to this variability in presentation, careful monitoring by an ophthalmologist is vital to preventing ocular complications and preserving vision. Both local and systemic immunosuppressive medications have been effective in the management of ocular disease. In this review, we will focus on the known ophthalmologic manifestations of common pediatric rheumatologic diseases and discuss recent advances in therapeutic considerations for these conditions.
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Affiliation(s)
- Neal V Palejwala
- Section of Vitreoretinal Surgery, Department of Ophthalmology, Emory University School of Medicine, 1365B Clifton Rd. NE, Atlanta, GA 30322, USA.
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Abstract
This article reviews current understanding of the clinical manifestations, diagnosis and treatment of Sjögren's syndrome. Sjögren's syndrome is a chronic inflammatory disorder of the exocrine glands with multiple nonexocrine features. It is found predominantly in middle-aged women but exists throughout the population. The diagnosis of Sjögren's syndrome can be challenging because the cardinal sicca symptoms may be subclinical or attributed to other causes, such as medications or aging. Differential diagnosis of Sjögren's syndrome can be confounded by the multiple exocrine manifestations in the mouth, eyes, ears, nose, skin, vagina, and respiratory and gastrointestinal tracts, as well as seemingly unrelated nonexocrine involvement in the thyroid, liver, kidneys and the musculoskeletal, vascular and nervous systems. This article concludes that early diagnosis of Sjögren's syndrome is crucial to prevent and/or minimize potentially life-threatening complications. Periodic follow-up of patients' status and collaboration between the primary-care physician and the rheumatologist, dentist, ophthalmologist and other specialists are indispensable.
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Affiliation(s)
- Ibtisam Al-Hashimi
- Baylor College of Dentistry, Salivary Dysfunction Clinic, Department of Periodontics, 3302 Gaston Avenue, Dallas, TX 75246, USA and University of Texas Southwestern Medical Centre, Faculty of Surgery, Division of Oral Surgery, Dallas, TX, USA.
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D'Souza JN, Geary C, Mukerji S. Neonatal parotid gland enlargement: Is it suppurative parotitis? A case report. AMERICAN JOURNAL OF CASE REPORTS 2012; 13:41-3. [PMID: 23569484 PMCID: PMC3616007 DOI: 10.12659/ajcr.882598] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2011] [Accepted: 11/03/2011] [Indexed: 11/25/2022]
Abstract
Background: Acute suppurative parotitis (ASP) is a rare finding in the neonate. It is commonly caused by S. aureus but other bacterial isolates may be emerging. Effective treatment includes prompt diagnosis, parenteral antibiotics and supportive measures such as rehydration and bimanual gland massage. Case Report: This case report describes an extremely premature female infant with a complicated post-natal course who presented with unilateral swelling of the parotid region. Diagnostic workup revealed purulent exudate from Stensen’s duct and ultrasound findings consistent with parotitis. Culture of the exudate showed growth of Staphylococcus aureus and Enterococcus species. The patient responded well to a ten-day antibiotic course and supportive measures. Conclusions: ASP, though rare, should be considered in the differential diagnosis of a neonatal parotid swelling since early and prompt diagnosis prevents morbidity and complications.
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Affiliation(s)
- Jill N D'Souza
- Department of Otolaryngology, University of Texas Medical Branch, Galveston, TX, U.S.A
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21
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Longhi BS, Appenzeller S, Centeville M, Gusmão RJ, Marini R. Primary Sjögren's syndrome in children: is a family approach indicated? Clinics (Sao Paulo) 2011; 66:1991-3. [PMID: 22086534 PMCID: PMC3203976 DOI: 10.1590/s1807-59322011001100023] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Barbara S Longhi
- Department of Pediatrics, Faculty of Medical Science State, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
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22
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Mina R, Brunner HI. Pediatric lupus--are there differences in presentation, genetics, response to therapy, and damage accrual compared with adult lupus? Rheum Dis Clin North Am 2010; 36:53-80, vii-viii. [PMID: 20202591 DOI: 10.1016/j.rdc.2009.12.012] [Citation(s) in RCA: 172] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Some complement deficiencies predispose to systemic lupus erythematosus (SLE) early in life. Currently, there are no known unique physiologic or genetic pathways that can explain the variability in disease phenotypes. Children present with more acute illness and have more frequent renal, hematologic, and central nervous system involvement compared to adults with SLE. Almost all children require corticosteroids during the course of their disease; many are treated with immunosuppressive drugs. Mortality rates remain higher with pediatric SLE. Children and adolescents accrue more damage, especially in the renal, ocular and musculoskeletal organ systems. Conversely, cardiovascular mortality is more prevalent in adults with SLE.
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Affiliation(s)
- Rina Mina
- Division of Rheumatology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MC 4010, Cincinnati, OH 45229, USA
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23
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TAKEI S. Sjoegren's syndrome (SS) in childhood: is it essentially different from adult SS? ACTA ACUST UNITED AC 2010; 33:8-14. [DOI: 10.2177/jsci.33.8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Syuji TAKEI
- School of Health Sciences, Faculty of Medicine, Kagoshima University
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24
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Reiff A. Ocular complications of childhood rheumatic diseases: nonuveitic inflammatory eye diseases. Curr Rheumatol Rep 2009; 11:226-32. [PMID: 19604468 DOI: 10.1007/s11926-009-0031-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Ocular involvement is common in pediatric rheumatologic diseases, supporting the concept that these conditions do not manifest in isolation but are components of a multisystem inflammatory process. It remains unclear why the eye and its adjacent tissues become a target during paninflammatory disease. Pediatric rheumatologists must recognize ocular disorders, as these conditions significantly concern the treatment team managing serious cases of inflammatory eye disease. Close collaboration between the treating rheumatologist and ophthalmologist is required to prevent potentially devastating outcomes. Therapeutic interventions, such as topical steroids, systemic immunosuppressants, and biologics, must balance the necessity of controlling ocular inflammation and treatment-related adverse effects. This article-the second in a series on ocular complications of childhood rheumatic diseases-reviews the presentation and management of the more common nonuveitic inflammatory ocular manifestations of childhood rheumatologic disease.
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Affiliation(s)
- Andreas Reiff
- Division of Rheumatology, Childrens Hospital Los Angeles, 4650 Sunset Boulevard, Mailstop 60, Los Angeles, CA 90027 USA.
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25
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26
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27
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Civilibal M, Canpolat N, Yurt A, Kurugoglu S, Erdamar S, Bagci O, Sever L, Kasapcopur O, Caliskan S, Arisoy N. A child with primary Sjögren syndrome and a review of the literature. Clin Pediatr (Phila) 2007; 46:738-42. [PMID: 17507575 DOI: 10.1177/0009922807301945] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Primary Sjögren syndrome (pSS) is an uncommon disease in childhood. Childhood pSS might have different clinical manifestations than adult pSS. We describe a 13-year-old girl with multiple episodes of bilateral parotid swelling lasting 2 years. Her history included severe arthralgia, local edema, and purpura episodes since 9 years of age. During her 3-week hospitalization, 2 episodes of parotid swelling occurred, which both resolved in 48 hours. Ultrasonography and magnetic resonance images of parotid glands showed parenchymal inhomogeneity related to adipose degeneration and nodular pattern. Investigations showed elevated erythrocyte sedimentation rate, the presence of hypergammaglobulinemia, positive antinuclear antibody, and elevated rheumatoid factor, anti-Sjögren syndrome antigen A, and anti-Sjögren syndrome antigen B. Histopathologic examination of labial minor salivary glands revealed focal periductal lymphocytic infiltrate and sialoduct ectasia. She was diagnosed as having pSS. Recurrent parotid swelling is a more characteristic feature of disease in children, and this finding should alert the clinician to the possible diagnosis of pSS.
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Affiliation(s)
- Mahmut Civilibal
- Department of Pediatric Nephrology, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey.
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28
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Sitheeque M, Sivachandran Y, Varathan V, Ariyawardana A, Ranasinghe A. Juvenile recurrent parotitis: clinical, sialographic and ultrasonographic features. Int J Paediatr Dent 2007; 17:98-104. [PMID: 17263859 DOI: 10.1111/j.1365-263x.2006.00804.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Juvenile recurrent parotitis (JRP) is a rare salivary gland disease of obscure aetiology that affects children. The aim of this study was to investigate the patterns of clinical presentation, and the sialographic and ultrasonographic features of JRP in Sri Lankan children. METHODS The authors analysed the hospital records of 26 subjects who had been diagnosed with JRP between January 2003 and April 2006. RESULTS The subjects consisted of 15 males and 11 females (male:female ratio=1.4:1). The age range of the sample was 2.5-16 years (mean=8.4 years). The age of onset was biphasic, with two major peaks at 6 years (n=6) and 10 years (n=5) (mean=6.73 years). Unilateral involvement was seen in 69.2% of patients. The commonest clinical features were swelling (100%), pain (80.8%) and fever (50.0%). The average frequency of recurrences of JRP in 18 patients was 7.1 times per year. The average duration of an individual episode, also in 18 patients, was 5.44 days. Sialography in 17 patients had revealed punctate sialectasis, whereas ultrasonography in 16 patients had demonstrated multiple hypoechoic areas and heterogeneous echoes CONCLUSIONS This study documents the clinical features of JRP in Sri Lankan children. It has established the usefulness of sialography and ultrasonography in the diagnosis of JRP.
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Affiliation(s)
- Mohaideen Sitheeque
- Division of Oral Medicine and Dental Radiology, Faculty of Dental Sciences, University Dental Hospital, Peradeniya, Sri Lanka.
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29
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Currarino G, Votteler TP. Lesions of the accessory parotid gland in children. Pediatr Radiol 2006; 36:1-7; quiz 84-5. [PMID: 16284760 DOI: 10.1007/s00247-005-0034-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2005] [Revised: 07/21/2005] [Accepted: 07/27/2005] [Indexed: 10/25/2022]
Abstract
The accessory parotid gland, a little-known and seldom-mentioned anatomical variant, is a nodule of normal salivary tissue separate from the main parotid gland, located on the masseter muscle and connected to the Stensen duct at that level. It can be the site of both congenital and acquired lesions.
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Affiliation(s)
- Guido Currarino
- Department of Radiology, Children's Medical Center, Dallas, TX, USA.
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30
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Parkin B, Chew JB, White VA, Garcia-Briones G, Chhanabhai M, Rootman J. Lymphocytic infiltration and enlargement of the lacrimal glands: a new subtype of primary Sjögren's syndrome? Ophthalmology 2005; 112:2040-7. [PMID: 16168486 DOI: 10.1016/j.ophtha.2005.06.014] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2005] [Accepted: 06/04/2005] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To review the clinical, radiologic, serologic, histopathologic, immunohistochemical, and molecular genetic features of patients having Sjögren's syndrome (SS) with lacrimal gland enlargement. DESIGN Retrospective case series review. PARTICIPANTS Fourteen patients histopathologically diagnosed with SS with lacrimal enlargement. Twenty-three age- and gender-matched controls were used for comparison on radiologic analysis. METHODS Clinical and serologic data were determined directly or by chart review. Computed tomography images from patients were compared with those from the control group. Histopathologic sections were reviewed and graded using the Chisholm-Mason scale, and quantitative immunohistochemical analysis was applied. MAIN OUTCOME MEASURES Clinically, patients were assessed for age, gender, onset, symptoms and signs, systemic features, treatment, and outcome. Existing histologic specimens were reviewed according to the Chisholm-Mason scale, and then the percentages of plasma cells containing immunoglobulin (Ig) A, IgG, and IgM were determined. Imaging was assessed for lacrimal gland thickness, prolapse, density, and margin contour; extraocular muscle size; orbital tissue displacement; and proptosis. RESULTS Clinical and histopathological data fulfilled the revised American-European criteria for primary SS in 79% of patients. Compared with other large series of primary SS patients, similarities were found with age, xerophthalmia, parotidomegaly, and articular involvement. Differences included a lower incidence of autoantibodies, xerostomia, and extraglandular features and a higher male-to-female ratio. In almost all patients (93%), the percentage of plasma cells positive for IgA was less than 70%, consistent with SS. Compared with controls, the lacrimal glands were enlarged significantly (P<0.0001) and prolapsed (P<0.001). Involved glands had blurred margins (P<0.007), caused displacement of adjacent tissues (P = 0.03), and were associated with hyperdense fat (P = 0.007). Lymphocytic infiltration of orbital fat was present in all patients for whom fat biopsy results were available. Three patients had monoclonal infiltrates, and 1 patient experienced subsequent extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue type, 4 years after presentation. CONCLUSIONS The criteria used to diagnose primary SS are controversial, but both diagnostic and quantitative immunohistochemical criteria suggest that these patients, with lacrimal gland enlargement resulting from lymphocytic infiltration, represent a new subtype of primary SS. This is clinically important in view of the increased risk of lymphoma associated with SS, compared with idiopathic nonspecific lacrimal inflammation.
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Affiliation(s)
- Ben Parkin
- Department of Ophthalmology and Visual Sciences, University of British Columbia and the Vancouver General Hospital, Vancouver, Canada
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Mignogna MD, Fedele S, Lo Russo L, Lo Muzio L, Wolff A. Sjögren's syndrome: the diagnostic potential of early oral manifestations preceding hyposalivation/xerostomia. J Oral Pathol Med 2005; 34:1-6. [PMID: 15610399 DOI: 10.1111/j.1600-0714.2004.00264.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Sjögren's syndrome (SS) is a systemic autoimmune exocrinopathy that affects mainly the salivary and lacrimal glands, leading to progressive reduction in saliva and tear flow. Although the underlying immuno-mediated glandular destruction is thought to develop slowly over several years, a long delay from the start of the symptoms to final diagnosis has been frequently reported. A limited knowledge concerning SS natural history is among the major causes of the actual diagnostic delay. Although very few studies have been focused on the analysis of SS early clinical onset, a series of oral features preceding xerostomia/hyposalivation development in patients eventually diagnosed as having SS have been reported. Sialochemistry alterations, salivary gland swelling, early dental loss and sialorrhea have been observed before the onset of typical signs and symptoms (namely xerostomia and/or hyposalivation), which usually lead to SS clinical presentation and diagnosis. Here we suggest, after evaluating available data, that the traditional 'untouchable' association between SS and xerostomia/hyposalivation might probably be reconsidered, and that astute clinicians should not underestimate the possible presence or development of SS in patients without xerostomia/hyposalivation and presenting these atypical early oral features.
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Affiliation(s)
- M D Mignogna
- Department of Odontostomatological and Maxillofacial Sciences, Section of Oral Medicine, University of Naples Federico II, Naples, Italy.
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Somers MJ, Daouk GH, McCluskey RT. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 11-2004. A boy with rash, edema, and hypertension. N Engl J Med 2004; 350:1550-9. [PMID: 15071130 DOI: 10.1056/nejmcpc030041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Michael J Somers
- Division of Nephrology, Department of Medicine, Children's Hospital, Boston, USA
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Nikitakis NG, Rivera H, Lariccia C, Papadimitriou JC, Sauk JJ. Primary Sjögren syndrome in childhood: report of a case and review of the literature. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2003; 96:42-7. [PMID: 12847443 DOI: 10.1016/s1079-2104(03)00159-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Sjögren syndrome (SS) in childhood is a rare and possibly underdiagnosed condition. The purpose of this study is to report a case of primary SS (PSS) in a 4-year-old Venezuelan girl and to review the pertinent literature. The patient presented with bilateral recurrent parotid enlargement, predominantly on the right side. She did not complain of dry mouth or eyes; however, decreased stimulated salivary flow rate and positive Schirmer and rose bengal tests were obtained. Sialography, sonograms, and a computed tomography scan of the parotid glands revealed pathologic changes consistent with SS. Anti-SS-A and anti-SS-B antibodies were present. Evaluation for antibodies against cytomegalovirus, Epstein-Barr virus, and HIV rendered negative results. Histopathologic examination of incisional biopsies of the right parotid and labial minor salivary glands revealed focal periductal lymphocytic infiltrate and sialoduct ectasia. Taken together, these findings are consistent with the diagnosis of juvenile PSS. The salient features of this rare disease are summarized on the basis of a comprehensive review of the epidemiologic, clinical, and serologic findings of the previously reported cases of PSS in children.
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Affiliation(s)
- Nikolaos G Nikitakis
- Department of Diagnostic Sciences and Pathology, University of Maryland, Baltimore 21201-1586, USA.
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Abstract
BACKGROUND Sjögren's syndrome, or SS, is a multisystem inflammatory disorder of the exocrine glands with a wide range of extraglandular involvement. Symptoms of dry eyes and xerostomia, although not invariably present, are characteristic features of SS. An increased risk of oral and dental diseases is a prominent consequence of SS. TYPES OF STUDIES REVIEWED The author reviewed recent medical and dental studies that have advanced our understanding of the causes and treatment of SS. She particularly focused on studies addressing the diagnosis and treatment of the oral component of the disease. RESULTS Sjögren's syndrome is a widely underdiagnosed disease. A delay in the diagnosis of SS may have a significant physical, psychological and economic impact on the affected person. The pathogenesis of SS appears to involve a number of factors: immunological, genetic, hormonal and possibly infectious. Successful management of SS requires a multidisciplinary approach, and the dentist plays an essential role in the diagnosis and treatment of the disease. ORAL IMPLICATIONS: Impairment of salivary function in SS increases the risk of developing oral diseases. Effective management of oral health comprises enhancement of salivary output (cholinergic agonist drugs such as pilocarpine or cevimeline) and prevention and treatment of dental caries, oral candidiasis and allergic mucositis. Finally, periodic evaluation of various clinical and laboratory parameters is needed to monitor disease status.
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Affiliation(s)
- I al-Hashimi
- Salivary Dysfunction Clinic, Baylor College of Dentistry, Department of Periodontology, 3302 Gastom Ave., Dallas, Texas 75246, USA.
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Pedersen AM, Nauntofte B. Primary Sjögren's syndrome: oral aspects on pathogenesis, diagnostic criteria, clinical features and approaches for therapy. Expert Opin Pharmacother 2001; 2:1415-36. [PMID: 11585021 DOI: 10.1517/14656566.2.9.1415] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Primary Sjögren's syndrome (pSS) is a chronic inflammatory systemic autoimmune disease affecting the exocrine glands and predominantly the salivary and lacrimal glands. The impaired gland function is assumed to be a result of progressive lymphocyte-mediated destruction of the exocrine gland tissue leading to the cardinal manifestations, hyposalivation and keratoconjunctivitis sicca (KCS), as well as devastating symptoms of oral and ocular dryness. Although primarily characterised as an exocrine dysfunction, non-exocrine organs may also be affected. The onset and course of pSS is usually insidious but may develop into a disabling disease, which profoundly affects the patient's general well being and quality of life. Moreover, pSS may even evolve into a lymphoid malignancy. The aetiology of pSS remains unknown but the pathogenesis of exocrine cell damage is apparently multi-factorial, including immunological, genetic, hormonal and viral components. Recent research also includes neurogenic aspects of exocrine gland dysfunction, including the interference of immune mediators with glandular response to neurotransmitters released from nerve fibres. pSS usually affects middle-aged women and the female:male ratio is 9:1. The prevalence varies from 0.29-4.8%, depending on the population sampled and the diagnostic criteria used. At present, there are no specific diagnostic tests for pSS and no universally accepted diagnostic criteria. The current therapy is primarily symptomatic. This review focuses on the current oral clinical, diagnostic, pathogenic and therapeutic aspects of pSS.
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Affiliation(s)
- A M Pedersen
- Department of Oral Physiology, Pathology and Medicine, School of Dentistry, University of Copenhagen, Denmark.
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