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Marino A, Romano M, Giani T, Gaggiano C, Costi S, Singh R, Mehta JJ, Lieberman SM, Cimaz R. Childhood Sjogren's syndrome: An Italian case series and a literature review-based cohort. Semin Arthritis Rheum 2020; 51:903-910. [PMID: 33261821 DOI: 10.1016/j.semarthrit.2020.11.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/19/2020] [Accepted: 11/20/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Sjogren's syndrome (SS) is a chronic autoimmune disease with a highly variable presentation. This study aims to describe childhood SS (cSS) features to help guide clinicians in their consideration of and workup for cSS. METHODS We retrospectively reviewed medical records of patients with cSS referred to three Italian pediatric rheumatology centers from 2015 to 2019 and we conducted a literature review of cSS. Statistical analysis was performed to detect associations between clinical/laboratory features. RESULTS We reviewed 12 cases (9 female) followed in 3 Italian centers and 240 cases (191 female) in the published literature reporting individual information. The median age at disease onset was 10 years for both cohorts. The most frequently reported clinical SS-specific feature was parotitis in both cohorts (67% each). Extraglandular manifestations were very common and joint involvement was the most frequent. In the cluster analysis, we identified a significant association between parotitis and younger patients (< 11 years). We verified the presence of the main SS features (exocrine gland inflammation, exocrine gland dysfunction, and presence of autoantibodies) in the Italian cohort and the literature review-based cohort: 92% and 80% of the cohorts, respectively, had at least 2/3 main characteristics. CONCLUSION We described cSS features with relative frequencies and we found that parotid involvement was related to cSS in younger patients. The majority of patients showed various combinations of exocrine gland inflammation, exocrine gland dysfunction, and presence of autoantibodies giving a theoretical basis for future research to pave the way for the development of cSS specific diagnostic criteria.
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Affiliation(s)
- Achille Marino
- Department of Pediatrics, Desio Hospital, ASST Monza. Via Mazzini 1, 20832 Desio (MB), Italy; ASST G.Pini-CTO, Via Gaetano Pini 9, 20122 Milan, Italy.
| | - Micol Romano
- ASST G.Pini-CTO, Via Gaetano Pini 9, 20122 Milan, Italy
| | - Teresa Giani
- Pediatric Rheumatology, Meyer Children's Hospital, Viale Gaetano Pieraccini, 24, 50139 Florence, Italy; Department of Medical Biotechnology, University of Siena, viale Mario Bracci, 16, Siena, Italy
| | - Carla Gaggiano
- Department of Pediatrics, University of Siena, viale Mario Bracci, 16, Siena, Italy
| | | | - Revika Singh
- Northwestern University, 633 Clark St, Evanston, IL 60208, USA
| | - Jay J Mehta
- Division of Rheumatology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA 19104-4399, USA
| | - Scott M Lieberman
- Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - Rolando Cimaz
- ASST G.Pini-CTO, Via Gaetano Pini 9, 20122 Milan, Italy; Department of Clinical Sciences and Community Health, and Research Center for Adult and Pediatric Rheumatic Diseases, University of Milan, Via della Commenda 19, 20122 Milan, Italy
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Hamidi S, Prose NS, Selim MA. Neutrophilic figurate erythema of infancy: A diagnostic challenge. J Cutan Pathol 2018; 46:216-220. [DOI: 10.1111/cup.13394] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 11/03/2018] [Accepted: 11/11/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Sepehr Hamidi
- Department of PathologyDuke University Durham North Carolina
| | - Neil S. Prose
- Department of DermatologyDuke University Durham North Carolina
| | - Maria A. Selim
- Department of PathologyDuke University Durham North Carolina
- Department of DermatologyDuke University Durham North Carolina
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Fox RI. Extraglandular Manifestations of Sjögren’s Syndrome (SS): Dermatologic, Arthritic, Endocrine, Pulmonary, Cardiovascular, Gastroenterology, Renal, Urology, and Gynecologic Manifestations. SJÖGREN’S SYNDROME 2011. [PMCID: PMC7124115 DOI: 10.1007/978-1-60327-957-4_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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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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Abstract
Sjogren's Syndrome (SS) is a systemic autoimmune disease characterized by dry eyes (keratoconjunctivis sicca) and dry mouth (xerostomia). To fulfill diagnostic criteria, patients must have objective signs of dryness on examination and laboratory confirmation of an autoimmune process as evidenced by a positive autoantibody to SS-A antigen or a characteristic lip biopsy. SS may exist as a primary condition or in association with other systemic autoimmune disorders (termed secondary SS) such as rheumatoid arthritis, systemic lupus erythematous (SLE), progressive systemic sclerosis (scleroderma), or dermatomyositis. Exclusions to the diagnosis include pre-existing lymphoma, hepatitis C or HIV infection. Pathogenesis involves both genetic (especially HLA-DR) and environmental factors. Both T-cells and B-cells are involved in the generation of cytokines and chemokines within the glands. The epithelial cells of the glands also play a role in pathogenesis. The dermatologic manifestations range from drynessness (sicca) and its complications to vasculitis. There is a significant overlap in the clinical manifestations, as well as treatment, of SS and SLE. However, SS patients require special attention to the complications of ocular dryness (keratocojunctivitis sicca and blepharitis) and oral dryness (rapid tooth loss and oral candidiasis) SS patients have a markedly increased risk of lymphoma and enlarged lymph nodes or persistently enlarged parotid/submandibular glands that require further evaluation.
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Affiliation(s)
- Robert I Fox
- Rheumatology Clinic Scripps Memorial Hospital and Research Foundation, La Jolla, CA 92037, USA.
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Hirohata M, Yasukawa Y, Ishida C, Komai K, Yamada M. Reversible cortical lesions in primary Sjögren's syndrome presenting with meningoencephalitis as an initial manifestation. J Neurol Sci 2005; 232:111-3. [PMID: 15850591 DOI: 10.1016/j.jns.2005.01.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2004] [Accepted: 01/20/2005] [Indexed: 10/25/2022]
Abstract
We report a 50-year-old woman with primary Sjögren's syndrome (SjS) who initially showed forgetfulness, and later developed disturbance of consciousness. In addition to aseptic meningoencephalitis revealed by cerebrospinal fluid examination and magnetic resonance imaging (MRI), the presence of serum anti-SS-A and anti-SS-B antibodies and inflammatory findings in lip biopsy indicated primary SjS. Fluid attenuated inversion recovery (FLAIR) of MRI revealed well defined small, high signal intensity areas in the cortex involving the subcortical white matter. Corticosteroid therapy resulted in rapid and nearly complete resolution of the cortical lesions with marked improvement of the clinical manifestations. Memory disturbance is a rare initial manifestation in meningoencephalitis associated with SjS. Our patient with SjS showed inflammatory cortical lesions on MRI, which were reversed by corticosteroid therapy.
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Affiliation(s)
- Mie Hirohata
- Department of Neurology and Neurobiology of Aging, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8641, Japan
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Miyagawa S, Tanaka M, Okamoto S, Ishihara T, Nakajima M, Taira K, Yoshioka A, Asada H. Autoimmune thyroid disease in anti-Ro/SS-A-positive children with annular erythema: report of two cases. Br J Dermatol 2004; 150:1005-8. [PMID: 15149517 DOI: 10.1111/j.1365-2133.2004.05926.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Anti-Ro/SS-A-associated recurrent annular erythema is a rare disorder, and represents a cutaneous manifestation of primary Sjögren's syndrome (SS). We report two childhood cases complicated with autoimmune thyroid disease, one with Graves' disease and the other with autoimmune thyroiditis. Both children were positive for anti-Ro/SS-A and anti-La/SS-B antibodies. One patient was lacking clinical SS with objective evidence of salivary gland involvement, while the other was diagnosed with primary SS. Our observation suggests that autoimmune thyroid disease in the subset of anti-Ro/SS-A-positive children with annular erythema might occur with similar frequency to that in adult primary SS.
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Affiliation(s)
- S Miyagawa
- Department of Dermatology, Nara Medical University, Kashihara City, Nara 634-8522, Japan. sachikom@naramedu-ac-jp
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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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Miyagawa S, Nakajima M, Nishio K, Sogami J, Tsubakimoto A, Yoshioka A, Shirai T. Guillain–Barré syndrome in a child with systemic lupus erythematosus and anti‐Ro/SSA and anti‐La/SSB autoantibodies. Br J Dermatol 2000. [DOI: 10.1046/j.1365-2133.2000.03942.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
| | - M. Nakajima
- Paediatrics and Emergency Medicine, Nara Medical University, Kashihara City, Nara 634, Japan
| | | | | | | | - A. Yoshioka
- Paediatrics and Emergency Medicine, Nara Medical University, Kashihara City, Nara 634, Japan
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Miyagawa S, Nakajima M, Nishio K, Sogami J, Tsubakimoto A, Yoshioka A, Shirai T. Guillain-Barré syndrome in a child with systemic lupus erythematosus and anti-Ro/SSA and anti-La/SSB autoantibodies. Br J Dermatol 2000; 143:1050-4. [PMID: 11069519 DOI: 10.1046/j.1365-2133.2000.03842.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We report a 9-year follow-up of a girl with systemic lupus erythematosus (SLE) and probable Sjögren's syndrome. At the age of 7 years, the patient developed a chilblain-like eruption with features of SLE, including leucopenia, oral ulcers, positive rheumatoid and antinuclear antibodies and positive anti-dsDNA, anti-Ro/SSA and anti-La/SSB antibodies. At the age of 13 years she developed Guillain-Barré syndrome, which completely resolved with aggressive treatment, including high-dose corticosteroids and the use of plasma exchange followed by intravenous gammaglobulin.
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Affiliation(s)
- S Miyagawa
- Departments of Dermatology, Paediatrics and Emergency Medicine, Nara Medical University, Kashihara City, Nara 634, Japan
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Affiliation(s)
- R I Fox
- Allergy and Rheumatology Clinic, Scripps Memorial Hospital and Research Foundation, La Jolla, California 92037, USA
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Miyagawa S, Shinohara K, Nakajima M, Kidoguchi K, Fujita T, Fukumoto T, Yoshioka A, Dohi K, Shirai T. Polymorphisms of HLA class II genes and autoimmune responses to Ro/SS-A-La/SS-B among Japanese subjects. ARTHRITIS AND RHEUMATISM 1998; 41:927-34. [PMID: 9588746 DOI: 10.1002/1529-0131(199805)41:5<927::aid-art21>3.0.co;2-r] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To investigate HLA class II allele associations with autoantibody responses to Ro/SS-A and La/SS-B among Japanese subjects. METHODS Haplotype and allele distributions, along with molecular polymorphisms, of HLA class II genes were analyzed by polymerase chain reaction-restriction fragment length polymorphism in 41 Japanese women with precipitating autoantibodies to Ro/SS-A and/or La/SS-B. RESULTS Among women with both Ro/SS-A and La/SS-B antibodies, the HLA class II haplotype DRB1*08032/DQA1*0103/DQB1*0601 and DRB1*08032 allele showed significantly increased frequencies compared with patients with anti-Ro/SS-A alone or with normal controls. All women with both anti-Ro/SS-A and anti-La/SS-B, but not those with anti-Ro/SS-A alone, carried DRB1 alleles that shared the same amino acid residues at positions 14-31 and 71 of the hypervariable regions of the DRB1 chain. All anti-Ro/SS-A positive women carried 1 or 2 alleles of DQB1*06 and DQB1*03 subtypes that shared the same amino acid residues at positions 71-77 of the DQB1 chain. HLA class II allele distributions did not differ among 3 anti-Ro/SS-A positive groups with different disease expressions, i.e., patients with systemic lupus erythematosus, patients with primary Sjögren's syndrome, and women with no apparent symptoms of rheumatic disease. CONCLUSION HLA class II allele distributions differ among anti-Ro/SS-A positive subjects according to the presence or absence of coexisting anti-La/SS-B antibodies, but not according to disease expression. Our findings suggest that different HLA class II molecules might control the development of anti-Ro/SS-A and/or anti-La/SS-B antibodies in the autoimmune response to the Ro/SS-A-La/SS-B complex.
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Affiliation(s)
- S Miyagawa
- Nara Medical University, Kashihara City, Japan
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Abstract
We describe a transient figurate erythema in an 11-month-old female infant with a 2-month history of arcuate and annular erythematous lesions localized on the face, trunk, and limbs. Constitutional symptoms were absent. Previous medical history was unremarkable. Full blood examination, erythrocyte sedimentation rate, antistreptolysin-O titer, anti-Ro, and anti-La antibodies were within normal limits or negative. Histologic examination revealed a superficial and deep perivascular and interstitial dermatitis constituted mostly of neutrophils and abundant nuclear dust. The lesions resolved spontaneously within a few months without scarring or atrophy. Recurrence has not occurred. This case suggests that figurate erythemas in infants rarely may disclose a neutrophilic histologic pattern, which must be differentiated from that of other neutrophilic dermatoses.
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Affiliation(s)
- G Annessi
- Laboratory of Dermatopathology, Istituto Dermopatico dell' Immacolata, IRCCS, Rome, Italy
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Miyagawa S, Fukumoto T, Hachiya T, Shirai T. Anti-Ro/SSA associated recurrent annular erythema: autoimmune response to recombinant 60- and 52-kDa Ro/SSA proteins. J Dermatol Sci 1996; 12:127-31. [PMID: 8814544 DOI: 10.1016/0923-1811(95)00471-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Recurrent annular erythema associated with anti-Ro/SSA antibody response has recently been recognized as a distinct clinical entity. Serum samples from 15 anti-Ro/SSA positive patients with recurrent annular erythema were tested by enzyme-linked immunosorbent assay (ELISA) for reactivity with full-length recombinant human 60-kDa and 52-kDa Ro/SSA proteins. All the 15 sera were positive for anti-60-kDa Ro/SSA, and 11 sera (73.3%) contained anti-52-kDa Ro/SSA. These results suggest the importance of 60-kDa polypeptide component of the Ro/SSA particle as a potential target in anti-Ro/SSA associated annular erythema.
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Affiliation(s)
- S Miyagawa
- Department of Dermatology, Nara Medical University, Japan
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