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Felix Gomez GG, Hugenberg ST, Zunt S, Patel JS, Wang M, Rajapuri AS, Lembcke LR, Rajendran D, Smith JC, Cheriyan B, Boyd LJ, Eckert GJ, Grannis SJ, Srinivasan M, Zero DT, Thyvalikakath TP. Characterizing clinical findings of Sjögren's Disease patients in community practices using matched electronic dental-health record data. PLoS One 2023; 18:e0289335. [PMID: 37523369 PMCID: PMC10389720 DOI: 10.1371/journal.pone.0289335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 07/17/2023] [Indexed: 08/02/2023] Open
Abstract
Established classifications exist to confirm Sjögren's Disease (SD) (previously referred as Sjögren's Syndrome) and recruit patients for research. However, no established classification exists for diagnosis in clinical settings causing delayed diagnosis. SD patients experience a huge dental disease burden impairing their quality of life. This study established criteria to characterize Indiana University School of Dentistry (IUSD) patients' SD based on symptoms and signs in the electronic health record (EHR) data available through the state-wide Indiana health information exchange (IHIE). Association between SD diagnosis, and comorbidities including other autoimmune conditions, and documentation of SD diagnosis in electronic dental record (EDR) were also determined. The IUSD patients' EDR were linked with their EHR data in the IHIE and queried for SD diagnostic ICD9/10 codes. The resulting cohorts' EHR clinical findings were characterized and classified using diagnostic criteria based on clinical experts' recommendations. Descriptive statistics were performed, and Chi-square tests determined the association between the different SD presentations and comorbidities including other autoimmune conditions. Eighty-three percent of IUSD patients had an EHR of which 377 patients had a SD diagnosis. They were characterized as positive (24%), uncertain (20%) and negative (56%) based on EHR clinical findings. Dry eyes and mouth were reported for 51% and positive Anti-Ro/SSA antibodies and anti-nuclear antibody (ANA) for 17% of this study cohort. One comorbidity was present in 98% and other autoimmune condition/s were present in 53% respectively. Significant differences were observed between the three SD clinical characteristics/classifications and certain medical and autoimmune conditions (p<0.05). Sixty-nine percent of patients' EDR did not mention SD, highlighting the huge gap in reporting SD during dental care. This study of SD patients diagnosed in community practices characterized three different SD clinical presentations, which can be used to generate SD study cohorts for longitudinal studies using EHR data. The results emphasize the heterogenous SD clinical presentations and the need for further research to diagnose SD early in community practice settings where most people seek care.
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Affiliation(s)
- Grace Gomez Felix Gomez
- Dental Informatics, Department of Cariology, Operative Dentistry & Dental Public Health, Indiana University School of Dentistry, Indianapolis, Indiana, United States of America
- Center for Biomedical Informatics, Regenstrief Institute Inc., Indianapolis, Indiana, United States of America
| | - Steven T. Hugenberg
- Indiana University School of Medicine, Indianapolis, Indiana, United States of America
- Indiana University Health, Indianapolis, Indiana, United States of America
| | - Susan Zunt
- Department of Oral Pathology, Medicine and Radiology, Indiana University School of Dentistry, Indianapolis, Indiana, United States of America
| | - Jay S. Patel
- Dental Informatics, Department of Cariology, Operative Dentistry & Dental Public Health, Indiana University School of Dentistry, Indianapolis, Indiana, United States of America
- Department of Health Services Administration and Policy, College of Public Health, Temple University, Philadelphia, Pennsylvania, United States of America
| | - Mei Wang
- Dental Informatics, Department of Cariology, Operative Dentistry & Dental Public Health, Indiana University School of Dentistry, Indianapolis, Indiana, United States of America
| | - Anushri Singh Rajapuri
- Dental Informatics, Department of Cariology, Operative Dentistry & Dental Public Health, Indiana University School of Dentistry, Indianapolis, Indiana, United States of America
- Center for Biomedical Informatics, Regenstrief Institute Inc., Indianapolis, Indiana, United States of America
| | - Lauren R. Lembcke
- Regenstrief Data Services, Regenstrief Institute Inc, Indianapolis, Indiana, United States of America
| | - Divya Rajendran
- Dental Informatics, Department of Cariology, Operative Dentistry & Dental Public Health, Indiana University School of Dentistry, Indianapolis, Indiana, United States of America
- Innovation Associates iA, Indianapolis, Indiana, United States of America
| | - Jonas C. Smith
- Regenstrief Data Services, Regenstrief Institute Inc, Indianapolis, Indiana, United States of America
- Med Shield, Inc., Indianapolis, Indiana, United States of America
| | - Biju Cheriyan
- Dental Informatics, Department of Cariology, Operative Dentistry & Dental Public Health, Indiana University School of Dentistry, Indianapolis, Indiana, United States of America
| | - LaKeisha J. Boyd
- Department of Biostatistics and Health Data Sciences, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - George J. Eckert
- Department of Biostatistics and Health Data Sciences, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Shaun J. Grannis
- Center for Biomedical Informatics, Regenstrief Institute Inc., Indianapolis, Indiana, United States of America
- Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Mythily Srinivasan
- Department of Oral Pathology, Medicine and Radiology, Indiana University School of Dentistry, Indianapolis, Indiana, United States of America
| | - Domenick T. Zero
- Dental Informatics, Department of Cariology, Operative Dentistry & Dental Public Health, Indiana University School of Dentistry, Indianapolis, Indiana, United States of America
| | - Thankam P. Thyvalikakath
- Dental Informatics, Department of Cariology, Operative Dentistry & Dental Public Health, Indiana University School of Dentistry, Indianapolis, Indiana, United States of America
- Center for Biomedical Informatics, Regenstrief Institute Inc., Indianapolis, Indiana, United States of America
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Urbanski G, Chabrun F, Delattre E, Lacout C, Davidson B, Blanchet O, Chao de la Barca JM, Simard G, Lavigne C, Reynier P. An immuno-lipidomic signature revealed by metabolomic and machine-learning approaches in labial salivary gland to diagnose primary Sjögren's syndrome. Front Immunol 2023; 14:1205616. [PMID: 37520535 PMCID: PMC10375713 DOI: 10.3389/fimmu.2023.1205616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/28/2023] [Indexed: 08/01/2023] Open
Abstract
Introduction Assessing labial salivary gland exocrinopathy is a cornerstone in primary Sjögren's syndrome. Currently this relies on the histopathologic diagnosis of focal lymphocytic sialadenitis and computing a focus score by counting lym=phocyte foci. However, those lesions represent advanced stages of primary Sjögren's syndrome, although earlier recognition of primary Sjögren's syndrome and its effective treatment could prevent irreversible damage to labial salivary gland. This study aimed at finding early biomarkers of primary Sjögren's syndrome in labial salivary gland combining metabolomics and machine-learning approaches. Methods We used a standardized targeted metabolomic approach involving high performance liquid chromatography coupled with mass spectrometry among newly diagnosed primary Sjögren's syndrome (n=40) and non- primary Sjögren's syndrome sicca (n=40) participants in a prospective cohort. A metabolic signature predictive of primary Sjögren's syndrome status was explored using linear (logistic regression with elastic-net regularization) and non-linear (random forests) machine learning architectures, after splitting the data set into training, validation, and test sets. Results Among 126 metabolites accurately measured, we identified a discriminant signature composed of six metabolites with robust performances (ROC-AUC = 0.86) for predicting primary Sjögren's syndrome status. This signature included the well-known immune-metabolite kynurenine and five phospholipids (LysoPC C28:0; PCaa C26:0; PCaaC30:2; PCae C30:1, and PCaeC30:2). It was split into two main components: the first including the phospholipids was related to the intensity of lymphocytic infiltrates in salivary glands, while the second represented by kynurenine was independently associated with the presence of anti-SSA antibodies in participant serum. Conclusion Our results reveal an immuno-lipidomic signature in labial salivary gland that accurately distinguishes early primary Sjögren's syndrome from other causes of sicca symptoms.
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Affiliation(s)
- Geoffrey Urbanski
- Department of Internal Medicine and Clinical Immunology, University Hospital, Angers, France
- Mitolab, MitoVasc Institute, CNRS 6015, INSERM U1083, University of Angers, Angers, France
- Department of Orofacial Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Floris Chabrun
- Mitolab, MitoVasc Institute, CNRS 6015, INSERM U1083, University of Angers, Angers, France
- Department of Biochemistry and Molecular Biology, University Hospital, Angers, France
| | - Estelle Delattre
- Department of Internal Medicine and Clinical Immunology, University Hospital, Angers, France
| | - Carole Lacout
- Department of Internal Medicine and Clinical Immunology, University Hospital, Angers, France
| | - Brittany Davidson
- Department of Orofacial Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Odile Blanchet
- Centre de Ressources Biologiques, University Hospital, Angers, France
| | - Juan Manuel Chao de la Barca
- Mitolab, MitoVasc Institute, CNRS 6015, INSERM U1083, University of Angers, Angers, France
- Department of Biochemistry and Molecular Biology, University Hospital, Angers, France
| | - Gilles Simard
- Mitolab, MitoVasc Institute, CNRS 6015, INSERM U1083, University of Angers, Angers, France
- Department of Biochemistry and Molecular Biology, University Hospital, Angers, France
| | - Christian Lavigne
- Department of Internal Medicine and Clinical Immunology, University Hospital, Angers, France
| | - Pascal Reynier
- Mitolab, MitoVasc Institute, CNRS 6015, INSERM U1083, University of Angers, Angers, France
- Department of Biochemistry and Molecular Biology, University Hospital, Angers, France
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Tang G, Luo Y, Mo Y, Yao J, Yang H, Hao S. Diagnostic value of ultrasound evaluation of major salivary glands for Sjögren's syndrome based on the novel OMERACT scoring system. Eur J Radiol 2023; 162:110765. [PMID: 36893528 DOI: 10.1016/j.ejrad.2023.110765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 02/26/2023] [Accepted: 02/28/2023] [Indexed: 03/07/2023]
Abstract
OBJECTIVE The novel Outcome Measures in Rheumatology Clinical Trials (OMERACT) scoring system was used to evaluate the diagnostic effectiveness of major salivary gland ultrasonography (SGUS) for Sjögren's syndrome (SS). MATERIALS AND METHODS SGUS was performed on the parotid glands (PGs) and submandibular glands of 242 patients (145 patients with SS and 97 patients without SS) using the OMERACT scoring system (grade 0-3). We also evaluated the association of SGUS scores with unstimulated whole salivary flow rate (UWSF), stimulated whole salivary flow rate (SWSF), and labial salivary gland biopsy (LSGB) results. RESULTS The SGUS scores were significantly higher for the SS group than for the non-SS group (p < 0.001). Using a cutoff value of 8 for the total score yielded the highest sensitivity (76%), specificity (90%), and area under the receiver operating characteristic curve (AUC, 0.828). The correlation between SGUS scores and salivary gland function was moderate to good. A cutoff value of 10 for the total score was more effective in predicting SWSF outcomes than UWSF outcomes (sensitivity: 73% > 58%, specificity: 98% > 87%, and AUC: 0.856 > 0.723). The association of OMERACT scores with LSGB results was fair to moderate. Among 61 anti-SSA-negative patients, 17 had positive PG scores (including ten SS and seven non-SS patients), and 44 had negative PG scores (including 37 non-SS and seven SS patients). CONCLUSION The OMERACT scoring system had good sensitivity and excellent specificity, demonstrating excellent diagnostic potential for SS and efficacy in assessing salivary gland function. Negative SGUS results may help reduce unnecessary biopsies in anti-SSA-negative patients.
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Affiliation(s)
- Guoxue Tang
- Department of Ultrasound, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, PR China
| | - Yi Luo
- Department of Ultrasound, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, PR China
| | - Yingqian Mo
- Department of Rheumatology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, PR China
| | - Jiyi Yao
- Department of Ultrasound, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, PR China
| | - Haiyun Yang
- Department of Ultrasound, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, PR China
| | - Shaoyun Hao
- Department of Ultrasound, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, PR China.
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Wiriyakijja P, Niklander S, Santos-Silva AR, Shorrer MK, Simms ML, Villa A, Sankar V, Kerr AR, Riordain RN, Jensen SB, Delli K. World Workshop on Oral Medicine VIII: Development of a Core Outcome Set for Dry Mouth: A Systematic Review of Outcome Domains for Xerostomia. Oral Surg Oral Med Oral Pathol Oral Radiol 2023:S2212-4403(23)00068-8. [PMID: 37198047 DOI: 10.1016/j.oooo.2023.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/11/2022] [Accepted: 01/25/2023] [Indexed: 03/08/2023]
Abstract
OBJECTIVE The purpose of this study was to identify all outcome domains used in clinical studies of xerostomia, that is, subjective sensation of dry mouth. This study is part of the extended project "World Workshop on Oral Medicine Outcomes Initiative for the Direction of Research" to develop a core outcome set for dry mouth. STUDY DESIGN A systematic review was performed on MEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials databases. All clinical and observational studies that assessed xerostomia in human participants from 2001 to 2021 were included. Information on outcome domains was extracted and mapped to the Core Outcome Measures in Effectiveness Trials taxonomy. Corresponding outcome measures were summarized. RESULTS From a total of 34,922 records retrieved, 688 articles involving 122,151 persons with xerostomia were included. There were 16 unique outcome domains and 166 outcome measures extracted. None of these domains or measures were consistently used across all the studies. The severity of xerostomia and physical functioning were the 2 most frequently assessed domains. CONCLUSION There is considerable heterogeneity in outcome domains and measures reported in clinical studies of xerostomia. This highlights the need for harmonization of dry mouth assessment to enhance comparability across studies and facilitate the synthesis of robust evidence for managing patients with xerostomia.
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Metabolic Profile of Whole Unstimulated Saliva in Patients with Sjögren’s Syndrome. Metabolites 2023; 13:metabo13030348. [PMID: 36984788 PMCID: PMC10054882 DOI: 10.3390/metabo13030348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 02/22/2023] [Accepted: 02/24/2023] [Indexed: 03/03/2023] Open
Abstract
(1) Background: Primary Sjögren’s Syndrome (pSS) is a multi-system autoimmune disease that involves the exocrine glands. Lymphocytes infiltrate the gland tissue, leading to anatomical modification and hypofunction. Even if the prognosis of pSS is favorable, quality of life is typically reduced due to the diverse manifestations of the disease. The aim of this study is to compare the salivary metabolomes of pSS with healthy controls (HCs). (2) Methods: Seven cases were selected from a cohort of pSS patients, and six age- and sex-matched HCs were recruited from a cohort of volunteers. Whole unstimulated saliva was collected for NMR analysis. Our metabolomic analysis focused on 360 ms total echo 1D 1H NMR CPMG spectra. Metabolites detected with CPMG NMR spectra were assigned through 2D NMR spectra (COSY, TOCSY, and HSQC). (3) Results: About 50 metabolites were detected and assigned. Unsupervised exploratory PCA returned partial clustering, and PLS-DA improved the separation between pSS and HCs, highlighting a pool of metabolites distinctly describing each group. (4) Conclusions: Despite the limited number of samples, the presented preliminary data are promising. PLS-DA indicated well-defined group separation, suggesting that the application of 1H-NMR metabolomics is suitable for the study of pSS.
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Lee KA, Kim SH, Kim HR, Kim HS. Impact of age on the diagnostic performance of unstimulated salivary flow rates and salivary gland ultrasound for primary Sjögren's syndrome. Front Med (Lausanne) 2022; 9:968697. [DOI: 10.3389/fmed.2022.968697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 10/04/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundAge-related changes and different patterns of salivary gland abnormalities according to age may affect the diagnostic performance of unstimulated salivary flow rate (USFR) and salivary gland ultrasound (SGUS) for primary Sjögren's syndrome (pSS). We aimed to evaluate the threshold and diagnostic performance of USFR and whether incorporating SGUS or replacing USFR with SGUS affects the performance of the ACR/EULAR criteria for pSS according to age.Materials and methodsThis medical chart review study included patients with suspected pSS who completed evaluations for pSS. Patients were classified based on age at pSS evaluation: elderly (≥65 years), middle-aged (40–64), and young (< 40). The USFR's optimal thresholds were evaluated using the ROC curve. The diagnostic performances of the USFR and modified ACR/EULAR criteria were compared.ResultsIn total, 239 pSS patients and 92 patients with idiopathic sicca syndrome were included. The cut-off of USFR ≤ 0.1 mL/min was irrelevant to age, demonstrating the best sensitivity (44.3–53.0%) and specificity (74.1–90.9%). SGUS had a significantly better AUC than USFR in the young (p < 0.01) and middle-aged groups (p < 0.01). The middle-aged group demonstrated better diagnostic performance of the ACR/EULAR criteria incorporating SGUS (AUC 0.957) (p < 0.01) and criteria replacing USFR with SGUS (AUC 0.957) (p < 0.001) compared to the original criteria (AUC 0.916). In the young and elderly groups, adding SGUS to the ACR/EULAR criteria or replacing USFR with SGUS did not significantly increase the AUC.ConclusionsThe thresholds of USFR ≤ 0.1 mL/min was optimal, irrespective of age. Using SGUS can improve diagnostic accuracy of ACR/EULAR criteria by supplementing the USFR, especially in middle-aged patients.
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Ibáñez-Mancera NG, Toral-Rizo VH, Lara-Carrillo E, López-Callejas R. Non-thermal atmospheric plasma generated with helium gas as a promoter of wound healing by salivary gland biopsy in Sjögren's syndrome. Presentation two cases. REUMATOLOGIA CLINICA 2022; 18:439-440. [PMID: 35940677 DOI: 10.1016/j.reumae.2021.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Norma Guadalupe Ibáñez-Mancera
- Clínica Orocentro, Facultad de Odontología, UAEMex, Toluca de Lerdo, Mexico; CICS-UST del Instituto Politécnico Nacional, Mexico City, Mexico.
| | | | | | - Régulo López-Callejas
- Plasma Physics Laboratory, Instituto Nacional de Investigaciones Nucleares, Ocoyoacac, Mexico
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Jung JY, Kim JW, Kim HA, Suh CH. Salivary Biomarkers in Patients with Sjögren's Syndrome-A Systematic Review. Int J Mol Sci 2021; 22:12903. [PMID: 34884709 PMCID: PMC8657642 DOI: 10.3390/ijms222312903] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 11/24/2021] [Accepted: 11/26/2021] [Indexed: 12/18/2022] Open
Abstract
Sjögren's syndrome (SS) is a chronic autoimmune disease characterized by dry mouth and dry eyes, with lymphocytic infiltration of the exocrine glands. Saliva is becoming a useful tool to determine the clinical and pathological characteristics of SS because the collection method is easy and non-invasive. Since 1900, salivary proteomic analysis has been performed continuously using a variety of optimized analytical methods. Many studies have identified distinct characteristics of salivary proteins in patients with primary SS, and the changes were related to chronic inflammation and overproduction of immunoglobulins or downregulated secretory function. Several proteomic studies using whole or parotid saliva have evaluated whether several salivary proteins can be used to discriminate SS, including salivary β2-microglobulin, calprotectin, carbonic anhydrase VI, neutrophil gelatinase-associated lipocalin, sialic acid-binding immunoglobulin-like lectin-5, and tripartite motif-containing protein 29. In addition, salivary proinflammatory cytokine levels have been reported to be increased in patients with SS. Although these candidate salivary proteins have exhibited considerable differences in patients with SS, more data are needed to confirm their role as biomarkers. Moreover, the identification of salivary characteristics that can accurately reflect disease activity, predict treatment response and prognosis, and diagnose SS is anticipated.
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Affiliation(s)
| | | | | | - Chang-Hee Suh
- Department of Rheumatology, Ajou University School of Medicine, Suwon 16499, Korea; (J.-Y.J.); (J.-W.K.); (H.-A.K.)
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Alvariño C, Bagan L, Murillo-Cortes J, Calvo J, Bagan J. Stimulated whole salivary flow rate: The most appropriate technique for assessing salivary flow in Sjögren syndrome. Med Oral Patol Oral Cir Bucal 2021; 26:e404-e407. [PMID: 33772564 PMCID: PMC8141317 DOI: 10.4317/medoral.24736] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 03/14/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND We sought to determine the most appropriate method for measuring salivary flow to aid the diagnosis of Sjögren's syndrome (SS). Specifically, we compared the unstimulated whole salivary flow rate (UWSFR) with the stimulated whole salivary flow rate (SWSFR). MATERIAL AND METHODS This case-control study comprised one group of 103 patients with SS and a control group of 50 healthy people. We measured the UWSFR and SWSFR in both groups according to the guidelines established by Navacet [1993]. RESULTS The UWSFR and SWSFR were significantly lower in the patient group compared with the controls (p < 0.01). Among the participants in the patient group, we found a decreased UWSFR in 84 individuals (81.5%) and a decreased SWSFR in 90 individuals (87.4%). We encountered difficulties obtaining saliva in 37 (35.9%) patients during the UWSFR test, and in 12 (11.7%) patients during the SWSFR test. There was no significant statistical difference in the UWSFR or SWSFR between patients with primary and secondary SS. CONCLUSIONS Compared with the UWSFR, the SWSFR is a more suitable and effective method for measuring salivary flow in patients with SS, as well as for qualitative analysis of the obtained saliva.
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Affiliation(s)
- C Alvariño
- Prof. Jose Vte. Bagan Service of Stomatology and Maxillofacial Surgery University General Hospital Avda Tres Cruces 2, 46014, Valencia, Spain
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Sebastian A, Woytala P, Madej M, Proc K, Czesak-Woytala K, Sebastian M, Zub K, Wiland P. Is it possible to not perform salivary gland biopsy in targeted patients according to unstimulated salivary flow results in patients with suspected Sjögren's syndrome? Rheumatol Int 2021; 41:1125-1131. [PMID: 33844038 PMCID: PMC8079304 DOI: 10.1007/s00296-021-04840-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 03/08/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION/OBJECTIVE Xerostomia is one of the main symptoms of primary Sjögren's syndrome (pSS). The unstimulated salivary flow (UWS) test is one of the objective Sjögren's syndrome classification criteria used to assess xerostomia's severity. The study's objective was to evaluate UWS rate measurements (with a threshold rate of 0.1 mL/min) in the screening of patients suspected with pSS, presenting with xerostomia in whom labial salivary gland biopsy (LSGB) should be performed. We will try to answer whether it is possible not to perform LSGB in targeted patients according to UWS results? We analyze the correlation between UWS value and focus score (FS) and anti-SSA antibodies. METHODS The study group consisted of subjects above 18 years of age with a subjective feeling of oral dryness. RESULTS A total of 105 subjects were qualified for the study. The final diagnosis of pSS was made in 44 patients according to the classification criteria from 2016. No age differences were identified between pSS patients and control group subjects (patients with dry mouth without autoimmune background). UWS rates were significantly lower in pSS patients than in the control group. No association was identified between UWS and focus score (FS) ≥ 1 in LSGB. No differences were observed between anti-SSA-positive and anti-SSA-negative patients in terms of age, UWS rates, FS. CONCLUSION LSGB should be performed in all suspected pSS cases regardless of the UWS rate value, particularly in subjects without specific anti-SSA antibodies. In patients with suspected pSS, only less than one-half of the UWS measurements are below the value of 0.1 mL/min adopted as the threshold in the classification criteria for pSS.
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Affiliation(s)
- Agata Sebastian
- Department of Rheumatology and Internal Medicine, Medical University of Wroclaw, Borowska 213, 50-556, Wroclaw, Poland.
| | - Patryk Woytala
- Department of Rheumatology and Internal Medicine, Medical University of Wroclaw, Borowska 213, 50-556, Wroclaw, Poland
| | - Marta Madej
- Department of Rheumatology and Internal Medicine, Medical University of Wroclaw, Borowska 213, 50-556, Wroclaw, Poland
| | - Krzysztof Proc
- Department of Rheumatology and Internal Medicine, Medical University of Wroclaw, Borowska 213, 50-556, Wroclaw, Poland
| | | | - Maciej Sebastian
- Department of General, Minimally Invasive and Endocrine Surgery, Medical University of Wroclaw, Wroclaw, Poland
| | - Krzysztof Zub
- Department and Clinic of Otolaryngology-Head and Neck Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Piotr Wiland
- Department of Rheumatology and Internal Medicine, Medical University of Wroclaw, Borowska 213, 50-556, Wroclaw, Poland
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Ibáñez-Mancera NG, Toral-Rizo VH, Lara-Carrillo E, López-Callejas R. Non-Thermal Atmospheric Plasma Generated with Helium Gas as a Promoter of Wound Healing by Salivary Gland Biopsy in Sjögren's Syndrome. Presentation Two Cases. REUMATOLOGIA CLINICA 2021; 18:S1699-258X(21)00033-4. [PMID: 33637443 DOI: 10.1016/j.reuma.2021.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/15/2021] [Accepted: 01/21/2021] [Indexed: 06/12/2023]
Affiliation(s)
- Norma Guadalupe Ibáñez-Mancera
- Clínica Orocentro, Facultad de Odontología, UAEMex, Toluca de Lerdo, México; CICS-UST del Instituto Politécnico Nacional, Ciudad de México, México.
| | | | | | - Régulo López-Callejas
- Plasma Physics Laboratory, Instituto Nacional de Investigaciones Nucleares, Ocoyoacac, México
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Lung CB, Watson GE, Verma S, Feng C, Saunders RH. Duration of effect of Biotène spray in patients with symptomatic dry mouth: A pilot study. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 131:415-421. [PMID: 33602603 DOI: 10.1016/j.oooo.2020.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 11/16/2020] [Accepted: 12/10/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The objective of this study was to assess the duration of effect of a single dose of Biotène Moisturizing Spray on xerostomia compared to water spray. STUDY DESIGN This double-blind randomized controlled crossover trial compared the duration of effect of 2 agents on relieving xerostomia in adult patients recruited through convenience sampling. Following a xerostomia questionnaire, qualifying patients with an unstimulated whole saliva flow rate of ≤0.20 mL/min rated their baseline level of discomfort from oral dryness and received a single dose (3 sprays) of Biotène Moisturizing Spray or water (active control). Patients indicated their level of oral discomfort every 15 min and the precise time when relief ceased. After a minimum 48-h washout, patients repeated the exercise with the alternative product. RESULTS The baseline severity of discomfort from oral dryness among qualifying patients was significantly related to their level of hyposalivation (P = .001). The mean duration of effect of Biotène Moisturizing Spray was 27 ± 25 min, which was not significantly different from that for water (26 ± 25 min; P = .88; n = 25). CONCLUSION Biotène Moisturizing Spray and water spray had variable durations of effect averaging approximately 30 min. The results of this pilot study provide guidance regarding anticipated usage and dispensing needs for patients with objective xerostomia. ClinicalTrials.gov NCT03663231.
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Affiliation(s)
- Christine Bambi Lung
- Dental Resident and Study Sub-PI, Department of General Dentistry, Department of Pediatric Dentistry, University of Rochester-Eastman Institute for Oral Health, Rochester, NY, USA.
| | - Gene E Watson
- Professor, Department of Dentistry, Center for Oral Biology, Department of Pharmacology and Physiology, Department of Environmental Medicine, University of Rochester-Eastman Institute for Oral Health, Rochester, NY, USA
| | - Swati Verma
- Dental Resident, Department of General Dentistry, University of Rochester-Eastman Institute for Oral Health, Rochester, NY, USA
| | - Changyong Feng
- Statistician, Department of Biostatistics and Computational Biology, University of Rochester-Eastman Institute for Oral Health, Rochester, NY, USA
| | - Ralph H Saunders
- Professor, Faculty, and Study PI, Department of General Dentistry, Eastman Institute for Oral Health, Rochester, NY, USA
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