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Qiao L, Chen J, Leng XM, Zhang W, Han B, Zhao Y, Zeng XF. Agranulocytosis and mixed-type autoimmune hemolytic anemia in primary sjögren's syndrome: a case report and review of the literature. Int J Rheum Dis 2015; 19:1351-1353. [PMID: 28371438 DOI: 10.1111/1756-185x.12803] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Lin Qiao
- Department of Internal Medicine; Peking Union Medical College Hospital; Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing China
| | - Jing Chen
- Department of Internal Medicine; Peking Union Medical College Hospital; Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing China
| | - Xiao-mei Leng
- Department of Rheumatology; Peking Union Medical College Hospital; Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing China
| | - Wen Zhang
- Department of Rheumatology; Peking Union Medical College Hospital; Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing China
| | - Bing Han
- Department of Hematology; Peking Union Medical College Hospital; Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing China
| | - Yan Zhao
- Department of Rheumatology; Peking Union Medical College Hospital; Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing China
| | - Xiao-feng Zeng
- Department of Rheumatology; Peking Union Medical College Hospital; Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing China
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Wen W, Liu Y, Zhao C, Sun X, Zhang C, Li Z. Clinical and serologic features of primary Sjögren’s syndrome concomitant with autoimmune hemolytic anemia: a large-scale cross-sectional study. Clin Rheumatol 2015; 34:1877-84. [DOI: 10.1007/s10067-015-3081-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 07/05/2015] [Accepted: 09/19/2015] [Indexed: 02/03/2023]
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Kuo CF, Grainge MJ, Valdes AM, See LC, Luo SF, Yu KH, Zhang W, Doherty M. Familial Risk of Sjögren's Syndrome and Co-aggregation of Autoimmune Diseases in Affected Families: A Nationwide Population Study. Arthritis Rheumatol 2015; 67:1904-12. [PMID: 25940005 PMCID: PMC5034806 DOI: 10.1002/art.39127] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 03/19/2015] [Indexed: 01/02/2023]
Abstract
Objective To investigate familial aggregation of Sjögren's syndrome (SS) and the relative risks (RRs) of other autoimmune disease in relatives of patients with SS. Methods We identified 23,658,577 beneficiaries enrolled in the Taiwan National Health Insurance system in 2010, of whom 12,754 had SS. We identified 21,009,551 parent–child relationships and 17,168,340 pairs of full siblings. The familial risks of SS and other autoimmune diseases, tetrachoric correlation, and familial transmission were estimated. Results We identified 105 patients with SS who had an affected first‐degree relative. The RR of SS was 18.99 (95% confidence interval [95% CI] 9.76–36.93) in siblings of patients with SS, 11.31 (95% CI 8.34–15.33) in offspring, and 12.46 (95% CI 9.34–16.62) in parents. Tetrachoric correlation coefficients were 0.53 (95% CI 0.41–0.65) for cotwins of affected individuals and 0.21 (95% CI 0.16–0.26) for full siblings. The familial transmission (heritability plus shared environmental contribution) was 0.54 (95% CI 0.44–0.77). In first‐degree relatives of patients with SS, the RRs were 2.95 (95% CI 2.33–3.73) for rheumatoid arthritis, 6.25 (95% CI 5.15–7.58) for systemic lupus erythematosus, 2.39 (95% CI 0.77–7.41) for systemic sclerosis, 0.71 (95% CI 0.10–5.07) for idiopathic inflammatory myopathy, 1.97 (95% CI 1.29–3.02) for type 1 diabetes mellitus, 3.38 (95% CI 1.26–9.05) for multiple sclerosis, 1.67 (95% CI 0.83–3.33) for myasthenia gravis, 1.25 (95% CI 1.04–1.50) for psoriasis, 1.21 (95% CI 0.39–3.76) for inflammatory bowel disease, and 2.29 (95% CI 1.19–4.40) for vasculitis. Conclusion The risk of SS and other autoimmune diseases is increased in relatives of patients with SS, and more than one‐half of phenotypic variance in SS can be explained by familial factors.
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Affiliation(s)
- Chang-Fu Kuo
- University of Nottingham, Nottingham, UK, and Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | | | | | | | - Shue-Fen Luo
- Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Kuang-Hui Yu
- Chang Gung Memorial Hospital, Taoyuan City, Taiwan
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Comparison of characteristics of connective tissue disease-associated interstitial lung diseases, undifferentiated connective tissue disease-associated interstitial lung diseases, and idiopathic pulmonary fibrosis in Chinese Han population: a retrospective study. Clin Dev Immunol 2013; 2013:121578. [PMID: 24171031 PMCID: PMC3792508 DOI: 10.1155/2013/121578] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 08/19/2013] [Indexed: 11/18/2022]
Abstract
Our study compared the prevalence and characteristics of patients with connective tissue disease-associated interstitial lung disease (CTD-ILD), undifferentiated connective tissue disease-associated interstitial lung disease (UCTD-ILD), or idiopathic pulmonary fibrosis (IPF) between January 2009 and December 2012 in West China Hospital, western China. Patients who met the criteria for ILD were included and were assigned to CTD-ILD, UCTD-ILD, or IPF group when they met the criteria for CTD, UCTD, or IPF, respectively. Clinical characteristics, laboratory tests, and high-resolution CT images were analyzed and compared among three groups. 203 patients were included, and all were Han nationality. CTD-ILD was identified in 31%, UCTD-ILD in 32%, and IPF in 37%. Gender and age differed among groups. Pulmonary symptoms were more common in IPF, while extrapulmonary symptoms were more common in CTD-ILD and UCTD-ILD group. Patients with CTD-ILD had more abnormal antibody tests than those of UCTD-ILD and IPF. Little significance was seen in HRCT images among three groups. A systematic evaluation of symptoms and serologic tests in patients with ILD can identify CTD-ILD, UCTD-ILD, and IPF.
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Komaru Y, Higuchi T, Koyamada R, Haji Y, Okada M, Kamesaki T, Okada S. Primary Sjögren syndrome presenting with hemolytic anemia and pure red cell aplasia following delivery due to Coombs-negative autoimmune hemolytic anemia and hemophagocytosis. Intern Med 2013; 52:2343-6. [PMID: 24126397 DOI: 10.2169/internalmedicine.52.0695] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 36-year-old woman presented with hemolytic anemia without a reticulocyte response 38 days after delivery. A marked reduction in erythroid cells and an increase in macrophages with active hemophagocytosis were noted in the bone marrow. While conventional Coombs' tests were negative, the level of red blood cell (RBC)-bound immunoglobulin G (IgG) was increased. The patient was diagnosed with primary Sjögren syndrome (pSS) based on her symptoms, positive anti-SS-A antibodies, Coombs-negative autoimmune hemolytic anemia and pure red cell aplasia associated with RBC-bound IgG and hemophagocytosis. The unique presentation was considered to be a consequence of immunological derangement associated with pSS, pregnancy and delivery.
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MESH Headings
- Adult
- Anemia, Hemolytic/diagnosis
- Anemia, Hemolytic/etiology
- Anemia, Hemolytic, Autoimmune/complications
- Anemia, Hemolytic, Autoimmune/diagnosis
- Coombs Test/methods
- Female
- Humans
- Lymphohistiocytosis, Hemophagocytic/complications
- Lymphohistiocytosis, Hemophagocytic/diagnosis
- Pregnancy
- Puerperal Disorders/diagnosis
- Puerperal Disorders/etiology
- Red-Cell Aplasia, Pure/diet therapy
- Red-Cell Aplasia, Pure/etiology
- Sjogren's Syndrome/diagnosis
- Sjogren's Syndrome/etiology
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Affiliation(s)
- Yohei Komaru
- Division of Hematology, St. Luke's International Hospital, Japan
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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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SHINODA K, TAKI H, HOUNOKI H, OGAWA R, SUGIYAMA E, TOBE K. Severe autoimmune hemolytic anemia associated with IgM warm auto-antibodies in primary Sjögren’s syndrome. Int J Rheum Dis 2010; 13:94-6. [DOI: 10.1111/j.1756-185x.2009.01450.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
The evidence for a strong genetic component conferring susceptibility to primary Sjögren's syndrome (SS) is mounting. Several associations with SS have been reported and provide evidence that the HLA region harbors important susceptibility loci and that multiple genes outside the HLA region play a role. Genetic discovery lags behind success observed in related autoimmune diseases. Identifying genetic factors that cause SS will allow more precise definition of pathogenic mechanisms leading to the overall SS phenotype and clinically heterogeneous subsets of patients. Critical opportunities are certain to follow for translation into improved diagnosis and therapies for SS and its spectrum diseases.
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Affiliation(s)
- Beth L Cobb
- Arthritis and Immunology Program, Oklahoma Medical Research Foundation, 825 NE 13th Street, Oklahoma City, OK 73104, USA
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Primary Sjögren Syndrome Complicated by Autoimmune Hemolytic Anemia and Pure Red Cell Aplasia. Am J Med Sci 2007; 334:493-6. [DOI: 10.1097/maj.0b013e318068b5fd] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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10
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Lachman RS. S. TAYBI AND LACHMAN'S RADIOLOGY OF SYNDROMES, METABOLIC DISORDERS AND SKELETAL DYSPLASIAS 2007. [PMCID: PMC7315357 DOI: 10.1016/b978-0-323-01931-6.50027-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kikawada M, Watanabe D, Kimura A, Hanyu H, Serizawa H, Iwamoto T. Autoimmune hemolytic anemia in an elderly patient with primary Sjögren's syndrome. Intern Med 2005; 44:1312-5. [PMID: 16415556 DOI: 10.2169/internalmedicine.44.1312] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Primary Sjögren's syndrome is an autoimmune disease characterized by lymphocytic infiltration of the salivary glands and lacrimal glands. The histological features of chronic inflammation in primary Sjögren's syndrome may be associated with B cell hyper-reactivity. This syndrome also has various manifestations associated with other exocrine glands and nonglandular tissues. The hematological abnormalities usually seen in Sjögren's syndrome are lymphopenia, leucopenia, and thrombocytopenia. Although the direct Coomb's test is often positive, the occurrence of autoimmune hemolytic anemia (AIHA) is rare. Here, we report an elderly patient with primary Sjögren's syndrome who developed AIHA during the clinical course.
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Ramos-Casals M, Font J, Garcia-Carrasco M, Brito MP, Rosas J, Calvo-Alen J, Pallares L, Cervera R, Ingelmo M. Primary Sjögren syndrome: hematologic patterns of disease expression. Medicine (Baltimore) 2002; 81:281-92. [PMID: 12169883 DOI: 10.1097/00005792-200207000-00004] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Manuel Ramos-Casals
- Department of Autoimmune Diseases, Clinical Institute of Infections and Immunology, Barcelona, Spain.
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14
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Bolstad AI, Jonsson R. Genetic aspects of Sjögren's syndrome. ARTHRITIS RESEARCH 2002; 4:353-9. [PMID: 12453311 PMCID: PMC153844 DOI: 10.1186/ar599] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2002] [Revised: 08/23/2002] [Accepted: 08/28/2002] [Indexed: 11/10/2022]
Abstract
Sjögren's syndrome is a multisystem inflammatory rheumatic disease that is classified into primary and secondary forms, with cardinal features in the eye (keratoconjunctivitis sicca) and mouth (xerostomia). The aetiology behind this autoimmune exocrinopathy is probably multifactorial and influenced by genetic as well as by environmental factors that are as yet unknown. A genetic predisposition to Sjögren's syndrome has been suggested on the basis of familial aggregation, animal models and candidate gene association studies. Recent advances in molecular and genetic methodologies should further our understanding of this complex disease. The present review synthesizes the current state of genetics in Sjögren's syndrome.
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Affiliation(s)
- Anne I Bolstad
- Broegelmann Research Laboratory, Department of Microbiology and Immunology, The Gade Institute, University of Bergen, Norway.
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15
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Foster H, Stephenson A, Walker D, Cavanagh G, Kelly C, Griffiths I. Linkage studies of HLA and primary Sjögren's syndrome in multicase families. ARTHRITIS AND RHEUMATISM 1993; 36:473-84. [PMID: 8457223 DOI: 10.1002/art.1780360407] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To define the role of HLA-DR phenotype in the expression of primary Sjögren's syndrome (SS). METHODS A family study of Caucasian probands with definite primary SS was conducted. Relatives with features of primary SS were classified according to the Fox criteria. Several types of linkage analysis between primary SS and HLA haplotype (HLA-A, B, and DR) were performed. RESULTS A trend toward haplotype sharing between affected siblings was evident for definite/probable primary SS when analyzed by the Green and Woodrow method. This reached statistical significance when data from other published family studies were included. LOD scores and analyses using the Penrose method showed little evidence of linkage. CONCLUSION In view of the strong association with HLA-DR3, these results suggest that the HLA-DR3 allele is an important susceptibility factor for expression of primary SS in Caucasians. The apparent haplotype sharing may be a consequence of this association. The potential influence of other genetic factors (major histocompatibility complex [MHC] and non-MHC) is discussed.
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Affiliation(s)
- H Foster
- Department of Rheumatology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
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Abstract
Xerostomia is a distressing condition which may be associated with a number of specific diseases, iatrogenically induced following the administration of drugs or radiotherapy, or the result of inflammatory processes affecting salivary gland tissue. In this article epidemiological background is briefly reviewed and aetiological conditions associated with xerostomic states are summarized. The oral sequelae of xerostomia are discussed and approaches to diagnosis demonstrated. Treatment of xerostomia is basically supportive and the main elements are presented.
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Montané de la Roque P, Arlet P, Chartier JP, Cornu JJ, Juchet H, Ollier S, Le Tallec Y. [Autoimmune hemolytic anemia disclosing primary Gougerot-Sjögren syndrome]. Rev Med Interne 1993; 14:133-4. [PMID: 8378628 DOI: 10.1016/s0248-8663(05)81268-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Besana C, Salmaggi C, Pellegrino C, Pierro L, Vergani S, Faravelli A, Rugarli C. Chronic bilateral dacryo-adenitis in identical twins: a possible incomplete form of Sjögren syndrome. Eur J Pediatr 1991; 150:652-5. [PMID: 1915519 DOI: 10.1007/bf02072627] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
We report an unusual case of chronic bilateral dacryo-adenitis in 10-year-old identical twin sisters. Both girls presented with bilateral lacrimal gland enlargement and developed moderate xerophthalmia and keratitis. Both the lacrimal and minor salivary gland biopsies showed a non-granulomatous inflammatory infiltration of mono-nuclear cells. All granulomatous diseases and neoplasms could therefore be ruled out and only Sjögren syndrome and very few other forms of chronic dacryo-adenitis remained as possible diagnoses. Both patients and their parents were evaluated for auto-antibodies. Very low titres of smooth muscle antibodies were found in one, antinuclear antibodies in two and anti-dsDNA antibodies in all four members of the family. Even though the titres of antinuclear and anti-dsDNA antibodies increased in one of the sisters, both patients did not develop any sign or symptom of a systemic connective tissue disease. During the 6 years' follow up, both patients showed persistent tarsal gland enlargement but no other symptoms apart from a moderate xerophthalmia and occasional mild keratitis.
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Affiliation(s)
- C Besana
- Department of Internal Medicine, Università di Milano
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Ng YC, Walport MJ. Immunogenetics of SLE and primary Sjögren's syndrome. BAILLIERE'S CLINICAL RHEUMATOLOGY 1988; 2:623-47. [PMID: 3067867 DOI: 10.1016/s0950-3579(88)80032-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
SLE is a syndrome defined by clinical criteria and by the presence of autoantibodies reactive with nucleic acids and proteins concerned with transcription and translation. Breeding experiments in mice have illustrated the enormous genetic heterogeneity of this syndrome, of which the final common pathway is a widespread immune complex disease. The causes of SLE in humans are likely to be equally multifactorial. Family studies have demonstrated that genetic factors exist, but each factor appears to be a relatively weak disease-susceptibility gene. The major exceptions to this are the very rare complete deficiencies of classical pathway complement components, which are almost invariably accompanied by the development of SLE. Observations of these patients have led to the formulation of hypotheses relating complement and its receptor, CR1, to the defective removal of immune complexes from the circulation.
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Fox PC, van der Ven PF, Sonies BC, Weiffenbach JM, Baum BJ. Xerostomia: evaluation of a symptom with increasing significance. J Am Dent Assoc 1985; 110:519-25. [PMID: 3858368 DOI: 10.14219/jada.archive.1985.0384] [Citation(s) in RCA: 317] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Xerostomia is the subjective sensation of oral dryness. Although it is most commonly associated with salivary gland dysfunction, it may also occur with normal gland activity. Xerostomia may be an early symptom of several morbid systemic conditions with important implications for the medical and dental management of patients. Oral dryness also has negative effects on an individual's emotional well-being and quality of life. The complaint of xerostomia necessitates a complete evaluation of a patient's general health, salivary gland function, and oral motor and sensory abilities. The salivary gland assessment includes symptom review, analysis of glandular secretions, scintiscanning, and minor labial gland biopsy. No single component is sufficient to adequately diagnose the presence, extent, or cause of salivary dysfunction. Treatment of a dry mouth, to date, is mainly palliative in nature, with the intent of preserving oral structures and functions. Better therapies are essential in the management of xerostomia, whatever the cause. The importance of xerostomia as a symptom is increasingly recognized in medicine and dentistry. The dentist is commonly the first health professional to hear this complaint and may be critical in directing a full and appropriate evaluation.
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Wilson RW, Provost TT, Bias WB, Alexander EL, Edlow DW, Hochberg MC, Stevens MB, Arnett FC. Sjögren's syndrome. Influence of multiple HLA-D region alloantigens on clinical and serologic expression. ARTHRITIS AND RHEUMATISM 1984; 27:1245-53. [PMID: 6208913 DOI: 10.1002/art.1780271106] [Citation(s) in RCA: 107] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The relationships of HLA-DR and the newer DS (second D locus) B cell alloantigens (MB and MT) to the clinical and serologic expression of primary and secondary forms of Sjögren's syndrome (SS) were examined in 102 patients (86 whites and 16 blacks). Although HLA-DR3 was significantly increased in whites (25 of 50, 50%) and blacks (4 of 5, 80%) with primary SS compared with race-matched normal controls, it was not appreciably elevated in those with systemic lupus erythematosus (SLE)-SS, rheumatoid arthritis (RA)-SS, or connective tissue disease-SS. The MT2 specificity, however, was more strongly associated with primary SS (86% of whites and 100% of blacks) and also with SLE-SS and RA-SS compared with race-matched normal controls. Furthermore, MT2 was significantly increased in SLE-SS and RA-SS when compared with non-sicca SLE and RA controls. Although primary and secondary SS were most strongly associated with this DS specificity (MT2), the anti-Ro (SS-A) and anti-La (SS-B) antibody responses were more closely allied to DR antigens. HLA-DR3 was increased in anti-Ro positive patients, both whites and blacks, with primary SS (74%) and in total anti-Ro positive subjects (54%) compared with their anti-Ro negative counterparts (38% and 31%, respectively). Among DR3 negative patients, HLA-DR2 correlated with anti-Ro in both primary SS (83%) and in the total SS group (58%). Thus, 96% of Ro antibody positive patients with primary SS had DR3 and/or DR2, as did 80% of anti-Ro positive subjects in all categories.(ABSTRACT TRUNCATED AT 250 WORDS)
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