Rational Diagnosis and Management of Sjogren's Syndrome

쉐그렌 증후군의 합리적 진단 및 관리

  • Tae, Il-Ho (Department of Oral Diagnosis & Oral Medicine, Dental Hospital, Yonsei University, College of Dentistry) ;
  • Kwon, Jeong-Seung (Department of Oral Diagnosis & Oral Medicine, Dental Hospital, Yonsei University, College of Dentistry) ;
  • Jeon, Young-Mi (Department of Oral Diagnosis & Oral Medicine, Dental Hospital, Yonsei University, College of Dentistry) ;
  • Choi, Jong-Hoon (Department of Oral Diagnosis & Oral Medicine, Dental Hospital, Yonsei University, College of Dentistry) ;
  • Shim, Woo-Hyun (Department of Oral Diagnosis & Oral Medicine, Dental Hospital, Yonsei University, College of Dentistry) ;
  • Ahn, Hyung-Joon (Department of Oral Diagnosis & Oral Medicine, Dental Hospital, Yonsei University, College of Dentistry)
  • 태일호 (연세대학교 치과대학 구강내과학교실) ;
  • 권정승 (연세대학교 치과대학 구강내과학교실) ;
  • 전영미 (연세대학교 치과대학 구강내과학교실) ;
  • 최종훈 (연세대학교 치과대학 구강내과학교실) ;
  • 심우현 (연세대학교 치과대학 구강내과학교실) ;
  • 안형준 (연세대학교 치과대학 구강내과학교실)
  • Published : 2007.12.30

Abstract

Sjogren's syndrome is a chronic autoimmune disorder of the exocrine glands with associated lymphocytic infiltrates of the affected glands. Primary SS presents alone as xerostomia, keratoconjunctivitis sicca and patotid gland enlargement, secondary SS occurs in connection with other autoimmune disorder such as rheumatitoid arthritis, systemic lupus erythematosus, or progressive systemic sclerosis. Among many other systemic complication, lymphoma is considered seriously. Patient with SS had a 44 times higher relative risk of lymphoma, and clinically identifiable lymphoma occurs in approximately 5% of patients with SS. So, patients with SS should be closely monitored. In dental office, diagnosis of SS is important in view of high risk of lymphoma. When a dentist diagnose and manage dry mouth, he or she should consider possibility of SS all the times and have knowledge of diagnostic criteria of SS.

References

  1. Kassan SS, Moutsopoulos HM. Clinical manifestations and early diagnosis of Sjögren syndrome. Arch Intern Med 2004;164(12):1275-1284 https://doi.org/10.1001/archinte.164.12.1275
  2. Vitali C, Bombardieri S, Jonsson R et al. European Study Group on Classification Criteria for Sjögren's Syndrome. Classification criteria for Sjögren's syndrome: a revised version of the European criteria proposed by the American-European Consensus Group. Ann Rheum Dis 2002;61(6):554-558 https://doi.org/10.1136/ard.61.6.554
  3. Dafni UG, Tzioufas AG, Staikos P et al. Prevalence of Sjögren's syndrome in a closed rural community. Ann Rheum Dis 1997;56(9):521-525 https://doi.org/10.1136/ard.56.9.521
  4. Daniels TE. Labial salivary gland biopsy in Sjögren's syndrome. Assessment as a diagnostic criterion in 362 suspected cases. Arthritis Rheum 1984;27(2):147-156 https://doi.org/10.1002/art.1780270205
  5. Daniels TE. Salivary histopathology in diagnosis of Sjogren's syndrome. Scand J Rheumatol Suppl 1986;61:36-43
  6. Manthorpe R, Asmussen K, Oxholm P. Primary Sjögren's syndrome: diagnostic criteria, clinical features, and disease activity. J Rheumatol 1997;24(suppl):8-11
  7. Kassan SS. Managing dry eyes and dry mouth in Sjogren's syndrome. Am J Manag Care 2001;7 (Suppl):S444-450
  8. Koopman WJ, Moreland LW. Arthritis and Allied Conditions. 13th ed., Philadelphia, 1997, Williams & Wilkins, pp.561-1580
  9. Al-Hashimi I, Khuder S, Haghighat N et al. Frequency and predictive value of the clinical manifestations in Sjogren's syndrome. J Oral Pathol Med 2001;30:1-6 https://doi.org/10.1034/j.1600-0714.2001.300101.x
  10. Franquet T, Diaz C, Domingo P et al. Air trapping in primary Sjögren's syndrome: correlation of expiratory CT with pulmonary function tests. J Comput Assist Tomogr 1999;23:169-173 https://doi.org/10.1097/00004728-199903000-00002
  11. Moutsopoulos HM. Sjögren's syndrome: autoimmune epithelitis. Clin Immunol Immunopathol 1994;72:162-165 https://doi.org/10.1006/clin.1994.1123
  12. Tu WH, Shearn MA, Lee JC et al. Interstitial nephritis in Sjogren's syndrome. Ann Intern Med 1968;69: 1163-1170 https://doi.org/10.7326/0003-4819-69-6-1163
  13. Cohen EP, Bastani B, Cohen MR et al. Absence of H(+)-ATPase in cortical collecting tubules of a patient with Sjögren's syndrome and distal renal tubular acidosis. J Am Soc Nephrol 1992;3:264-271
  14. Shearn MA, Tu W. Nephrogenic diabetes insipidus and other defects of tubular function in Sjogren's syndrome. Am J Med 1965;39:312 https://doi.org/10.1016/0002-9343(65)90057-4
  15. Wrong OM, Feest TG, Maclver AG. Immunerelated potassium-losing interstitial nephritis: a comparison with distal renal tubular acidosis. Q J Med 1993;86:513-534 https://doi.org/10.1093/qjmed/86.8.513
  16. Bloch KJ, Buchanan WW, Wohl MJ et al. Sjogren's syndrome: a clinical, pathological, and serological study in 62 cases. Medicine(Baltimore) 1965;44:187-231
  17. Bailey RR, Swainson CP. Renal involvement in Sjogren's. N Z Med J 1986;99:579-580
  18. Talal N, Zisman E, Schur PH. Renal tubular acidosis, glomerulonephritis and immunologic factors in Sjogren's syndrome. Arthritis Rheum 1968;11:774-786 https://doi.org/10.1002/art.1780110607
  19. Gemignani F, Marbini A, Pavesi G et al. Peripheral neuropathy associated with primary Sjögren's syndrome. J Neurol Neurosurg Psychiatry 1994;57: 983-986 https://doi.org/10.1136/jnnp.57.8.983
  20. Kassan SS, Thomas TL, Moutsopoulos HM et al. Increased risk of lymphoma in sicca syndrome. Ann Intern Med 1978;89:888-892 https://doi.org/10.7326/0003-4819-89-6-888
  21. Freimark B, Fantozzi R, Bone R et al. Detection of clonally expanded salivary gland lymphocytes in Sjogren's syndrome. Arthritis Rheum 1989;32:859-869
  22. Kassirer JP, Greene HL. Current Therapy in Adult Medicine. 4th ed., Baltimore, 1997, Mosby, pp.1291-1298
  23. Skopouli FN, Dafni U, Ioannidis JP et al. Clinical evolution, and morbidity and mortality of primary Sjogren's syndrome. Semin Arthritis Rheum 2000;29:296-304 https://doi.org/10.1016/S0049-0172(00)80016-5
  24. Tzioufas AG, Boumba DS, Skopouli FN et al. Mixed monoclonal cryoglobulinemia and monoclonal rheumatoid factor crossreactive idiotypes as predictive factors for the development of lymphoma in primary Sjogren's syndrome. Arthritis Rheum 1996;39:767-772 https://doi.org/10.1002/art.1780390508