Clinical factors influencing the resting and stimulated salivary flow

Objective: The objective of this study was to examine the clinical and immunological factors influ encing sialometry in xerostomia patients. Method: The association between sialometry and other clinical examinations were investigated in a cross-sectional study. A total of 179 dry mouth patients showing hyposalivation who underwent a clinical examination were enrolled in this study. Multiple regression analyses were employed to examine the relative con-tributions of clinical and immunological factors including age, gender, parotid sialography, labial Salivary gland biopsy, anti-Ro/SS-A antibodies, and anti-La/SS-B antibodies to the resting (RSF) or stimulated saliva flow rate (SSF). Results: An increase of the stage of sialography, the grade of a labial biopsy, and the presence of anti-La/SS-B antibody had a significant correlation with a decrease of sialometry. Results of the multiple regression analysis showed that age (standardized coefficient = -0.244), grade of lip biopsy (-0.189), and anti-SS-B antibody (-0.171), were significantly associated with the RSF. The stage of sialography (?0.423) and age (-0.169) were significantly related to the sialometry in the SSF according to a multiple regression analysis. Conclusion: The results of this study suggest that the measurement of RSF reflects the immunological factors and SSF reflects the damage to the parotid gland.

Serum-negative Sjogren's syndrome with minimal lesion nephropathy as the initial presentation:A case report

BACKGROUND Primary Sjogren's syndrome(pSS)is an autoimmune disease,and renal involvement has been considered to be one of the systemic complications of pSS.Patients who have sjogren's syndrome with renal disease as the first manifestation and no exocrine gland involvement or autoantibodies can be missed clinically.CASE SUMMARY We here in report an unusual case of a primary Sjogren's syndrome in a 43-yearold female who had minimal lesion nephropathy as the initial presentation,and the patient was negative for serum anti-SSA and anti-SSB antibodies and did not have signs of exocrine gland involvement.The patient’s Sjogren's syndrome was confirmed by a minor salivary gland biopsy(MSGB)and a filter paper test.the patient’s oedema subsided,and the patient’s urinary protein resolved,showing that the treatment was effective.CONCLUSION MSGB should be considered if pSS is suspected in patients who do not have the typical pSS symptoms or who are positive for the specific autoantibodies.

Peripheral Neuropathies Revealing Gougerot-Sjögren’s Syndrome: Description of 3 Cases

Introduction: Sjögren’s syndrome is an autoimmune epithelitis with various extraglandular signs, among which are neurological, with a variable frequency according to studies. We report three cases of peripheral neuropathy revealing Gougerot-Sjögren’s syndrome, collected in the Neurology Department of the Fann University Hospital in Dakar (Senegal). Observations: The first patient, aged 48 years, presented with a length-dependent sensitivomotor polyneuropathy associated with retrobulbar optic neuritis, with dry eyes and dry mouth noticed by the patient for several years. The second patient, aged 28 years, was admitted to the hospital with chronic generalized paresthesia in the context of xerostomia and xerophthalmia. The results of the clinical examination and the electroeneuromyogram were in favour of pure sensory neuronopathy. The third patient was 32 years old female, with a history of thyroidectomy and acute inflammatory demyelinating polyneuropathy (AIDP), who was seen for acute ascending flaccid tetraplegia with facial diplegia, preceded by diffuse paresthesia. The diagnosis of recurrence of acute demyelinating polyradiculonueropathy was retained in view of the rapidly increasing character of the deficit, the hyperproteinorachy at the lumbar puncture, and the signs of demyelination at the ENMG. The diagnosis of Gougerot-Sjögren’s syndrome in our three patients was established on the basis of the 2016 ACR/EULAR criteria. Indeed, the anti-SSA antibodies (Ro) were positive in our 3 patients with a biopsy of the salivary glands which showed stage 3 in the first patient and stage 4 in the two others. Corticosteroid therapy and immunosuppressive treatment resulted in a favourable clinical evolution on the neurological and general levels. Conclusion: Gougerot-Sjögren’s syndrome is an autoimmune exocrinopathy that may present with peripheral neuropathy, which may precede the diagnosis of Sjögren’s syndrome, be concomitant or occur during the course of the disease.

CLINICAL APPLICATION AND EVALUATION OF SALIVA FERNING TEST IN SJGREN' S SYNDROME

Objective To evaluate the saliva ferning test (SFT) as diagnostic test for xerostomia in patients with Sjogren’s Syndrome (SS). Methods In this study, dried samples of freshly produced saliva from 78 patients with established SS according to European Community criteria and 80 healthy controls were examined by light microscopy. The crystallization was classified into 4 types according to the ferning phenomenon: uniformity, branching, spreading and integrity (type I normal and type Ⅱ,Ⅲ,Ⅳ abnormal ). Then, the 78 patients underwent lebial salivary gland biopsy. According to Tarpley’s classifica- tion, minor salivary gland biopsy (≥2 + ) was considered to be positive . Results 1. The sensitivity of SFT was high (70/ 78 = 89. 74% ). And the specificity wes also high (67/80 = 83. 75% ). 2. Abnormal SFT was observed in 70/78 (89. 74% ) samples from patients group and in 13 /80 (16. 25% ) samples from healthy controls. The differences of SFT in patients group versus controls were statistically significant (P< 0. 01 ). 3. The sensitivity of SFT and mini labial gland biopsy had no significant differences (P > 0. 05) as diagnostic tests in SS. Conclusion SFT was simple, sensitive and specific as diagnostic test in SS suspect patients just as mini labial gland biopsy.