Aim and purpose: To evaluate the effects of two NSAIDs on corneal sensitivity and ocular surface in Sj¨ogren’s syndrome (SS) patients. Methods: In all, 20 SS patients with epithelial corneal defects, were random...Aim and purpose: To evaluate the effects of two NSAIDs on corneal sensitivity and ocular surface in Sj¨ogren’s syndrome (SS) patients. Methods: In all, 20 SS patients with epithelial corneal defects, were randomly divided into two groups: group 1 (10 females, age 35-63 years), treated with 0.1%indomethacin, one drop three times a day; group 2 (nine females, one male, age 38-65 years) treated with 0.1%diclofenac, at the same regimen. No systemic NSAIDs were allowed. Use of tear substitute was allowed. Corneal sensitivity, corneal staining, BUT, and ocular discomfort, were evaluated before and after 15, 30 days of treatment and 7 days after NSAID discontinuation. For statistical analysis, the Student’s t-test and Mann-WhitneyU test were used. Results: Both groups showed at day 30 a statistically significant reduction of corneal sensitivity (P < 0.05), although the diclofenac-treated group showed a statistically significant lower sensitivity if compared to the indomethacin-treated group (P < 0.05). Corneal fluorescein score showed a statistically significantly worst alteration in group 2, 7 days after the discontinuation of the therapy (P=0.02). The ocular discomfort score was statistically significantly reduced in both groups starting from day 15 (P < 0.05). Discussion: The results indicate that NSAIDs can be useful in resolving symptoms of ocular discomfort in SS patients. However, they should be usedwith caution and under close monitoring, and the treatment should be promptly discontinued if corneal epithelial defects develop or worsen during treatment.展开更多
Background. Dyspareunia is frequently associated with a psychiatric origin, particularly in patients with no obvious Sjogrens Sjogrens Sjogrens Sjogrens¨ Sjogrensvulvovaginal or pelvic disease. The aim ...Background. Dyspareunia is frequently associated with a psychiatric origin, particularly in patients with no obvious Sjogrens Sjogrens Sjogrens Sjogrens¨ Sjogrensvulvovaginal or pelvic disease. The aim of this study was to assess the frequency of dry syndrome in patients with dyspareunia and to evaluate the main clinical and biological features and follow-up data for women with dyspareunia and dry syndrome. Patients and methods. Twenty-two patients presenting chronici diopathic dyspareunia (without clear vulvovaginal dermatosis or infection) were included in this retrospective study. All patients underwent history-taking, gynecological examination, a Schirmer tear test, a sugar test, labial salivary gland biopsy assessment and immunological examination. A diagnosis of syndrome was considered where histological examination of the salivary glands showed a lymphocyte infiltration corresponding to stage 3 or 4 in the Chisholm classification. Diagnosis of dry syndrome without syndrome was made in patients with xerostomia and/or xerophthalmia without a specific histological picture of syndrome or immunological abnormalities at salivary gland biopsy. Results. Based on our criteria, 10 patients (45% ) had dry syndrome, including 4 with syndrome and 6 with dry syndrome without syndrome. 9 of these 10 patients presented either xerostomia (7 cases) and/or xerophthalmia (7 cases). Vaginal dryness was reported by 3 of the 10 women with dry syndrome but also by 4 of 12 women without dry syndrome. Examination of the vulva showed no particular clinical features and treatment with an emollient was not effective in all cases. Discussion. This study showed a high frequency of dry syndrome in patients with chronic “ idiopathic” dyspareunia. The incidence of the condition was even greater in women with functional conditions evocative of dry syndrome. Women presenting dyspareunia with no clearly related clinical causes should thus be carefully assessed for dry syndrome.展开更多
A 41- year- old Japanese woman presented at a local outpatient clinic because of a slightly pruritic pustular eruption on the trunk and extremities. Her skin lesion had been treated using an antifungal cream, but the ...A 41- year- old Japanese woman presented at a local outpatient clinic because of a slightly pruritic pustular eruption on the trunk and extremities. Her skin lesion had been treated using an antifungal cream, but the condition had continued to worsen. According to the patient, the same pustular eruption had occurred during pregnancy, but diminished after delivery. She has no family history of skin eruption. On physical examination, she presented with well- circumscribed erythematous macules with small pustules on the borders, involving the axilla, groin, upper and lower extremities and upper back (Fig. 1). Bacterial and fungal cultures of the lesions were negative. A skin biopsy obtained from a lesion in the left forearm demonstrated a subcorneal pustule containing polymorphonuclear leukocytes (Fig. 2). A perivascular dermal infiltrate was present, consisting predominantly of mononuclear cells. There was no spongiosis or acantholysis. On direct immunofluorescence, there were no immunoglobulinA (IgA) and complement 3 (C3) deposits in the intercellular space of the epidermis. The clinical and histopathological findings were consistent with a diagnosis of subcorneal pustular dermatosis (SPD). Laboratory investigations showed hyper immunoglobulin A (IgA) immunoglobulinemia (479 mg/dL, normal, 110- 410) and a high titer of antinuclear antigen (speckled type) at 1: 160 (normal < 1: 40) and anti- single- strand (anti- ss) DNA- IgG at 1: 25 (normal: negative). Other findings were normal. Serum and urine immunoelectrophoresis showed no paraprotein bands. Administration of topical diflupredonate ointment and oral prednisolone improved but did not completely resolve the eruption. The patient was then treated with dapsone 75 mg daily, leading to reasonable control. Because speckled type antinuclear antibody and anti- ss- DNA antibody were positive in spite of the fact that autoantibodies anti- Sj gren’ s syndrome (SS)- A and SS- B were negative, we asked the patient if she had experienced a dry sensation in her eyes and mouth. As she reported a dry sensation of both eyes and mouth, we referred her to the ophthalmology clinic. The Schilmer test was positive (2 mm of wetting per 5 min, with the patient unanesthetized). Rose Bengal dye and slit- lamp examination revealed Sj gren’ s syndrome pattern. Lip biopsy revealed the accumulation of numerous lymphocytes in the salivary gland. Thus, our patient fulfilled four criteria of the European multicenter study1, suggesting a diagnosis of definite Sj gren’ s syndrome.展开更多
文摘Aim and purpose: To evaluate the effects of two NSAIDs on corneal sensitivity and ocular surface in Sj¨ogren’s syndrome (SS) patients. Methods: In all, 20 SS patients with epithelial corneal defects, were randomly divided into two groups: group 1 (10 females, age 35-63 years), treated with 0.1%indomethacin, one drop three times a day; group 2 (nine females, one male, age 38-65 years) treated with 0.1%diclofenac, at the same regimen. No systemic NSAIDs were allowed. Use of tear substitute was allowed. Corneal sensitivity, corneal staining, BUT, and ocular discomfort, were evaluated before and after 15, 30 days of treatment and 7 days after NSAID discontinuation. For statistical analysis, the Student’s t-test and Mann-WhitneyU test were used. Results: Both groups showed at day 30 a statistically significant reduction of corneal sensitivity (P < 0.05), although the diclofenac-treated group showed a statistically significant lower sensitivity if compared to the indomethacin-treated group (P < 0.05). Corneal fluorescein score showed a statistically significantly worst alteration in group 2, 7 days after the discontinuation of the therapy (P=0.02). The ocular discomfort score was statistically significantly reduced in both groups starting from day 15 (P < 0.05). Discussion: The results indicate that NSAIDs can be useful in resolving symptoms of ocular discomfort in SS patients. However, they should be usedwith caution and under close monitoring, and the treatment should be promptly discontinued if corneal epithelial defects develop or worsen during treatment.
文摘Background. Dyspareunia is frequently associated with a psychiatric origin, particularly in patients with no obvious Sjogrens Sjogrens Sjogrens Sjogrens¨ Sjogrensvulvovaginal or pelvic disease. The aim of this study was to assess the frequency of dry syndrome in patients with dyspareunia and to evaluate the main clinical and biological features and follow-up data for women with dyspareunia and dry syndrome. Patients and methods. Twenty-two patients presenting chronici diopathic dyspareunia (without clear vulvovaginal dermatosis or infection) were included in this retrospective study. All patients underwent history-taking, gynecological examination, a Schirmer tear test, a sugar test, labial salivary gland biopsy assessment and immunological examination. A diagnosis of syndrome was considered where histological examination of the salivary glands showed a lymphocyte infiltration corresponding to stage 3 or 4 in the Chisholm classification. Diagnosis of dry syndrome without syndrome was made in patients with xerostomia and/or xerophthalmia without a specific histological picture of syndrome or immunological abnormalities at salivary gland biopsy. Results. Based on our criteria, 10 patients (45% ) had dry syndrome, including 4 with syndrome and 6 with dry syndrome without syndrome. 9 of these 10 patients presented either xerostomia (7 cases) and/or xerophthalmia (7 cases). Vaginal dryness was reported by 3 of the 10 women with dry syndrome but also by 4 of 12 women without dry syndrome. Examination of the vulva showed no particular clinical features and treatment with an emollient was not effective in all cases. Discussion. This study showed a high frequency of dry syndrome in patients with chronic “ idiopathic” dyspareunia. The incidence of the condition was even greater in women with functional conditions evocative of dry syndrome. Women presenting dyspareunia with no clearly related clinical causes should thus be carefully assessed for dry syndrome.
文摘A 41- year- old Japanese woman presented at a local outpatient clinic because of a slightly pruritic pustular eruption on the trunk and extremities. Her skin lesion had been treated using an antifungal cream, but the condition had continued to worsen. According to the patient, the same pustular eruption had occurred during pregnancy, but diminished after delivery. She has no family history of skin eruption. On physical examination, she presented with well- circumscribed erythematous macules with small pustules on the borders, involving the axilla, groin, upper and lower extremities and upper back (Fig. 1). Bacterial and fungal cultures of the lesions were negative. A skin biopsy obtained from a lesion in the left forearm demonstrated a subcorneal pustule containing polymorphonuclear leukocytes (Fig. 2). A perivascular dermal infiltrate was present, consisting predominantly of mononuclear cells. There was no spongiosis or acantholysis. On direct immunofluorescence, there were no immunoglobulinA (IgA) and complement 3 (C3) deposits in the intercellular space of the epidermis. The clinical and histopathological findings were consistent with a diagnosis of subcorneal pustular dermatosis (SPD). Laboratory investigations showed hyper immunoglobulin A (IgA) immunoglobulinemia (479 mg/dL, normal, 110- 410) and a high titer of antinuclear antigen (speckled type) at 1: 160 (normal < 1: 40) and anti- single- strand (anti- ss) DNA- IgG at 1: 25 (normal: negative). Other findings were normal. Serum and urine immunoelectrophoresis showed no paraprotein bands. Administration of topical diflupredonate ointment and oral prednisolone improved but did not completely resolve the eruption. The patient was then treated with dapsone 75 mg daily, leading to reasonable control. Because speckled type antinuclear antibody and anti- ss- DNA antibody were positive in spite of the fact that autoantibodies anti- Sj gren’ s syndrome (SS)- A and SS- B were negative, we asked the patient if she had experienced a dry sensation in her eyes and mouth. As she reported a dry sensation of both eyes and mouth, we referred her to the ophthalmology clinic. The Schilmer test was positive (2 mm of wetting per 5 min, with the patient unanesthetized). Rose Bengal dye and slit- lamp examination revealed Sj gren’ s syndrome pattern. Lip biopsy revealed the accumulation of numerous lymphocytes in the salivary gland. Thus, our patient fulfilled four criteria of the European multicenter study1, suggesting a diagnosis of definite Sj gren’ s syndrome.
文摘目的探讨原发性干燥综合征(primary Sj gren syndrome,pSS)患者唾液胱抑素D水平与唾液腺损伤的相关性。方法纳入2022年9月1日至2023年6月30日就诊于西安交通大学第一附属医院风湿免疫科pSS组患者51例及年龄、性别匹配的来院健康体检对照组人员51例。检测唾液中胱抑素D水平,采用独立样本t检验评估两组胱抑素D水平的差异,采用Pearson相关性检验评估pSS组胱抑素D与临床指标的关系。结果pSS组唾液中胱抑素D水平明显低于对照组(206.55±108.11 vs 374.32±172.24 pg/mL,P<0.01)。pSS患者胱抑素D水平与其静态唾液流率(r=0.433,P=0.002)及动态唾液流率(r=0.363,P=0.009)呈正相关。高唾液腺超声检查评分的pSS患者唾液胱抑素D水平明显低于低评分患者(腮腺:160.75±85.56 vs 290.53±95.17 pg/mL,P<0.01;颌下腺:157.76±87.59 vs 276.25±97.06 pg/mL,P<0.01)。pSS患者胱抑素D水平与外周血IL-6水平(r=-0.453,P=0.001)及CD4+T细胞计数(r=-0.396,P=0.005)呈负相关。结论pSS患者唾液胱抑素D水平可作为反映唾液腺损伤的指标。
