Comparison of the meibomian gland dysfunction in patients with chronic ocular graft-versus-host disease and Sjogren's syndrome

AIM: To investigate the abnormalities in the meibomian gland in patients with dry eye disease(DED) associated with chronic ocular graft-versus-host disease(coGVHD) in comparison with Sj?gren's syndrome(SS), a major form of aqueous deficient DED and meibomian gland dysfunction(MGD), a common cause of evaporative DED.METHODS: A total 135 eyes of 135 subjects included in this study: patients with DED associated with coGVHD(n=30), patients with SS(n=35), patients with MGD(n=35), and normal controls(n=35). All participants completed the Ocular Surface Disease Index(OSDI) questionnaire, ocular surface examination [Schirmer test, tear film breakup time(TFBUT), and ocular surface staining], and meibomian gland assessment [meiboscore(gland dropout detected on meibography using infrared camera of the Keratograph 5 M), meibum expressibility score(MES), meibum quality score(MQS), lid margin abnormality]. In addition, correlations of meibomian gland characteristics with ocular surface parameters as well as disease severity score were investigated in coGVHD group.RESULTS: The coGVHD group showed significantly higher meiboscore, MES, and MQS than the other 3 groups(all P<0.05). In the coGVHD group, parameters of meibomian gland showed a significant correlation each other and those of ocular surface. The correlation between meibomian gland parameters and severity score of co GVHD was also established(meiboscore, r=0.62; MES, r=0.47; MQS, r=0.47; lid margin abnormality score, r=0.55; all P<0.05).CONCLUSION: Patients with DED associated with co GVHD show poorer gland morphology and worse glandfunction than other types of DED. In addition, meibomian gland damage is not only associated with ocular surface damage but also disease severity of coGVHD.

Oral Candidiasis in Sjgoren's Syndrome：Prevalence，Clinical Features，and Treatment

This paper reports the diagnosis of 65 patients with Sjogren′s Syndrome. Among these patients, 20 patients(30.77%) were complicated with oral candidiasis. The twenty patients were treated by topical nystatin smearing, 2% sodium bicarbonate solution rinsing, and transfer factor injecting for about 2 months. The soreness, erythema, unpleasant feeling, angular cheilitis in mouths significantly diminished or completely disappeared, following two months treatments. The good results have been kept 6 months after follow up. However, dry mouth and atrophic changes, though showed no furture development, the therapeutic response was not significant.

Subclavian steal syndrome associated with Sjogren's syndrome: A case report

BACKGROUND Subclavian steal syndrome(SSS)caused by Sjogren's syndrome is rare,especially for elderly patients with risk factors for atherosclerosis.The current report presents the uncommon etiology and treatment of SSS,aiming to improve doctor’s clinical experience.CASE SUMMARY A 69-year-old man was diagnosed with hypertension and acute cerebral infarction presenting with left upper limb weakness and pain even gradually aggravating to left limb hemiplegia 30 years ago.He was managed with antihypertensive and antithrombotic therapy;however,his condition was recurrent,and he never had any further examination.It was found that the difference of the bilateral upper arm systolic pressure was over 20 mmHg,and Doppler examination showed that the blood flow of the left vertebral artery was reversed,suggesting SSS.Further tests revealed a benign lymphoepithelial lesion in salivary gland tissue,confirming the Sjogren's syndrome.CONCLUSION The patient was found to have hypertension when he was 33 years old,and the blood pressure of both sides was asymmetric,which was ignored.The patient's symptoms of dizziness and upper limb weakness were misdiagnosed as general cerebral infarction.It is necessary to test the aorta computed tomography angiography to prove secondary hypertension factors such as Sjogren's syndrome.

Study on the correlation between TCM syndrome differentiation and immune inflammation index of Sjogren's syndrome

Objective:To observe the relationship between the distribution of TCM Syndromes of primary Sjogren's syndrome(pSS)and the changes of erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),immunoglobulin IgA,IgG and IgM.Methods:157 diagnosed PSS patients were divided into dampness heat obstructing collaterals syndrome,dryness evil invading lung syndrome,Qi blood stasis syndrome,liver kidney yin deficiency syndrome and Qi Yin deficiency syndrome according to TCM syndrome differentiation standard.The age,course of disease,general health score in international universal quality of life scale,self rating Anxiety scale(SAS),self rating Depression Scale(SDS)and erythrocyte sedimentation rate were observed and detected(ESR,C-reactive protein(CRP),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),immunoglobulin IgA,IgG and IgM and other immune inflammatory indexes were detected.The relationship between different TCM Syndromes of PSS and molecular level changes of immune inflammatory indexes was analyzed and compared,as well as the impact on quality of life and mental emotion.Results:The overall health score of patients with Qi Yin deficiency syndrome was significantly lower than that of patients with dampness heat obstructing collaterals and dampness evil invading lung syndrome(P<0.01),while the SAS and SDS scores of patients with Qi Yin deficiency syndrome were significantly higher than those of patients with dampness heat invading lung syndrome and dampness heat obstructing collaterals syndrome(P<0.05,P<0.01);ESR,CRP,RF,TNF-α,IL-6,IgA,IgG and IgM related laboratory indexes of patients with dampness heat obstructing collaterals syndrome were significantly higher than those of patients with dry evil invading lung syndrome,liver kidney yin deficiency syndrome and liver kidney yin deficiency syndrome Qi Yin deficiency syndrome and Qi blood stasis syndrome(P<0.05,P<0.01).Correlation test found that the above five syndrome types were positively correlated with hs-CRP,IL-6,TNF-ɑindicators(P<0.05).Conclusion:The overall health,SAS,SDS and related hs-CRP,IL-6,TNF-ɑand some others indexes of SS patients are associated with TCM syndromes.

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.

Meta analysis of efficacy and safety of traditional Chinese medicine combined with hydroxychloroquine sulfate in the treatment of Sjogren's syndrome

Objective:To systematically evaluate the efficacy and safety of traditional Chinese medicine combined with hydroxychloroquine sulfate in the treatment of Sjogren's Syndrome(SS).Methods:Two researchers searched the databases of Chinese National Knowledge Infrastructure(CNKI),Wanfang Database,Weipu Database,Chinese Biomedical Literature Database,PubMed Database,Web of science Database and The Cochrane Library Database(the retrieval period is from the establishment of the database to October 2020)and screened the literatures independently.The data were extracted for bias risk assessment,and then meta-analysis was performed using Revman 5.3 software.Results:A total of 19 articles involving 1185 patients were included,including 617 cases in the treatment group and 568 cases in the control group.Combined data analysis showed that the total effective rate of traditional Chinese medicine combined with hydroxychloroquine sulfate in the treatment of Sjogren's syndrome was significantly higher than that of hydroxychloroquine sulfate alone[R R=1.34,95%CI(1.24,1.44),P<0.00001].The improvement of salivary gland[SMD=0.66,95%CI(0.47,0.85),P<0.00001],tear secretion function[MD=2.56,95%CI(1.29,3.83),P<0.0001]and reducing CRP[MD=-3.53,95%CI(-3.93,-3.14),P<0.00001],ESR[MD=-5.80,95%CI(-8.48,-3.13),P<0.00001]were better than those of the control group.However,there was no significant difference in the reduction of IgG and the incidence of adverse reactions between the two groups.Conclusion:Traditional Chinese medicine combined with hydroxychloroquine sulfate in the treatment of SS is superior to the control group in total effective rate,improvement of salivary gland and tear secretion function,and reduction of CRP and ESR,and we didn’t see the significantly increase on the adverse event.However,due to the small sample size and low quality of the included studies,the conclusion needs to be verified by larger sample and higher quality randomized controlled trials.

Study on immunological characteristics of T lymphocyte in peripheral blood from patients with sjogren's syndrome

Objective: To study on in immunological characteristics of T lymphocyte in peripheral blood from patients with Sjogren's syndrome (SS), provide the theory basis for the further research of Traditional Chinese medicine (TCM) targeted therapy.Methods:T lymphocyte subsets in peripheral blood from SS, RA and normal control groups were tested with various monocbnal antibodies and multicolor flow cytometry.T lymphocyte subsets were tested in peripheral blood from SS patients of different TCM Syndromes. The relationship between T Lymphocyte subsets and disease activity was measured by erythrocyte sedimentation rate (SR)and serum IgG. Results: The percentage of CD4^+T cells and the ration of CD4^+/CD8^+T cells in peripheral bbod from SS patients decreased significantly, and the percentage of CD8^+T cells increased than that in control groups (P<0.05). Compared with patients in inactive period, the percentage of CD4^+T cells in peripheral bLood from SS patients in the active stage increased (P>0.05), the percentage of CD8^+T cells decreased (P>0.05), and the ration of CD4^+/ CD8^+T cells increased (P<0.05).Compared with control groups, the percentage of CD69 expressed on T cells in peripheral blood from SS patients decreased, and the percentage of CD95's expression increased (P<0.05).The percentage of CD69CD95's expression also increased (P>0.05). There were no differences among CD4^+T cells, CD8^+T ceLs and CD4^+/ CD8^+ in peripheral blood from SS patients of different TCM Syndromes (P>0.05). CD69 and CD95's expression on SS patients of different TCM Syndromes was no significantLy different (P>0.05).T cell receptor Vβ(TCR Vβ) subfamilies gene in peripheral blood from SS patients and control groups were expressed in all. Compared witji control groups, Vβ 5.3,Vβ 13.1,Vβ 12,Vβ 7.2 had significant differences (P<0.05).Comparison of different TCM Syndromes in SS group: Vβ 13.1 and Vβ 14 were significantly different (P<0.05).Conclusion:There was dysimmunity on T lymphocyte subsets in peripheral blood of SS patients, which was related to disease activity;apoptosis after activation of autoreactive T cell may be induced by Chinese medicine;TCR Vβ subfamilies of different TCM syndromes were different, which noted that different autoreactive T cells of abnormal activation tended to result in different expression of TCM Different syndromes.

Treatment of Sjogren's Syndrome with Liver Depression

Liu Chunying is a famous old Chinese medicine doctor for more than 30 years.He has rich experience in the understanding and treatment of Sjogren's syndrome(SS).Liu Shi systematically discusses the etiology and pathogenesis of SS from the angle of liver depression.In the treatment,it is emphasized that"Muyu Da Zhi"is the first,with the addition and subtraction of the disease,to provide a new idea for the treatment of Sjogren's syndrome from liver depression,and to attach a test case.

Research progress on BDNF in Sjogren's syndrome with depressive disorder

Brain-derived neurotrophic factor(BDNF)is a widely studied neurotrophic factor,which plays an important role in the growth,development,dif-ferentiation,injury,repair,survival and apoptosis of nerve cells.More and more studies have found that there is a high prevalence of depressive disorders in patients with autoimmune diseases.Sjogren's syndrome is a chronic autoimmune exocrine disease characterized by lympho-cytic infiltration and exocrine gland destruction.Depres-sive disorders are common in patients with Sjogren's syndrome.The quality of life of patients with Sjogren's syndrome with depression was generally lower than that of patients with Sjogren's syndrome without depres-sion.In this article,we reviewed the research progress of BDNF and depression in Sjogren's syndrome at home and abroad.

Long COVID and gut candidiasis:What is the existing relationship?

Since the beginning of the coronavirus disease(COVID)2019 pandemic,thou-sands of articles on the topic have been published,and although there is a growing trend of research on another associated condition,long coronavirus disease,important points still remain to be clarified in this respect.Robust evidence has suggested a relevant link between new clinical discoveries and molecular mechanisms that could be associated with the manifestations of different signs and symptoms involving cases of long COVID.However,one of the existing gaps that requires further investigation concerns a possible rela-tionship between gut candidiasis and long COVID.While recent studies also suggest an interplay between the occurrence of these two conditions,it is not yet fully clear how this may happen,as well as the specifics regarding the possible pathophysiological mechanisms involved.In this connection and with the advent of a potential strengthening of the body of evidence supporting the hypothesis of a link between gut candidiasis and long COVID,a better understanding of the clinical presentation,pathophysiology and clinical management of such a relationship should be essential and useful for both,additional advances towards more targeted research and appropriate case management.Knowing more about the signs,symptoms,and complications associated with cases of long COVID is essential in order to more effectively mitigate the related burden and provide a higher quality of care and life for the affected population.In light of this and the need for better outcomes,here we review and discuss the content on different aspects of long COVID,including its pathophysiology and the existing evidence of a potential relationship between such a condition and gut candidiasis,as well as suggest propositions for future related research.INTRODUCTION Long coronavirus disease(COVID)is a condition characterized by the emergence of new symptoms or the persistence of existing symptoms for at least two months,three months after the initial infection[1].Although such a condition has initially been extensively studied,there are still many contradictions between the findings and methodologies of different related research articles[2,3].Within this context and since the middle of the COVID-19 pandemic,important studies have been published in the literature reporting the occurrence of fungal infections among COVID-19 patients[4,5],including mucormycosis,and oral candidiasis[6].On the other hand,evidence on a possible relationship between gut candidiasis and long COVID is still recent[7].Indeed,a marked gastrointestinal(GI)fungal dysbiosis together with perturbation of the lung-gut axis has been observed in severe COVID-19 patients.This combined with neutrophilia and an exacerbated worsening of the inflammatory response,which can be implicated in the acute and chronic immunopathology of such a viral disease[7,8].Furthermore,persistent changes in the immune system may also occur,resulting in a possible relationship with the occurrence of long COVID[7].However,more targeted evidence is still scarce and the specific topic related to gut candidiasis has been the subject of little discussion.In response to this,in this article we discuss general aspects of long COVID,the inherent pathophysiology and current evidence of a potential relationship between this condition and gut candidiasis,in addition to providing recommendations for future research.ACKNOWLEDGEMENTS Tovani-Palone MR thanks the Saveetha Institute of Medical and Technical Sciences for supporting this study.

外阴阴道假丝酵母菌病的中医治疗现状

外阴阴道假丝酵母菌病是一种常见的妇科疾病,具有发病率与复发率高的特点,严重影响女性日常生活及心理健康。西医主要以抗真菌药物治疗,长期使用会导致多系统、多脏器损伤,使阴道菌群失衡,增加二重感染风险,甚至产生耐药性,疗效欠佳。中医疗法具有毒副作用小、多系统共调、有效等特点,患者易于接受。通过查阅近年来中医内服、外治疗法治疗外阴阴道假丝酵母菌病的文献,从病因病机着手,引用历代医籍、医家的理论以分析疗法的合理性和有效性,以期为临床治疗提供借鉴。

Menstrual and Reproductive Characteristics of Patients with Primary Sjogren’s Syndrome:A 7-year Single-center Retrospective Study

Objective Primary Sjogren’s syndrome(pSS)is a systemic autoimmune disease that mainly affects the exocrine gland,especially in women.Currently,the results of studies on the menstruation or fertility of pSS patients remain controversial.This study aimed to examine the menstrual and reproductive characteristics of pSS patients.Methods Clinical data of 449 pSS patients who were admitted to Tongji Hospital in Hubei,China,from January 2015 to November 2021 were obtained and their menstrual and reproductive information analyzed.In addition,the clinical features of pSS patients with premenopausal or postmenopausal onset were compared.Results The spontaneous abortion rate of pSS patients was not higher than the reported rate of the general population and that the age of menarche,menstrual cycle,and menstrual period of pSS patients did not significantly differ from those reported in the general population;however,early menopause seemed to be more common in pSS patients.Skin involvement(27.96%vs.15.00%,P=0.005)and hyperglobulinemia(10.64%vs.4.16%,P=0.033)were more common in patients with premenopausal pSS onset,but patients with postmenopausal onset had a significantly greater incidence of interstitial lung disease(32.50%vs.17.02%,P=0.0004).Also,erythropenia(47.00%vs.31.25%,P=0.002),hypoalbuminemia(19.49%vs.8.22%,P=0.0009),and prevalence of high hypersensitive C-reactive protein levels(21.67%vs.10.94%,P=0.005)were more common in pSS patients with postmenopausal onset.Notably,the rate of abnormal pregnancy was significantly greater in patients with premenopausal onset(9.72%vs.2.50%,P=0.011).Conclusion Patients with pSS onset before or after menopause may have different risks in pulmonary involvement and laboratory manifestations.

Lessons from Sj?gren's syndrome etiopathogenesis:Novel cellular and molecular targets

Sjogren’s syndrome （SS） is a systemic autoimmune disease that affects primarily the lacrimal and salivary glands. In addition to a systemic autoimmune response directed against ubiquitous antigens （such as Ro and La antigens）, patients with SS mount a localized response that affects the epithelial component of exocrine glands leading to the establishment of a destructive inflammatory infiltrate comprised of activated T and B cells. Local chemokine and cytokine production drive the recruitment and local activation of immune cells that cause injury to acinar cells. CD4 T cells with different functional differentiation programs including Th1 （IFN-γ）, Th2 （IL-13, IL-4） and Th17 （IL-17, IL-21, IL-22） as well as diverse cytokine signaling pathways, are involved at the initiation, perpetuation, and progression of the disease. Which factors initiate this response and allow it to become chronic are unknown. Proposed mecha-nisms include viral infections and acinar cell apoptosis. Moreover risk-conferring genetic variants, probably through the facilitation of innate and adaptive immune activation, most certainly contribute to the creation of an underlying environment that fosters tolerance loss and facilitates perpetuation of the autoimmune response. In this review, we describe the mechanisms through which the immune response causes SS and emphasize the pathways that are amenable of being targeted with therapeutic purposes.

Sjgren’s综合征伴发白色念珠菌感染的临床研究

作者对38例Si(?)gren’s综合征(SS)患者合并白色念球菌感染情况进行了临床分析.结果显示:与对照组相比,SS患者口腔中白色念珠菌感染的阳性率高于对照组(P<0.05).同时发现白念感染的程度与唾流量多少关系密切,其中唾液不足6ml者,白念培养阳性率明显高于流量超过6ml者(PM<O.001).SS 患者并发口腔念珠菌感染常见的临床表现形成为舌乳头萎缩、发红,伴有重裂形成.另外,口角炎及义齿性口炎也常见到.

基于夏桂成改邪养正观探讨重建RVVC患者阴道微生态的辨治思路与方法

复发性外阴阴道假丝酵母菌病(RVVC)较难治愈,常反复发作,病程缠绵。国医大师夏桂成教授团队基于改邪养正学术观点,以分消走泄为基本治法,调理阴道整体内环境为立足点,重建阴道微生态为基础,扶植优势菌群如乳酸杆菌等的恢复,从而纠正局部免疫微环境的失调,发挥治愈疾病的目的,并研发了加味二妙颗粒用于临床治疗。

微循环营养药二羟苯磺酸钙的合成

设计用对苯二酚为起始原料，经重铬酸钾氧化、连二硫酸钾加成及高氯酸钙置换三步反应合成了微循环营养药二羟苯磺酸钙。经甲苯－乙醇洗涤，热水重结晶得纯品，薄层色谱检查无明显杂质斑点，Ｒｆ值＝０．５３，ＨＬＣＴ测定结果表明，纯度在９９％以上，化学结构由ＩＲ和元素分析证实。

完带汤联合氟康唑胶囊治疗复发性外阴阴道假丝酵母菌病临床观察

目的:观察完带汤联合氟康唑胶囊治疗复发性外阴阴道假丝酵母菌病(RVVC)肝郁脾虚证的临床疗效,及对患者阴道pH值的影响。方法:选取82例RVVC肝郁脾虚证患者,随机分为治疗组及对照组各40例。对照组给予氟康唑胶囊治疗,治疗组在对照组用药基础上加用完带汤。治疗后观察2组临床症状的改善情况及阴道pH值的变化,比较2组复发率。结果:治疗组临床治愈率为81.0%,对照组临床治愈率为57.5%,2组比较,差异有统计学意义(P<0.05)。治疗后,2组阴道pH值均较治疗前下降(P<0.05)。随访6月,治疗组的阴道pH值与同组治疗后比较,差异无统计学意义(P>0.05);对照组的阴道pH值较同组治疗后升高(P<0.05)。治疗结束6月,治疗组的复发率低于对照组,差异有统计学意义(P<0.05)。结论:完带汤联合氟康唑胶囊治疗RVVC肝郁脾虚证,能提高临床治愈率,降低阴道pH值,减少复发。

两性霉素B雾化吸入治疗AIDS合并口腔念珠菌病的疗效观察

【目的】探讨两性霉素B雾化吸入治疗HIV感染者/艾滋病患者(HIV/AIDS)合并口腔念珠菌病的疗效及安全性。【方法】随机选取2017年6月至2018年6月于本院住院的HIV/AIDS合并口腔白色念珠菌病的患者55例,应用两性霉素B雾化吸入,观察疗效及不良反应。【结果】两性霉素B雾化吸入治疗HIV/AIDS合并口腔念珠菌病的总有效率为96.4%。不良反应咳嗽的发生率为9.0%,恶心的发生率为5.5%,但均能耐受。【结论】两性霉素B雾化吸入治疗HIV/AIDS合并口腔念珠菌病安全有效,不良反应少,值得临床推广。

脾虚湿阻型复发性外阴阴道假丝酵母菌病的阴道微生态研究

目的:研究复发性外阴阴道假丝酵母菌病(Recurrent Vulvovaginal Candidiasis,RVVC)脾虚湿阻证的阴道微生态特点。方法:收集RVVC患者35例(脾虚湿阻证30例,湿热证5例),外阴阴道假丝酵母菌病(Vulvovaginal Candidiasis,VVC)患者39例(脾虚湿阻证30例,湿热证9例),正常组37例,通过比较证候分布及积分来探讨RVVC患者证候特点,以高通量测序(Illumina MiSeq Seguencing)作为研究手段,通过比较阴道微生态异同来阐析RVVC脾虚湿阻证阴道微生态与RVVC发病之间的关系。结果:RVVC组与VVC组间证型分布差异无统计学意义。两组脾虚湿阻证积分、过氧化氢(H_(2)O_(2))阳性率比较差异有统计学意义(P<0.05)。RVVC组湿热证患者阴道pH值与脾虚湿阻证患者阴道pH值比较差异有统计学意义(P<0.0001);RVVC组(35~45岁)较组内(20~34岁)阴道pH值升高(P=0.0004);VVC组(20~34岁)较组内(35~45岁)阴道pH值升高(P=0.0008);RVVC组的阴道菌落多样性下降;RVVC组、VVC组脾虚湿阻证患者的阴道菌落丰度均显著下降。结论:RVVC脾虚湿阻证与湿热证患者的阴道微生态功能均存在一定的失调,但RVVC湿热证患者表现更为显著,其阴道pH值较脾虚湿阻证患者显著升高;RVVC组脾虚湿阻证积分较VVC组脾虚湿阻证积分高,说明VVC反复发作,久则深入,或本自脾虚湿易潜伏,治宜扶正祛邪。RVVC脾虚湿阻证患者的阴道菌落多样性下降,乳酸杆菌占比升高,治疗RVVC需重视重建阴道菌落丰度,促进优势菌群功能的恢复。

Role of Helicobacter pylori infection in autoimmune systemic rheumatic diseases

The relationship between infection and autoimmunity has been increasingly defined over the last 20 years. The systemic rheumatic diseases are characterized by dysregulation of the immune system resulting in a loss of tolerance to self-antigen. The exact etiology for the majority of these diseases is unknown; however, a complex combination of host and environmental factors are believed to play a pivotal role. Helicobacter pylori(H. pylori) is one of the most widely studied infectious agents proposed as agents triggering autoimmune response. The persistent presence of H. pylori in the gastric mucosa results in chronic immune system activation with ongoing cytokine signaling, infiltration of gastric mucosa by neutrophils, macrophages, lymphocytes, as well as production of antibodies and effector T-cells. Various mechanisms have been proposed in an attempt to explain the extra-intestinal manifestations of H. pylori infections. These include: molecular mimicry, endothelial cell damage, superantigens and microchimerism. I performed a systematic literature review using the keywords "rheumatoid arthritis", "Sjgren's syndrome", "systemic sclerosis", "systemic lupus erythematosus","Helicobacter pylori " and "pathogenesis". A systematic literature search was carried out in MEDLINE; EMBASE; Cochrane Library and ACR/EULAR meeting abstracts. In systemic rheumatic diseases H. pylori infection prevalence alone should not be expected to provide sufficient evidence for or against a pathologic role in the disease. In this article Ⅰ review studies examining the potential involvement of H. pylori infection in autoimmune systemic rheumatic diseases. Further studies of the immunological response to H. pylori and its role in the pathogenesis of systemic rheumatic diseases are warranted.