The Relationship Between Pathological Findings of Minor Salivary Gland Biopsy Performed at the Time of Diagnosis and Schirmer Test and Serological Tests in Patients with primary Sjögren's Syndrome
Öz
Aim
Our aim was to assess the correlation between minor salivary gland pathology and the results of Schirmer and serological tests conducted during the diagnosis of primary Sjögren's syndrome (pSS).
Method
A total of 41 patients who were diagnosed with pSS after having serological tests, minor salivary gland biopsy and Schirmer test performed at our institution at the time of diagnosis between June 2018 and July 2023 were included in the study. Focus score, atrophy and fibrosis values were scored in biopsy samples. The relationship between histopathological findings and clinical, Schirmer test and serological tests was evaluated.
Results
Of the 41 patients, 38 were female (92.7%), 3 (7%) were male, and the average age was 55.54 ± 14.06. In patients with focal score≥1, antinuclear antibody value≥1/320 (42.9%), rheumatoid factor positivity (28.6%), anti Sjögren's syndrome (SS) A/SSB positivity (76.2%, 38.1%) ) was detected at a higher rate. Additionally, acinar atrophy and fibrosis were higher in patients with focus score≥1, and there was a significant relationship between fibrosis (p<0.008). A significant correlation was detected between age with acinar atrophy and fibrosis score1≥ (p=0.030, p=0.006) and between dry mouth with fibrosis (p=0.008). In multivariate analysis, schimer test positivity in focal score was observed as an independent risk factor (OR = 22.531, 95%CI 1.369–370.174).
Conclusion
In our study, a high focus score was found to be correlated with positive serological tests and impaired exocrine functions, and a positive Schirmer test was found to have an increasing effect on the focus score.
Anahtar Kelimeler
Minör tükürük bezi biyopsisi Serolojik Testler Schirmer testi Sjögren sendromu
Etik Beyan
T.C. RECEP TAYYİP ERDOĞAN ÜNİVERSİTESİ Girişimsel Olmayan Klinik Araştırmalar Etik Kurul Başkanlığı Sayı : E-40465587-050.01.04-1030 24.04.2024 Konu : Etik Kurul Sayın Dr. Öğr. Üyesi Osman CÜRE Üniversitemiz Girişimsel Olmayan Klinik Araştırmalar Etik Kuruluna yapmış olduğunuz “Romatoloji polikliniğinde sjögren sendromu tanısı almış hastalarının klinik ve otoantikor pozitifliği ile minör tükrük bezi biopsisinde bakılan inflamasyon skorlarının karşılaştırılması ” isimli başvurunuz etik kurulumuz yönergesine göre 18.04.2024 tarihinde yapmış olduğu toplantıda incelenmiş olup, 2024/84 karar numarası ile bilimsel ve etik yönden uygun bulunmuştur. Bilgilerinizi ve gereğini saygılarımla rica ederim. Doç. Dr. Tahsin Gökhan TELATAR Başkan
Kaynakça
- 1. Negrini S, Emmi G, Greco M, et al (2022) Sjögren's syndrome: a systemic autoimmune disease. Clin Exp Med 22(1):9-25. https://doi: 10.1007/s10238-021-00728-6
- 2. Singh AG, Singh S, Matteson EL (2016) Rate, risk factors and causes of mortality in patients with Sjögren's syndrome: a systematic review and meta-analysis of cohort studies. Rheumatology 55(3):450-60. https:// doi:10.1093/rheumatology/kev354
- 3. Shiboski CH, Shiboski SC, Seror R, et al (2017) International Sjögren's Syndrome Criteria Working Group. 2016 American College of Rheumatology/European League Against Rheumatism classification criteria for primary Sjögren's syndrome: A consensus and data-driven methodology involving three international patient cohorts. Ann Rheum Dis 76(1):9-16. https:// doi: 10.1136/annrheumdis-2016-210571
- 4. Zhan Q, Zhang J, Lin Y, Chen W, Fan X, Zhang D (2023) Pathogenesis and treatment of Sjogren's syndrome: Review and update. Front Immunol 14:1127417.https:// doi:10.3389/fimmu.2023.1127417
- 5. Konsta OD, Le Dantec C, Charras A, et al (2016) Defective DNA methylation in salivary gl and epithelial acini from patients with Sjögren's syndrome is associated with SSB gene expression, anti-SSB/LA detection, and lymphocyte infiltration. J Autoimmun 68:30-8. https://doi: 10.1016/j.jaut.2015.12.002
- 6. Kyriakidis NC, Kapsogeorgou EK, Tzioufas AG (2014) A comprehensive review of autoantibodies in primary Sjögren's syndrome: clinical phenotypes and regulatory mechanisms. J Autoimmun 51:67-74. https://doi: 10.1016/j.jaut.2013.11.001
- 7. Hernández-Molina G, Avila-Casado C, Nuñez-Alvarez C, et al (2015) Utility of the American-European Consensus Group and American College of Rheumatology Classification Criteria for Sjögren's syndrome in patients with systemic autoimmune diseases in the clinical setting. Rheumatology (Oxford) 54(3):441-8. https://doi:10.1093/rheumatology/keu352
- 8. Vitali C, Bombardieri S, Jonsson R, Moutsopoulos HM, et al (2002) and the European Study Group on Diagnostic Criteria for Sjo¨gren’s Syndrome. Classification criteria for Sjo¨gren’s syndrome: a revised version of the European criteria proposed by the American-European Consensus Group. Ann Rheum Dis 61:554–8. https://doi: 10.1136/ard.61.6.554. P
- 9. Daniels, T., Greenspan, J. S., Cox, D., Criswell, L. A., DeSouza, Y., & Dong, Y (2007) Objective measures in Sjögren’s syndrome are strongly associated with each other but not with sicca symptoms: analysis of 564 enrollees in the SICCA international registry and repository. Arthritis Rheum 56(Suppl), S446
- 10. Daniels TE, Cox D, Shiboski CH, et al (2011) Sjögren's International Collaborative Clinical Alliance Research Groups. Associations between salivary gland histopathologic diagnoses and phenotypic features of Sjögren's syndrome among 1,726 registry participants. Arthritis Rheum 63(7):2021-30. https://doi: 10.1002/art.30381
- 11. Triantafyllias K, Bach M, Otto M, et al (2023) Diagnostic Value of Labial Minor Salivary Gland Biopsy: Histological Findings of a Large Sicca Cohort and Clinical Associations.Diagnostics13(19):3117. https://doi:10.3390/diagnostics13193117
- 12. Tzioufas AG, Tatouli IP, Moutsopoulos HM et al (2012) Autoantibodies in sjögren's syndrome: Clinical presentation and regulatory mechanisms. Presse Med 41:e451–60. https://doi: 10.1016/j.lpm.2012.05.022
- 13. Ramos-Casals M, Solans R, Rosas J, et al (2008) Primary sjögren syndrome in Spain: Clinical and immunologic expression in 1010 patients. Med (Baltimore) 87:210–9
- 14. Haldorsen K, Moen K, Jacobsen H, et al (2008) Exocrine function in primary Sjögren syndrome: natural course and prognostic factors. Ann Rheum Dis 67(7):949-54. doi: 10.1136/ard.2007.074203
- 15. Llamas-Gutierrez FJ, Reyes E, Martínez B, et al (2014) Histopathological environment besides the focus score in Sjögren's syndrome. Int J Rheum Dis 17(8):898-903. https://doi: 10.1111/1756-185X.12502
- 16. Erkılınç G, Doğru A, Arslan Y, et al (2021) Evaluation of histopathological results of minor salivary gland biopsies in patients with the diagnosis of Sjögren's syndrome. Arch Rheumatol. 2021;37(1):49-58. https://doi: 10.46497/ArchRheumatol.2022.8607
Primer Sjögren Sendromlu Hastalarda Tanı Anında Yapılan Minör Tükürük Bezi Biyopsisindeki Patolojik Bulgular ile Schirmer Testi ve Serolojik Testler Arasındaki İlişki
Öz
Giriş ve Amaç
Primer Sjögren sendromlu (pSS) hastalarda tanı anında yapılan minör tükrük bezi patolojisi ile schirmer testi ve serolojik test sonuçları arasındaki ilişkiyi değerlendirmeyi amaçladık.
Gereç ve Yöntemler
Haziran 2018-Temmuz 2023 tarihleri arasında tanı anında kurumumuzda serolojik testleri, minör tükürük bezi biyopsisi ve schirmer testi yapılıp pSS tanısı alan toplam 41 hasta çalışmaya dahil edildi. Biyopsi örneklerinde odak skoru, atrofi ve fibrozis değerleri skorlandı. Histopatolojik bulgular ile demografik, klinik, schirmer testi ve serolojik testler arasındaki ilişki değerlendirildi.
Bulgular
41 hastanın 38'i (%92,7) kadın, 3'ü (%7) erkek olup yaş ortalaması 55,54±14,06 idi. Fokus skoru≥1 olan hastalarda; antinükleer antikor değeri≥1/320 (%42,9), romatoid faktör pozitifliği (%28,6), anti Sjögren sendromu (SS) A/SSB pozitifliği (%76,2, %38,1) daha yüksek oranda saptandı. Ayrıca, fokus skoru≥1 olan hastalarda asiner atrofi ve fibrozis daha yüksek olmakla fibrozisle arasında anlamlı ilişki vardı (p<0.008). Yaş ile asiner atrofi ve fibrozis skoru1≥ arasında (p=0,030, p=0,006) ve ağız kuruluğu ile fibrozis arasında (p=0,008) anlamlı korelasyon saptandı. Çok değişkenli analizde fokus skorunda schimer testi pozitifliği bağımsız bir risk faktörü olarak gözlendi (OR = 22,531, %95CI 1,369–370,174).
Sonuç
Çalışmamızda yüksek fokus skorunun serolojik testlerin pozitifliği ve ekzokrin fonksiyonların bozulmasıyla ilişkili olduğu, Schirmer testinin pozitif olmasının fokus skorunu artırıcı etkisi olduğu belirlendi.
Anahtar Kelimeler
Minör tükürük bezi biyopsisi Serolojik Testler Schirmer testi Sjögren sendromu
Kaynakça
- 1. Negrini S, Emmi G, Greco M, et al (2022) Sjögren's syndrome: a systemic autoimmune disease. Clin Exp Med 22(1):9-25. https://doi: 10.1007/s10238-021-00728-6
- 2. Singh AG, Singh S, Matteson EL (2016) Rate, risk factors and causes of mortality in patients with Sjögren's syndrome: a systematic review and meta-analysis of cohort studies. Rheumatology 55(3):450-60. https:// doi:10.1093/rheumatology/kev354
- 3. Shiboski CH, Shiboski SC, Seror R, et al (2017) International Sjögren's Syndrome Criteria Working Group. 2016 American College of Rheumatology/European League Against Rheumatism classification criteria for primary Sjögren's syndrome: A consensus and data-driven methodology involving three international patient cohorts. Ann Rheum Dis 76(1):9-16. https:// doi: 10.1136/annrheumdis-2016-210571
- 4. Zhan Q, Zhang J, Lin Y, Chen W, Fan X, Zhang D (2023) Pathogenesis and treatment of Sjogren's syndrome: Review and update. Front Immunol 14:1127417.https:// doi:10.3389/fimmu.2023.1127417
- 5. Konsta OD, Le Dantec C, Charras A, et al (2016) Defective DNA methylation in salivary gl and epithelial acini from patients with Sjögren's syndrome is associated with SSB gene expression, anti-SSB/LA detection, and lymphocyte infiltration. J Autoimmun 68:30-8. https://doi: 10.1016/j.jaut.2015.12.002
- 6. Kyriakidis NC, Kapsogeorgou EK, Tzioufas AG (2014) A comprehensive review of autoantibodies in primary Sjögren's syndrome: clinical phenotypes and regulatory mechanisms. J Autoimmun 51:67-74. https://doi: 10.1016/j.jaut.2013.11.001
- 7. Hernández-Molina G, Avila-Casado C, Nuñez-Alvarez C, et al (2015) Utility of the American-European Consensus Group and American College of Rheumatology Classification Criteria for Sjögren's syndrome in patients with systemic autoimmune diseases in the clinical setting. Rheumatology (Oxford) 54(3):441-8. https://doi:10.1093/rheumatology/keu352
- 8. Vitali C, Bombardieri S, Jonsson R, Moutsopoulos HM, et al (2002) and the European Study Group on Diagnostic Criteria for Sjo¨gren’s Syndrome. Classification criteria for Sjo¨gren’s syndrome: a revised version of the European criteria proposed by the American-European Consensus Group. Ann Rheum Dis 61:554–8. https://doi: 10.1136/ard.61.6.554. P
- 9. Daniels, T., Greenspan, J. S., Cox, D., Criswell, L. A., DeSouza, Y., & Dong, Y (2007) Objective measures in Sjögren’s syndrome are strongly associated with each other but not with sicca symptoms: analysis of 564 enrollees in the SICCA international registry and repository. Arthritis Rheum 56(Suppl), S446
- 10. Daniels TE, Cox D, Shiboski CH, et al (2011) Sjögren's International Collaborative Clinical Alliance Research Groups. Associations between salivary gland histopathologic diagnoses and phenotypic features of Sjögren's syndrome among 1,726 registry participants. Arthritis Rheum 63(7):2021-30. https://doi: 10.1002/art.30381
- 11. Triantafyllias K, Bach M, Otto M, et al (2023) Diagnostic Value of Labial Minor Salivary Gland Biopsy: Histological Findings of a Large Sicca Cohort and Clinical Associations.Diagnostics13(19):3117. https://doi:10.3390/diagnostics13193117
- 12. Tzioufas AG, Tatouli IP, Moutsopoulos HM et al (2012) Autoantibodies in sjögren's syndrome: Clinical presentation and regulatory mechanisms. Presse Med 41:e451–60. https://doi: 10.1016/j.lpm.2012.05.022
- 13. Ramos-Casals M, Solans R, Rosas J, et al (2008) Primary sjögren syndrome in Spain: Clinical and immunologic expression in 1010 patients. Med (Baltimore) 87:210–9
- 14. Haldorsen K, Moen K, Jacobsen H, et al (2008) Exocrine function in primary Sjögren syndrome: natural course and prognostic factors. Ann Rheum Dis 67(7):949-54. doi: 10.1136/ard.2007.074203
- 15. Llamas-Gutierrez FJ, Reyes E, Martínez B, et al (2014) Histopathological environment besides the focus score in Sjögren's syndrome. Int J Rheum Dis 17(8):898-903. https://doi: 10.1111/1756-185X.12502
- 16. Erkılınç G, Doğru A, Arslan Y, et al (2021) Evaluation of histopathological results of minor salivary gland biopsies in patients with the diagnosis of Sjögren's syndrome. Arch Rheumatol. 2021;37(1):49-58. https://doi: 10.46497/ArchRheumatol.2022.8607
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Romatoloji ve Artrit |
| Bölüm | Araştırma Makalesi |
| Yazarlar | |
| Erken Görünüm Tarihi | 26 Mart 2025 |
| Yayımlanma Tarihi | 26 Mart 2025 |
| Gönderilme Tarihi | 30 Nisan 2024 |
| Kabul Tarihi | 24 Şubat 2025 |
| Yayımlandığı Sayı | Yıl 2025 Cilt: 12 Sayı: 1 |
