An investigation of interactions between the immune system and stimulus–secretion coupling in mouse submandibular acinar cells. A possible mechanism to account for reduced salivary flow rates associated with the onset of Sjögren's syndrome

Abstract Sjogren’s syndrome (SS) is a complex, chronic, systemic, autoimmune disease that mainly affects the exocrine glands, especially the salivary and lacrimal glands, leading to the dryness of the mouth and eyes, along with fatigue, joint and muscle pain. The prevalence of SS is estimated to be between 0.05% and 1% in European population. Diagnosis of SS is based on the revised criteria of the American-European consensus group (AECG). Sjogren’s syndrome can be subclassified into primary disease (primary Sjogren syndrome, pSS) and a secondary disease (secondary Sjogren syndrome, sSS) when present with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and systemic sclerosis. The decrease in salivary flow and qualitative alterations in saliva could explain many of the oral manifestations frequently present in patients with SS. Low salivary flow may affect chewing, swallowing, speech and sleeping in pSS patients. Oral manifestations include dental erosion, dental caries, mucosal infection, ulcers and oral candidiasis. Recent studies reveal that pSS patients experience impaired olfactory and gustatory functions and have higher occurrence of oral complications such as dysgeusia, burning sensation in the tongue (BST) and halitosis. The exocrine manifestations and systemic involvement in SS significantly impact the patient’s perception of oral healthrelated quality of life (OHRQoL).

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Sjögren’s syndrome—management

Oxford Textbook of Rheumatology ◽

10.1093/med/9780199642489.003.0128_update_003 ◽

2013 ◽

pp. 1054-1059

Author(s):

Wan-Fai Ng ◽

Arjan Vissink ◽

Elke Theander ◽

Francisco Figueiredo

Keyword(s):

Sjögren’S Syndrome ◽

Sjögren's Syndrome ◽

Sjogren’S Syndrome ◽

Salivary Flow ◽

Sjogren's Syndrome ◽

Classification Criteria ◽

Disease Assessment ◽

American College Of Rheumatology ◽

Assessment And Treatment ◽

Sjögren‘S Syndrome

Management of Sjögren’s syndrome (SS) encompasses confirmation of diagnosis, disease assessment, and treatment of glandular and systemic manifestations including special situations such as pregnancy and SS-related lymphoma. The 2016 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) classification criteria are the current gold standard for the diagnosis of SS. These criteria replace the 2002 American European Consensus Group (AECG) classification criteria. Salivary gland sialometry, sialochemistry, and ultrasound and tear osmolarity may be useful adjuncts. Symptoms of SS are non-specific and must be actively explored. When assessing patients with SS, it is important to consider not only objective parameters such as abnormalities in blood tests and changes in tear and salivary flow, but also patient-reported outcome measures and impact on quality of life. Current management of patients with SS is hampered by the lack of evidence-based strategies. The symptoms experienced by patients with SS are often not fully appreciated by clinicians, which may contribute to the suboptimal management of the condition. Management of fatigue remains a major challenge and a holistic, multidisciplinary approach is recommended. Factors that may contribute to fatigue should be fully addressed. Recent advances in the understanding of the pathogenic mechanisms of SS have informed more targeted therapeutic strategies with some promising data. Optimal management of SS requires expertise from different disciplines. Combined clinics with rheumatology, oral medicine, and ophthalmology input will improve care and communications as well as reduce the number of clinic visits for patients and healthcare-related cost. Effective link between pSS specialists, dentists, opticians, and general practitioners will facilitate early diagnosis and reduce risk of long-term disability of SS.

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Sjögren’s syndrome—management

10.1093/med/9780199642489.003.0128_update_001 ◽

2014 ◽

Author(s):

Wan-Fai Ng ◽

Arjan Vissink ◽

Elke Theander ◽

Francisco Figueiredo

Keyword(s):

Sjögren’S Syndrome ◽

Sjögren's Syndrome ◽

Sjogren’S Syndrome ◽

Salivary Flow ◽

Patient Reported Outcome Measures ◽

Sjogren's Syndrome ◽

Classification Criteria ◽

Disease Assessment ◽

Patient Reported ◽

Sjögren‘S Syndrome

Management of Sjögren’s syndrome (SS) encompasses confirmation of diagnosis, disease assessment, and treatment of glandular and systemic manifestations including special situations such as pregnancy and SS-related lymphoma. The American European Consensus Group (AECG) classification criteria 2002 are the current gold standard for the diagnosis of SS. Salivary gland sialometry, sialochemistry, and ultrasound and tear osmolarity may be useful adjuncts. Recently, preliminary classification criteria of the American College of Rheumatology have been introduced as an alternative to the AECG criteria. Symptoms of SS are non-specific and must be actively explored. When assessing patients with SS, it is important to consider not only objective parameters such as abnormalities in blood tests and changes in tear and salivary flow, but also patient-reported outcome measures and impact on quality of life. Current management of patients with SS is hampered by the lack of evidence-based strategies. The symptoms experienced by patients with SS are often not fully appreciated by clinicians, which may contribute to the suboptimal management of the condition. Management of fatigue remains a major challenge and a holistic, multidisciplinary approach is recommended. Factors that may contribute to fatigue should be fully addressed. Recent advances in the understanding of the pathogenic mechanisms of SS have informed more targeted therapeutic strategies with some promising data. Optimal management of SS requires expertise from different disciplines. Combined clinics with rheumatology, oral medicine, and ophthalmology input will improve care and communications as well as reduce the number of clinic visits for patients and healthcare-related cost. Effective link between pSS specialists, dentists, opticians, and general practitioners will facilitate early diagnosis and reduce risk of long-term disability of SS.

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Measurement of whole unstimulated salivary flow in the diagnosis of Sjogren's syndrome.

Annals of the Rheumatic Diseases ◽

10.1136/ard.51.4.499 ◽

1992 ◽

Vol 51 (4) ◽

pp. 499-502 ◽

Cited By ~ 27

Author(s):

P M Speight ◽

A Kaul ◽

R D Melsom

Keyword(s):

Sjögren’S Syndrome ◽

Sjögren's Syndrome ◽

Sjogren’S Syndrome ◽

Salivary Flow ◽

Sjogren's Syndrome ◽

Sjögren‘S Syndrome

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Electrical Stimulation of Salivary Flow in Patients with Sjögren's Syndrome

Journal of Dental Research ◽

10.1177/00220345880670101701 ◽

1988 ◽

Vol 67 (10) ◽

pp. 1334-1337 ◽

Cited By ~ 35

Author(s):

M. Steller ◽

L. Chou ◽

T.E. Daniels

Keyword(s):

Electrical Stimulation ◽

Sjögren's Syndrome ◽

Sjogren’S Syndrome ◽

Salivary Flow ◽

Sjogren's Syndrome ◽

Flow Rates ◽

Active Devices ◽

Whole Saliva ◽

Saliva Flow ◽

Sjögren‘S Syndrome

Patients with the salivary component of Sjögren's syndrome (SS) develop chronic xerostomia, which causes oral symptoms and functional impairment in approximate proportion to its severity. The purpose of this double-blind study was to determine whether an electrical stimulus applied to the tongue and hard palate by a battery-operated device (SAL II, Biosonics, Inc.) could stimulate salivary flow in subjects with generally severe SS. Twenty-nine patients with the salivary component of SS (diagnosed as the presence of focal chronic sialadenitis in a labial salivary gland biopsy specimen with a focus score of > 1 focus/4 mm2) were randomly assigned active or placebo devices, which they used for three minutes, three times a day for four weeks. Whole saliva flow rates were measured at weeks 0, 2, and 4 by collection of whole saliva both before and after stimulation with the device. Twenty-four subjects completed the study. The change in mean post-stimulation flow rate from week 0 to week 4 was greater for the 13 subjects using an active device (0.08 ± S.D. 0.08 gl2 min, to 0.24 ± 0.33 gl2 min) than for the 11 subjects using a placebo device (0.11 ± 0.15 gl2 min, to 0.08 ± 0.18 gl2 min) (p = 0.04). However, the magnitude of the mean difference was small, because three subjects using active devices responded and others did not. Only five subjects, all using active devices, reported a subjective increase in the amount of their saliva. The results of this study indicate that some SS patients with residual salivary flow show a significant response to electrical stimulation, but others with low or absent whole saliva flow rates do not respond.

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Localization of 99mTechnetium in the Region of the Nose in Sjögren's Syndrome

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348947408300313 ◽

1974 ◽

Vol 83 (3) ◽

pp. 370-378 ◽

Cited By ~ 3

Author(s):

Alfred E. Jones ◽

Alvin L. Larson ◽

Ralph D. Powell ◽

Gerald S. Johnston ◽

Robert I. Henkin

Keyword(s):

Sjögren’S Syndrome ◽

Mucous Membrane ◽

Sjögren's Syndrome ◽

Sjogren’S Syndrome ◽

Salivary Flow ◽

Sjogren's Syndrome ◽

Control Group ◽

Nasal Mucous Membrane ◽

Nasal Region ◽

Sjögren‘S Syndrome

Patients with Sjögren's syndrome accumulated abnormal amounts of 99mtechnetium pertechnetate in the region of the nose during isotopic salivary flow studies. It was concurrently and independently observed that many patients with Sjögren's syndrome had hyposmia and pathological changes in the nasal mucous membranes. Fourteen patients with Sjögren's syndrome were studied for the relationship of the above observations and the nasal accumulation of radionuclide was compared with a control group of 16 subjects. Eleven of 14 patients with Sjögren's syndrome (78%) had nasal accumulation of the radionuclide; 14 had hyposmia and 13 of 14 had chronic inflammation of the nasal mucous membrane. One of 16 controls (6%) localized radionuclide in the nasal region. Results suggest that hyposmia, inflammatory changes in the nasal mucous membrane, and nasal accumulation of 99mtechnetium pertechnetate are interrelated aspects of Sjögren's syndrome.

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Sjögren’s syndrome—management

10.1093/med/9780199642489.003.0128 ◽

2013 ◽

Author(s):

Wan-Fai Ng ◽

Arjan Vissink ◽

Elke Theander ◽

Francisco Figueiredo

Keyword(s):

Sjögren’S Syndrome ◽

Sjögren's Syndrome ◽

Sjogren’S Syndrome ◽

Salivary Flow ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Sjogren's Syndrome ◽

Disease Assessment ◽

Patient Reported ◽

Sjögren‘S Syndrome

Management of Sjögren's syndrome (SS) encompasses confirmation of diagnosis, disease assessment, and treatment of glandular and systemic manifestations including special situations such as pregnancy and SS-related lymphoma. The American European Consensus Group classification criteria 2002 are the current gold standard for the diagnosis of SS. Salivary gland sialometry, sialochemistry, and ultrasound and tear osmolarity may be useful adjuncts. Symptoms of SS are non-specific and must be actively explored. When assessing patients with SS, it is important to consider not only objective parameters such as abnormalities in blood tests and changes in tear and salivary flow, but also patient-reported outcome measures and impact on quality of life. Current management of patients with SS is hampered by the lack of evidence-based strategies. The symptoms experienced by patients with SS are often not fully appreciated by clinicians, which may contribute to the suboptimal management of the condition. Management of fatigue remains a major challenge and a holistic, multidisciplinary approach is recommended. Factors that may contribute to fatigue should be fully addressed. Recent advances in the understanding of the pathogenic mechanisms of SS have informed more targeted therapeutic strategies with some promising data. Optimal management of SS requires expertise from different disciplines. Combined clinics with rheumatology, oral medicine, and ophthalmology input will improve care and communications as well as reduce the number of clinic visits for patients and healthcare-related cost. Effective link between pSS specialists, dentists, opticians, and general practitioners will facilitate early diagnosis and reduce risk of long-term disability of SS.

Download Full-text