Ultrasound shear wave elastography for assessing minor salivary gland involvement in anti-centromere antibody-positive primary Sjögren's syndrome: a retrospective study.
The aim of this study is to investigate salivary gland involvement in patients with anti-centromere antibody (ACA)-positive primary Sjögren's syndrome (pSS). We retrospectively evaluated 134 patients with pSS. Patients were divided into four groups based on the results of ACA and SSA antibodies. We compared clinical manifestations, laboratory findings, salivary gland shear wave elastography, minor salivary gland biopsy results, and EULAR Sjögren's syndrome disease activity index (ESSDAI) scores among the four groups. A total of 134 patients were classified as having pSS and divided into three groups based on serum ACA and anti-SSA antibody status: ACA + SSA + , ACA + SSA-, ACA-SSA + , and seronegative. The primary analysis focused on comparing the clinical and SWE findings between the ACA + SSA + and ACA + SSA- groups. In the double-positive group, SWE revealed fewer minor salivary glands along with higher mean (Emean) and maximum (Emax) values of Young's moduli than those in the ACA-negative group. Patients in the positive group had increased occurrence of Raynaud's phenomenon, liver involvement, and a higher incidence of malignancy (P < 0.05). ACA-positive pSS patients are a subgroup with different clinical manifestations and more pronounced involvement of the minor salivary glands. SWE findings revealed that ACA-positive patients exhibit significantly higher mean and maximum stiffness values compared to ACA-negative patients, indicating more extensive glandular fibrosis and involvement. These results underscore the utility of SWE as a valuable method for evaluating salivary gland pathology and supporting the stratification of pSS patients.
Wang X
，Wang X
，Wu J
，Dong F
，Chang X
，Wang A
... -
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The titers of antinuclear antibodies are associated with the degree of inflammation and organ damage in Primary Sjögren's Syndrome.
Primary Sjögren's Syndrome (pSS) falls within the category of connective tissue diseases, characterized by the presence of autoantibodies such as antinuclear antibodies (ANA). However, according to the classification criteria for pSS, some patients may exhibit a negative result for autoantibodies. Patients with a negative result for autoantibodies may lack typical features of connective tissue diseases, and the immunological state as well as the extent of organ involvement and damage may differ from those with positive autoantibodies. This study aims to compare the clinical phenotypes of patients with positive and negative autoantibodies, providing insights for disease classification and treatment selection for clinicians. Patients with pSS were grouped based on the presence and titers of their autoantibodies. Subsequently, differences in organ damage and laboratory indicators were compared between these groups, aiming to analyze the value of autoantibody titers in assessing the condition of pSS. (1) Patients with positive ANA exhibited elevated levels of inflammatory indicators, including ESR, IgG levels, lip gland biopsy pathology grade, and overall organ involvement, in comparison with patients with negative ANA (P < 0.05). Furthermore, ANA-positivity correlated with a higher occurrence of multi-organ damage, particularly affecting the skin, mucous membranes, and the hematological system (P < 0.05). (2) As ANA titers increased, patients demonstrated elevated levels of IgG and an escalation in organ involvement (P < 0.05). (3) Patients in the positive autoantibody group (positive for antinuclear antibodies, anti-SSA, or anti-SSB antibodies) had higher IgG levels compared to the negative group (P < 0.05). (4) Patients with positive anti-SSA and anti-SSB antibodies exhibited higher levels of inflammatory indicators and IgG compared to other patients (P < 0.05); however, no significant differences were observed in terms of organ involvement and organ damage. Patients with positive ANA in pSS typically exhibit higher levels of inflammation and an increased likelihood of experiencing multi-organ damage. Furthermore, as the ANA titers increase, both inflammation levels and the risk of multi-organ damage also escalate. Additionally, the presence of anti-SSA and anti-SSB antibodies may contribute to an elevated risk of increased inflammation levels, but does not increase the risk of organ damage.
Shao H
，Wu Y
，Tao X
，Liu Q
，Ran C
，Jin L
，Tao J
... -
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Accuracy of Labial Salivary Gland Biopsy in Suspected Cases of Sjogren's Syndrome.
Sjögren's syndrome (SS) is a chronic autoimmune disorder primarily characterized by dysfunction of the exocrine glands, leading to dryness of the eyes and mouth (sicca symptoms). Labial salivary gland biopsy (LSGB) is a key diagnostic tool used to confirm SS through histopathological analysis. LSGB evaluates lymphocytic infiltration in the salivary glands, a hallmark of SS. Despite its utility, discrepancies between LSGB results and other diagnostic methods, like serology and clinical examination, persist. Given the potential for false negatives, especially in early-stage or mild diseases, LSGB is often used alongside other diagnostic tools. Assessing its diagnostic accuracy and correlation with clinical, demographic, and serological factors is critical for improving diagnostic precision in SS.
This study aims to evaluate the diagnostic accuracy of LSGB in suspected SS cases, focusing on its correlation with clinical diagnoses, serological markers, and demographic factors. It also investigates whether LSGB can serve as a standalone diagnostic tool or should be integrated with other methods to enhance accuracy.
This retrospective study evaluated 166 patients who underwent LSGB for suspected SS. Results were classified as "suggestive" or "not suggestive" of SS based on the histopathological evidence of lymphocytic infiltration. The relationship between LSGB outcomes and various demographics, serological markers, and the presence of other autoimmune diseases was examined. Statistical analyses assessed the significance of these associations. Categorical data were presented by frequency with percentage, and continuous data by mean with standard deviation (SD). Analyses were conducted using the Statistical Package for the Social Sciences (SPSS) version 27.0, with a P-value < 0.05 considered statistically significant.
Among the 166 patients, 55 (33.1%) had LSGB results suggestive of SS, while 111 (66.9%) had non-suggestive findings. A significant association was found between antinuclear antibody (ANA) positivity and suggestive LSGB results (P = 0.003), indicating that ANA-positive patients were more likely to show histopathological evidence of SS. No significant associations were found with other serological markers, except for a near-significant trend with anti-Ro (anti-Ro/SSA antibodies) (P = 0.062). Age did not significantly influence biopsy outcomes (P = 0.580). The presence of other autoimmune diseases was significantly associated with suggestive LSGB findings (P = 0.034).
LSGB remains a valuable diagnostic tool for SS, especially when serological and clinical findings are inconclusive. The study confirmed significant associations between ANA positivity and suggestive LSGB results, as well as the influence of other autoimmune diseases on histopathological outcomes. While Schirmer's test may detect ocular dryness, its correlation with LSGB findings was limited. LSGB should not be used as a standalone diagnostic measure but integrated with other tools, including serology and imaging, to improve accuracy. Future research should explore combining LSGB with salivary gland ultrasonography (SGUS) to enhance the detection of SS, particularly in early-stage or seronegative patients.
AlMannai AI
，Alaradi K
，Almahari SAI
《Cureus》
Role of chemokines CXCL9, CXCL10, CXCL11, and CXCR3 in the serum and minor salivary gland tissues of patients with Sjögren's syndrome.
This study aimed to investigate the serum and expression levels of C-X-C motif chemokine ligand 9 (CXCL9), CXCL10, CXCL11, and CXC receptor 3 (CXCR3) in minor salivary glands (MSGs) of patients with primary Sjögren's syndrome (pSS), and to explore their correlations with clinical parameters. Serum samples from 49 patients diagnosed with pSS, 33 patients with rheumatoid arthritis (RA), and 30 healthy controls (HCs) were collected for measurements of CXCL9, CXCL10, CXCL11, and CXCR3. Additionally, CXCL levels in the MSG tissues were measured in 41 patients who underwent MSG biopsy. Correlations between CXCL and CXCL/CXCR levels in serum/MSG tissues and clinical factors/salivary scintigraphy parameters were analyzed. Serum CXCL11 and CXCR3 showed statistically significant differences among patients with pSS and RA and HCs (serum CXCL11, pSS:RA:HC = 235.6 ± 500.1 pg/mL:90.0 ± 200.3 pg/mL:45.9 ± 53.6 pg/mL; p = 0.041, serum CXCR3, pSS:RA:HC = 3.27 ± 1.32 ng/mL:3.29 ± 1.17 ng/mL:2.00 ± 1.12 ng/mL; p < 0.001). Serum CXCL10 showed a statistically significant difference between pSS (64.5 ± 54.2 pg/mL) and HCs (18.6 ± 18.1 pg/mL, p < 0.001), while serum CXCL9 did not exhibit a significant difference among the groups. Correlation analysis of clinical factors revealed that serum CXCL10 and CXCL11 levels positively correlated with erythrocyte sedimentation rate (r = 0.524, p < 0.001 and r = 0.707, p < 0.001, respectively), total protein (r = 0.375, p = 0.008 and r = 0.535, p < 0.001, respectively), globulin (r = 0.539, p < 0.001 and r = 0.639, p < 0.001, respectively), and European Alliance of Associations for Rheumatology SS Disease Activity Index (r = 0.305, p = 0.033 and r = 0.321, p = 0.025). Additionally, serum CXCL10 negatively correlated with the Schirmer test score (r = - 0.354, p = 0.05), while serum CXCL11 positively correlated with the biopsy focus score (r = 0.612, p = 0.02). In the MSG tissue, the percentage of infiltrating CXCL9-positive cells was highest (75.5%), followed by CXCL10 (29.1%) and CXCL11 (27.9%). In the correlation analysis, CXCL11-expressing cells were inversely related to the mean washout percentage on salivary gland scintigraphy (r = - 0.448, p = 0.007). Our study highlights distinct serum and tissue chemokine patterns in pSS, emphasizing CXCL9's potential for early diagnosis. This suggests that CXCL10 and CXCL11 are indicators of disease progression, warranting further investigation into their roles in autoimmune disorders beyond pSS.
Kim JW
，Ahn MH
，Jung JY
，Suh CH
，Han JH
，Kim HA
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ResearchGate
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