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Eduardo Rocha, Danilo Ribeiro, Monica Alves, Jayter Paula, Peter Reinach; Unraveling diagnostic correlates indicative of Sjögren’s Syndrome. Invest. Ophthalmol. Vis. Sci. 2013;54(15):6022.
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To determine in Sjögren’s Syndrome (SS) patients whether or not their diagnosis is characterized by specific symptom sets. They include: 1) dry eye signs; 2) ocular surface alterations; 3) declines in salivary fluid flow; 4) clinical laboratory test results. Such an assessment was undertaken to obtain a better understanding of the pathophysiological mechanisms underlying this disease.
SS patients were subjected to ocular surface evaluation; tear flow measurements and tear film osmolarity (TFOsm) with the TearLab Osmometer. In addition, their whole salivary flow (WSF), minor salivary gland biopsy focus score (FS) and blood tests were performed. Dry eye disease (DED) diagnosis was made if: 1) Osm ≥ 315 mOsm; 2) Schirmer test (ST) ≤ 1 mm/min; 3) tear film break-up time (TFBUT) ≤ 5 sec; 4) sodium fluorescein (SF) or lissamine green (LG) staining ≥ 3. DED severity was categorized based on a method adapted from the Dry Eye Workshop (DEWS).
Thirty-three patients were confirmed with SS by the American-European Criteria. Their mean age was 49.2±16 years and gender ratio was 1M:32F. All were diagnosed with DED. Among them, 63 % tested positive for anti-Ro, 48% had FS ≥ grade 2 on minor salivary gland biopsy and 75% had salivary flow ≤ 0.1 ml/min. The most relevant systemic correlations were: age and LG staining (r=0.44, p=0.016), WSF and conjunctival hyperemia (r= 0.41, p=0.026), FS and ST (r= -0.491, p=0.017). The most relevant ocular correlations were: DED symptoms and TFBUT (r= -0.47, p= 0.0064), SF with LG, ST and TFBUT (r=0.623, -0.798, -0.427, p= 0.0003, 0.0001, 0.0187, respectively), LG with ST and TFBUT (r=-0.726, -0.599p=0.0001, 0.0005, respectively), and TFBUT with TFOsm (r=-0.45, p=0.0098). There was no significant correlation between meibomian gland dysfunction and any other sign: namely, neither between ST and WSF or TOsm.
This study confirms that SS is frequently associated with DED. Furthermore, in SS there is a close correlation between declines in tear secretion and ocular surface damage. On the other hand, significant correlations are fewer between physical or other organ clinical test results and ocular signs or symptoms. These findings will benefit efforts to design future studies to clarify the mechanisms underlying SS.
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