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J. A. Smith, V. Kutty, G. Reed, R. Nashwinter, R. Leakan, D. Koutsandreas, G. Illei; A Sex-Based Comparison of the Disease Manifestations of Sjogren’s Syndrome. Invest. Ophthalmol. Vis. Sci. 2007;48(13):413.
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To compare the ocular, oral, immunologic, rheumatologic and non-sicca manifestations of Sjogren’s syndrome in women and men.
We conducted a matched case-control study of patients (pts)with Sjogren’s syndrome (SS). All pts met the European/American SS diagnostic criteria. Women were matched to men by age (+/- 2 yrs) and race. Women on menopausal hormone therapy were excluded. Ocular outcomes were: Tear production (Schirmer with and without anesthesia), ocular surface vital dye staining, tears breakup time, standardized graded slit lamp biomicroscopic exam and patient-reported symptoms. Oral outcomes were stimulated and unstimulated salivary flow and lymphocytic infiltration of minor salivary gland on biopsy (Focus score). Records were reviewed for 1) arthritis, Raynaud’s phenomenon, neuropathy, fatigue and other SS- associated conditions, 2) use of immunosuppressive and secretogogue medications and 3) immunologic markers: ESR, ANA, SSA, SSB, C3, C4, IgA, WBC and rheumatoid factor.
28 men (23 white, 2 hispanic and 3 black) were matched by age (+/- 2 years) and race to 56 women. There were no significant differences between women and men for any objective ocular or oral outcomes.Prevalence of arthritis was significantly greater in women (69.6%) than men (29.6%), p=0.008; however, the prevalence of other systemic conditions did not differ. Prevalence of autoantibodies was similar for women and men for: SSA, SSB, ANA and RF. Mean ESR was significantly higher in women (37.9 vs. 28.3, p=0.04), but there were no significant differences in immune markers: C3 (111 both), C4 (23, 21.3), WBC (5.6, 5.8) or IgA (344, 324).There were no differences in prevalence of immunosuppressive medications, muscarinic agonists, punctal occlusion or total number of medications used.
Despite similar objective evidence of extent of oral, ocular and non-sicca manifestations of Sjogren’s syndrome, women reported more severe symptoms than age and race-matched men. There may be sex or gender-related differences in pain perception, willingness to report pain or adaptive responses.
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