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J.A. Smith, V. Sankar, L. Goodman, R. Leakan, S. Pillemer, S. Vitale; Evaluation of Ocular, Oral and Immunologic Disease Activity Measures in Sjogren's Syndrome Over Time . Invest. Ophthalmol. Vis. Sci. 2003;44(13):2470.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: There are few longitudinal studies of Sjogren's syndrome (SS) with detailed assessment of ocular, oral and immunologic parameters. Methods: 40 patients (mean age, 55y) with SS (based on European criteria, (+) salivary gland biopsy) were assessed at baseline and follow-up (f/u) 1-37 mo later (mean 10 mo). Ocular signs (Schirmer 1 (Sch) and 2, total Oxford score (Ox), conjunctival Lissamine green staining (Liss), van Bijsterveld score (VB), and tear film breakup time (TFB)), salivary flow (SAL)), immunologic parameters (IgG, IgM, CRP, RF, ESR, C3, C4, ANA), and patient symptoms were analyzed. A change of +/- 20% defined improvement or worsening. Patients with the worst possible score for a parameter were unable to exhibit worsening and were not included in the change analysis. Results: The magnitude of change was not associated with duration of f/u for any parameter. No ocular sign showed clinically or statistically significant change over time. Parameters associated with saliva and tear production: (SAL, Sch 1, Sch2) and TFB were more likely to worsen than improve over time. For parameters indicative of ocular surface damage (Ox, Liss, VB), roughly 1/2 of patients showed neither improvement nor worsening, but overall, patients were more likely to worsen than improve. Serum IgG (mean change, -33+-206) was the only immunologic factor consistently significantly associated with ocular parameters at baseline and f/u: Spearman correlations (r) at baseline and f/u were: w/ Ox: 0.41, 0.56; w/ Liss: 0.42, 0.50; w/ VB: 0.42, 0.52; w/ Sch 1: -0.33, -0.50; w/ Sch 2: -0.36, -0.52; w/ TFB: -0.35, -0.21(ns). Change in C4 was significantly associated w/change in Ox (r=-0.48). Conclusions: Our data are consistent with gradual worsening of saliva and tear production in this group of SS patients. A wide spectrum of ocular surface changes was seen, with no clear patterns of association, except with IgG. Sample size estimations for clinical trials in this area should take into consideration the variability of these ocular findings in SS patients. View OriginalDownload SlideView OriginalDownload Slide
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