Viral infection has often been suggested as a possible cause of Sjögren's syndrome or chronic lymphocytic sialadenitis, and Epstein-Barr virus has been found in the salivary glands of patients with this condition. After we had noted Sjögren's syndrome in several patients infected with hepatitis C virus (HCV), a virus also excreted in saliva, we set up a prospective study to investigate the association of chronic lymphocytic sialadenitis, with or without symptoms, to chronic HCV liver disease. The histological appearances of labial salivary glands in patients with proven HCV hepatitis or cirrhosis were compared with those in dead controls. Histological changes characteristic of Sjögren's syndrome were significantly more common in HCV-infected patients (16 of 28, 57%) compared with controls (1 of 20, 5%). Focal lymphocytic sialadenitis characteristic of Sjögren's syndrome (though only 10 patients had xerostomia and none complained of xerophthalmia) appears to be common in patients with chronic HCV liver disease; if this association is confirmed, identification of the underlying mechanism may improve our understanding of both disorders.

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Serum urate levels were studied in 18 patients with primary hyperparathyroidism (pHPT) and in 36 controls (group 2) matched for age, sex, nationality and blood pressure. These two groups were compared with general surgical inpatients (group 3). The prevalence of hyperuricemia was markedly higher in the pHPT patient group (especially for men) than in the other two groups [44,17 and 9%, respectively; p < 0.05 and < 0.001]. The prevalence of hypertension was markedly higher in the pHPT patient group (66.7%) than in the surgical inpatients [15%; p < 0.0001]. Five of the 9 male patients had both hypertension and hyperuricemia, the pathogenesis of which may be related to the action of hypercalcemia on renal functions. As the prevalence of hypertension and hyperuricemia were markedly higher than previously noted, it is suggested that more attention should be paid to blood pressure, serum urate and renal function in patients with primary hyperparathyroidism, in order to improve diagnosis and therapy.

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