Liver Involvement in Primary Sjögren's Syndrome

Abstract

Three hundred patients with primary Sjögren's syndrome (pSS) were investigated for liver involvement using clinical, biochemical, immunological and histological data. Seven per cent of patients showed evidence of liver disease either subclinical (2%) or asymptomatic (5%) with elevated liver enzymes. In 6.6% of patients antimitochondrial antibodies (AMA) were detected by immunofluorescence and 27% of pSS patients showed antibodies to pyruvate dehydrogenase (a-PDH) using ELISA. AMA-positive patients were further investigated with transcutaneous liver biopsy. Ninety-two per cent of patients with AMA showed liver involvement with features of chronic cholangitis similar to stage I primary biliary cirrhosis. It is concluded that liver involvement in pSS patients is rare and subclinical with histological features predominantly of stage I primary biliary cirrhosis. AMA is the most sensitive indicator of underlying liver pathology in pSS patients.

Advances in the treatment of ocular dryness associated with Sjögren׳s syndrome

“…Methotrexate did not improve objective features of ocular dryness, despite being effective in improving the reported symptoms of dryness, as assessed by an open, one-year pilot study with weekly methotrexate (43). A small open-label study with leflunomide 20 mg daily, including 15 patients with pSS with early and active disease, found no statistical significant difference in terms of perceived ocular dryness of objective improvement in the Schirmer test (44).…”

Oral pilocarpine for the treatment of ocular symptoms in patients with Sjogren's syndrome: a randomised 12 week controlled study

“…Systemic corticosteroid treatment may increase salivary and tear secretion, but it is associated with significant long term side effects that outweigh its benefit for this purpose. 4 Systemic agents, including antimalarial drugs, 11 cyclosporin A, 12 methotrexate, 13 and azathioprine, 14 are useful for treating extraglandular manifestations rather than for improving salivary or tear flow rates, in which their effects are minimal. On the other hand, the topical use of cyclosporin A has a beneficial effect on dry eyes in patients with SS, because it significantly reduces the number of activated lymphocytes within the conjunctiva.…”

Sjögren syndrome

“…76 In patients with primary Sjögren syndrome, blockade of tumor necrosis factor α (infliximab and etanercept) does not appear to be effective in reducing subjective and objective measures of salivary and lacrimal function or joint inflammation; augmentation of the already activated type I interferon/B-cell activating factor (BAFF) axis has been suggested to account for this failure. 77,78 Cytotoxic drugs (e.g., cyclophosphamide) are reserved for severe extraglandular manifestations, including cutaneous vasculitis and glomerulonephritis.…”