Parallel ocular and serologic course in a patient with early Sjogren's syndrome markers

Abstract

PurposeTo report on a case of a young female with progressing dry eye symptoms and evolving autoimmune markers consistent with a presentation of early Sjogren's syndrome (SS).ObservationsA 32 year-old female presented with chronic dry eye symptoms refractory to artificial tears. Slit lamp examination revealed punctate epithelial erosions, decreased tear break-up time, and decreased tear lake bilaterally. Initial tests for ocular surface inflammation (InflammaDry, Quidel, San Diego) and systemic autoantibodies (antinuclear antibodies, anti-SSA/Ro and anti-SSB/La) were negative. After 4 months of persistent ocular symptoms and signs, ocular surface inflammation was detected via InflammaDry and blood results included a positive antinuclear antibody (1:160), rheumatoid factor (IgG 25.3 EU/ml), and carbonic anhydrase 6 (IgM 20.2 EU/ml), but persistently negative anti-SSA/Ro and anti-SSB/La antibodies.Conclusions and importanceTaken together, these findings were suggestive of early Sjogren's syndrome with simultaneous appearance of both ocular and serum biomarkers. Novel autoantibodies testing in suspected patients can guide early intervention and potentially improve both the glandular and extra-glandular function in patients.

The Human Carbonic Anhydrase II in Platelets: An Underestimated Field of Its Activity

“…Up to date aCAAs have been described in patients with rheumatoid disorders (rheumatoid arthritis, Behçet's disease, lupus erythematosus, polymyositis, systemic sclerosis, and Sjögren syndrome) [ 16 – 18 ], digestive tract disorders (idiopathic chronic pancreatitis, primary biliary cirrhosis, autoimmune cholangitis, and gastric cancer) [ 18 , 19 ], endometriosis [ 18 ], Grave's disease [ 20 ], acute myeloid leukaemia [ 21 ], renal tubular acidosis [ 22 ] (significant influence on pathogenesis proved in the animal model of Sjögren's syndrome [ 23 ]), and end-stage kidney disease [ 24 ]. Moreover, autoantibodies against carbonic anhydrase II were proved to play an important role in pathogenesis of retinopathy [ 25 ] and these against CAVI seem to induce dry eye syndrome in Sjögren's syndrome [ 26 , 27 ]. Interestingly, the autoantibodies against carbonic anhydrase II might be produced in humans due to cross-reactivity with carbonic anhydrase of Helicobacter pylori [ 28 ].…”

In vitro validation of the tear matrix metalloproteinase 9 in-situ immunoassay

“…If InflammaDry can reflect tear concentrations of MMP-9 quantitatively, this may play a crucial role in determining the severity of inflammation and improve the outcomes for dry eye patients beyond a simple diagnosis. Furthermore, clinical interpretation of the faint test (red) line during examination can be ambiguous, particularly because conditions involving deficiency of aqueous tears (such as Sjögren syndrome 19 or ocular graft-versus-host disease 20 ) yield negative results despite severe signs and symptoms of dry eye. Therefore, we need to know exactly how the results of the kit change as tear volume changes.…”

The Diagnostic Role of Anti-Human Salivary Gland Protein-1 (anti-SP1) in the Early Detection of Primary Sjogren’s Syndrome in Some Iraqi Patients

“…Therefore, this relationship of anti-SP1 with the shorter disease duration, and the inflammatory as well as immunological markers indicating the involvement of immunoinflammatory reactions in the salivary glands with early emergence of these autoantibodies during the disease onset. Phung et al [21] referred that anti-SP1 was more specific than anti-Ro/La for early identification of SS since SP1 was located particularly in the salivary glands contrasting Ro/La that existed in any nucleated cells. Likewise, the anti-SP1 was rarely detected in healthy persons (<5%), and the patients suffering early SS have >60% of novel autoantibodies (e.g.…”