Reversibility of histological and immunohistological abnormalities in sublabial salivary gland biopsy specimens following treatment with corticosteroids in Sjogren's syndrome

Abstract

Sjögren's syndrome (SS) is a chronic autoimmune disease characterised by specific lesions in exocrine glands, so sublabial minor salivary gland biopsy (SLGB) plays an important part in its diagnosis. The extent and composition of the lymphocytic infiltrate in SLGB specimens can be considered as target organ specific parameters. They are quantified after histological and immunohistological examination by a focus score (describing the extent of the infiltrate) and IgA% score (describing the composition of the infiltrate), respectively. However, little is known about the factors that contribute to the extent and composition of the infiltrate and whether these features are reversible as repeated SLGBs are rarely performed. A patient with SS is described who underwent SLGBs before and after treatment with high dose corticosteroids. After treatment there was not only clinical improvement, but also improvement in the histological and immunohistological parameters. Although these findings need to be confirmed in further studies, this suggests that histopathological changes may be reversible in SS. Furthermore, it shows that the potential eVects of corticosteroid use should be taken into account when interpreting SLGB specimens. When clinical changes do parallel histological changes, repeated SLGBs might oVer a marker for disease activity in patients with SS.

Diagnostic utility of Acoustic Radiation Force Impulse (ARFI) imaging in primary Sjoegren`s syndrome

“…Other rheumatic diseases, exogenic factors such as nicotine abuse, aging effects, and chronic nonspecific sialadenitis frequently exhibit lymphocytic focus scores ≥1. Moreover, the Chisholm and Mason scoring system does not include a score for burnout of salivary glands [43][44][45][46][47]. Bodeutsch established quantitative immunohistochemical assessment of IgA-positive plasma cells in minor salivary gland samples, resulting in improved sensitivity and specificity of 96 % and 99 %, respectively.…”

Efficacy and safety of rebamipide for the treatment of dry mouth symptoms in patients with Sjögren’s syndrome: a double-blind placebo-controlled multicenter trial

“…In this study, corticosteroids were concomitantly administered in 13 of 28 subjects (46%) with secondary Sjögren's syndrome, versus only 8 of 72 subjects (11%) with primary Sjögren's syndrome. Corticosteroids have been reported to have an improving effect on Sjögren's syndrome [19,20]. Further evidence suggesting that these concomitantly administered drugs may have influenced the results of the study was that in the placebo group, while almost no increase in salivary secretion was seen in subjects with primary Sjögren's syndrome, a marked salivary secretion increasing effect was observed in subjects with secondary Sjögren's syndrome.…”

Primary Sjӧgren's Syndrome with Granulomatous Interstitial Nephritis

“…Zandbelt et al described patients with SS treated with high doses of corticosteroids, who demonstrated an improvement in the main clinical, histological, and immunohistological features after treatment (6) .Sonia et alreported agood response with MMF in SS patients (7) In addition toDean et al who reported agood response with this agent in TIN (8) .…”