Whole stimulated salivary flow: Correlation with the pathology of inflammation and damage in minor salivary gland biopsy specimens from patients with primary Sjögren's syndrome but not patients with sicca

Abstract

Objective. To determine which measure of the salivary flow rate, stimulated or unstimulated, is most strongly associated with pathologic changes in minor salivary gland (MSG) biopsy specimens, and to explore the correlation of salivary flow with oral surface damage, disease duration, and symptom severity in patients with primary Sjögren's syndrome (SS).Methods. In all patients (n ‫؍‬ 32), a biopsy of the MSG was performed, and stimulated salivary flow was assessed. Beginning in 2002, unstimulated salivary flow was also assessed. Scores for the severity of symptoms, according to the decayed/missing/filled teeth (DMF) index, were recorded. Associations between measures of salivary flow and covariates characterizing pathology were examined.Results. A definite association between stimulated salivary flow and the MSG focus score, the grade of MSG fibrosis, the duration of dry mouth symptoms, and the DMF score was observed. In contrast, unstimulated salivary flow was not associated with fibrosis, atrophy, the DMF score, or the duration of dry mouth symptoms. In patients with primary SS, the DMF score was associated with pathologic changes in the MSG. Among patients with sicca, 57.9% had an abnormal unstimulated salivary flow rate (versus 82.4% of patients with primary SS), and 15.2% had an abnormal stimulated salivary flow rate (versus 61.8% of patients with primary SS). Among patients with sicca, neither stimulated salivary flow nor unstimulated salivary flow was associated with the degree of fibrosis or atrophy or with the DMF score.

Real-Time Sonoelastography of Salivary Glands for Diagnosis and Functional Assessment of Primary Sjögren’s Syndrome

“…Another limitation is the use of an unstimulated instead of stimulated Saxon test. A report published after the initiation of the present study indicated a better reflection of salivary gland fibrosis with stimulated than with unstimulated flow measurements (Bookman et al 2011). We acknowledge that RTS, as a new ultrasonography technique in rheumatology, is not generally available and that interpretation of ultrasonography and RTS results may be subject to variability in clinical practice.…”

“…Given that fibrotic/ fatty transformation results in functional loss of salivary glands, our findings nevertheless indicate that RTS may be useful in identifying patients with salivary gland atrophy (Bookman et al 2011;Jonsson et al 2011). A proportion of pSS patients may certainly have reduced saliva production because of the inflammation itself, and as the architecture of acini is preserved in these cases, a normal RTS signal can be expected (Bookman et al 2011). The use of salivary gland function as a surrogate for glandular pathology might thus underestimate the true value of RTS in detecting salivary gland atrophy.…”

“…Future studies using fresh biopsies and/or other imaging techniques detailing tissue composition (e.g., MRI) as a reference may be useful in clarifying this issue (Niemel€ a et al 2004). Given that fibrotic/ fatty transformation results in functional loss of salivary glands, our findings nevertheless indicate that RTS may be useful in identifying patients with salivary gland atrophy (Bookman et al 2011;Jonsson et al 2011). A proportion of pSS patients may certainly have reduced saliva production because of the inflammation itself, and as the architecture of acini is preserved in these cases, a normal RTS signal can be expected (Bookman et al 2011).…”

“…We considered a reduced Saxon test and/or abnormal findings at sialoscintigraphy as measures of salivary gland atrophy (Bookman et al 2011;Jonsson et al 2011). Uniand multivariate linear regression models (method of least squares) were developed to investigate the association between B-mode ultrasonography or RTS (predictors of primary interest) and the Saxon test, Schirmer test and sialoscintigraphy, as well as physician-and patientbased disease scores (dependent variables), adjusting for the following possible confounders: age; sex; duration of xerostomia/xerophthalmia; treatment with immunosuppressive, anti-cholinergic or anti-depressant drugs; corticosteroid use; and smoking.…”

Salivary Gland Pathology in Sjögren's Syndrome

“…Correlations have been made between the extent of the lymphocytic infiltrate (focus score) and salivary gland function; however, to date the contribution of SGEC dysfunction, tissue destruction, autoantibody production, and fibrosis to oral dryness is not clear. An association between fibrosis and saliva production has also been reported 79 and, finally, a potential role for dysregulated neuroendocrine mechanisms has to be taken into consideration. 80 Thus, multiple pathogenic components could contribute to oral dryness and further studies are needed to dissect their relative weight.…”