This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (6)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Musculoskeletal Syndromes (Chronic Fatigue, Gulf War)  • Immunology  • Ophthalmology  • External Eye Disease  • Inflammatory Disease of Head & Neck  • Neoplasms of Head & Neck  • Salivary Gland Disorders  • Alert me on articles by topic

Arjan Vissink, DDS, MD, PhD; Wouter W. I. Kalk, DDS, MD, PhD; Khaled Mansour, MD; Fred K. L. Spijkervet, DDS, PhD; Hendrika Bootsma, MD, PhD; Jan L. N. Roodenburg, DDS, PhD; Cees G. M. Kallenberg, MD, PhD; Arie V. Nieuw Amerongen, PhD

Arch Otolaryngol Head Neck Surg. 2003;129:966-971.

Objectives  To determine the performance of different tear and salivary tests applied in Sjögren's syndrome (SS) and to disclose how these tests relate to common serologic tests in SS.

Design  In addition to the routine ocular and oral tests for diagnosing SS (Schirmer test, rose bengal score, unstimulated whole saliva flow, and parotid sialography), tear breakup time and flow rate of glandular saliva (parotid and submandibular-sublingual [SM/SL]) were evaluated in patients referred for diagnosis of SS. Patients were categorized into primary SS, secondary SS, and non-SS groups according to the revised European classification criteria for SS.

Setting  Referral center.

Patients  Referred sample of 80 consecutive patients.

Main Outcome Measure  Correlation between ocular and salivary measures.

Results  Breakup time performed insufficiently in diagnosing SS, as opposed to the rose bengal score. In patients with primary and secondary SS, a clear correlation was noted between tear and saliva quality and secretion rate, and between the rose bengal score and parotid sialography. Increased rose bengal scores also correlated significantly with hyperglobulinemia and presence of SS-B antibodies in serum, with duration of subjective eye dryness, and with decreased tear-gland function. With regard to the oral tests, whole, parotid, and SM/SL salivary flow decreased significantly with increasing duration of oral complaints, with the stimulated SM/SL flow rate showing the strongest decrease and being more specific in diagnosing SS. Also, parotid sialography was more specific in excluding patients without SS than the commonly applied diagnostic criterion of secretion of unstimulated whole saliva.

Conclusions  The rose bengal score remains the eye test of choice, as it has the highest specificity for SS. Hyperglobulinemia and especially positive serologic findings for SS-B may warrant close monitoring of the eyes, since these serum findings appear to relate to the severity of ocular surface damage. Parotid sialography and stimulated secretion of SM/SL saliva are more specific in diagnosing SS than unstimulated secretion of whole saliva.

From the Departments of Oral and Maxillofacial Surgery (Drs Vissink, Kalk, Spijkervet, and Roodenburg), Ophthalmology (Dr Mansour), and Internal Medicine (Drs Bootsma and Kallenberg), University Hospital Groningen, Groningen, the Netherlands; and Division of Oral Biochemistry, Department of Oral Biology, Faculty of Dentistry, Amsterdam, the Netherlands (Dr Nieuw Amerongen). The authors have no relevant financial interest in this article.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Khat (Catha edulis) Induces Reactive Oxygen Species and Apoptosis in Normal Human Oral Keratinocytes and Fibroblasts
Lukandu et al.
Toxicol Sci 2008;103:311-324.
ABSTRACT | FULL TEXT