Al-Hashimi Ibtisam
Department of Periodontics, Salivary Dysfunction Clinic, Baylor College of Dentistry, Dallas, TX 75246, USA.
Drugs Aging. 2005;22(11):887-99. doi: 10.2165/00002512-200522110-00001.
Xerostomia is a common symptom in the elderly population. Studies have suggested that the underlying cause of approximately 40% of xerostomia in the elderly is Sjögren's syndrome. Although it is highly prevalent among middle-aged individuals, elderly patients account for up to 20% of Sjögren's syndrome cases. Sjögren's syndrome is a multisystem exocrinopathy characterised by dry mouth and dry eyes with wide-ranging extraglandular involvement. The exocrine manifestations of Sjögren's syndrome affect the mouth, eyes, nose, ears, skin, vagina and the entire respiratory and gastrointestinal systems. The nonexocrine involvement may include the joints, thyroid gland, liver, kidneys and the musculoskeletal, vascular and central nervous systems. Currently, the mechanism(s) of development and progression of Sjögren's syndrome is/are not clear. Inflammation and lymphocytic infiltration of the exocrine glands is a classical feature of Sjögren's syndrome. During the progression of the disease, the acinar cells of the exocrine glands are replaced by fibrosis, rendering the glands nonfunctional. Sjögren's syndrome remains one of the most underdiagnosed conditions, particularly in the elderly population, because the cardinal sicca symptoms, which are the hallmark of the disease, are frequently attributed to aging and/or medications, which consequently delays the diagnosis. This delay in diagnosis imposes significant physical, psychological and economic burdens on elderly patients. The diagnosis of Sjögren's syndrome requires evaluation of both the exocrine and nonexocrine components of the disease. Management of Sjögren's syndrome requires collaboration by the primary-care physician, rheumatologist, ophthalmologist and dentist. This article reviews current understanding of the clinical manifestations, diagnosis and treatment of Sjögren's syndrome with special emphasis on the oral component of the disease.
口干症是老年人群中的常见症状。研究表明，老年人口干症约40%的潜在病因是干燥综合征。尽管干燥综合征在中年个体中高度流行，但老年患者占干燥综合征病例的20%。干燥综合征是一种多系统外分泌腺病，其特征为口干、眼干，并伴有广泛的腺体外受累。干燥综合征的外分泌表现累及口腔、眼睛、鼻子、耳朵、皮肤、阴道以及整个呼吸和胃肠道系统。腺体外受累可能包括关节、甲状腺、肝脏、肾脏以及肌肉骨骼、血管和中枢神经系统。目前，干燥综合征的发生和发展机制尚不清楚。外分泌腺的炎症和淋巴细胞浸润是干燥综合征的典型特征。在疾病进展过程中，外分泌腺的腺泡细胞被纤维化取代，导致腺体功能丧失。干燥综合征仍然是诊断最不足的疾病之一，尤其是在老年人群中，因为作为该疾病标志的主要干燥症状常常被归因于衰老和/或药物，从而延误了诊断。这种诊断延迟给老年患者带来了巨大的身体、心理和经济负担。干燥综合征的诊断需要评估该疾病的外分泌和腺体外组成部分。干燥综合征的管理需要初级保健医生、风湿病学家、眼科医生和牙医的协作。本文综述了目前对干燥综合征临床表现、诊断和治疗的认识，特别强调了该疾病的口腔方面。
