Hajiabbasi Asghar, Shenavar Masooleh Irandokht, Alizadeh Yousef, Banikarimi Amir Sadredin, Ghavidel Parsa Pooneh
Guilan Rheumatology Research Center, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran.
Guilan Eye Research Center, Amir Almomenin Hospital, Guilan University of Medical Sciences, Rasht, Iran.
Acta Med Iran. 2016 Jul;54(7):448-53.
Sjogren syndrome (SS) can occur alone, primary Sjogren syndrome, or in association with other rheumatic diseases, secondary Sjogren syndrome (sSS), such as Rheumatoid arthritis (RA). The occurrence of Sjogren syndrome with RA makes it course worse and increases high morbidity and mortality of RA. In this exploratory study we aim to determine the prevalence of sSS (diagnosed based on the revised version of American-European consensus Group Classification Criteria: AUCG-criteria), sicca symptoms (dry eye, dry mouth), positive autoantibody tests (Anti RO or Anti-LA antibodies), UWSFR (Unstimulated Whole Salivary Flow Rate), Schirmer and Lissamine test. In this cross-sectional study, eighty three consecutive RA patients (according to American College of Rheumatology criteria 1987) who were visited at rheumatology clinic of Razi General Hospital located in the north of Iran entered into our study. Our exclusion criteria was a positive history of past head and neck radiation treatment, Hepatitis C infection, acquired immunodeficiency disease (AIDS), pre-existing lymphoma, sarcoidosis, graft versus host disease, use of anticholinergic drugs (including neuroleptics, antidepressants, antihypertensive and parasympatholytics). They examined with UWSFR by a rheumatologist and with Schirmer test and Lissamine test by an ophthalmologist. Participants were 90.4% female with the mean age 48.3±13 years. Duration of RA was in 36.1% less than 5 years, in 22.9% 5-10 years, in 12.1% 11-15 years and in 28.9% more than 15 years. Our results demonstrated that the prevalence of sSS was 5.9% (CI:0.6%-10.5%). Number of 27.7% of RA patients positively responded to at least one question about sicca symptoms. Among objective tests, only Positive UWSFR and Lissamine test were significantly more common in RA patients with sSS in comparison to ones without sSS (P<0.001, P=0.01 respectively). In RA patients, we found a linear trend between sicca symptoms and aging (P=0.02). In patients with sicca symptoms, among tests that used for assessing decrease in saliva or tear production, only USWFR significantly more common (P=0.01).
In RA population in North of Iran prevalence of sSS was less than 10%. In them, a significant linear trend existed between aging and sicca symptoms. Among objective tests of AUCG-criteria (except for lip biopsy that was not performed in the current study) only UWSFR and Lissamine test were significantly more common in patients with sSS in comparison ones without it.
干燥综合征（SS）可单独出现，即原发性干燥综合征，也可与其他风湿性疾病相关，如类风湿关节炎（RA）伴发的继发性干燥综合征（sSS）。RA合并干燥综合征会使病情恶化，并增加RA的高发病率和死亡率。在这项探索性研究中，我们旨在确定sSS的患病率（根据欧美共识小组分类标准修订版：AUCG标准诊断）、干燥症状（干眼、口干）、自身抗体检测阳性（抗RO或抗LA抗体）、无刺激全唾液流速（UWSFR）、Schirmer试验和丽丝胺试验。在这项横断面研究中，83例连续就诊于伊朗北部拉齐综合医院风湿病门诊的RA患者（根据1987年美国风湿病学会标准）纳入我们的研究。我们的排除标准为既往有头颈部放疗史、丙型肝炎感染、获得性免疫缺陷病（AIDS）、既往存在淋巴瘤、结节病、移植物抗宿主病、使用抗胆碱能药物（包括抗精神病药、抗抑郁药、抗高血压药和副交感神经阻滞剂）。由风湿病学家进行UWSFR检测，眼科医生进行Schirmer试验和丽丝胺试验。参与者中女性占90.4%，平均年龄48.3±13岁。RA病程小于5年的占36.1%，5 - 10年的占22.9%，11 - 15年的占12.1%，超过15年的占28.9%。我们的结果表明，sSS的患病率为5.9%（可信区间：0.6% - 10.5%）。27.7%的RA患者对至少一个关于干燥症状的问题回答为阳性。在客观检测中，与无sSS的RA患者相比，只有UWSFR阳性和丽丝胺试验在有sSS的RA患者中显著更常见（分别为P<0.001，P = 0.01）。在RA患者中，我们发现干燥症状与年龄之间存在线性趋势（P = 0.02）。在有干燥症状的患者中，在用于评估唾液或泪液分泌减少的检测中，只有UWSFR显著更常见（P = 0.01）。
在伊朗北部的RA人群中，sSS的患病率低于10%。在他们当中，年龄与干燥症状之间存在显著的线性趋势。在AUCG标准的客观检测中（除了本研究未进行的唇腺活检），与无sSS的患者相比，只有UWSFR和丽丝胺试验在有sSS的患者中显著更常见。
