D.A. Ripsman, medical student (Year 3), BSc, University of Ottawa, Department of Medicine, Ottawa, Ontario.
A.A.M. Bookman, MD, FRCPC, Associate Professor of Medicine, University of Toronto, Toronto, Ontario, Canada.
J Rheumatol. 2021 Aug;48(8):1290-1294. doi: 10.3899/jrheum.200907. Epub 2021 May 1.
Sjögren syndrome (SS) is a common autoimmune disease primarily affecting the eyes and mouth. With no single gold standard test for its diagnosis, accurate identification of patients with SS continues to be challenging. We aimed to assess the correlation of ocular and oral symptoms of dryness with objective measures in order to evaluate reliability in the screening of primary SS (pSS) in clinical practice.
We conducted a cross-sectional analysis of pre-screened pSS and sicca control patients assessed in the Multidisciplinary Sjögren's Clinic at the University Health Network in Toronto. The signs, symptoms, and objective measure of oral and ocular dryness and damage of each patient were prospectively recorded using a standardized protocol.
Subjective measures of severity for xerophthalmia and xerostomia correlated in general with objective severity. Oral symptoms tend to have a stronger correlation with objective findings than ocular symptoms. Many patients with few or insignificant eye symptoms had profound ocular dryness and damage. Similarly, some patients with few or no symptoms of oral dryness had profound objective salivary hypofunction. The absence of symptoms does not rule out profound eye and mouth dryness or damage.
Although objective measures of xerostomia may not be practical for general population screening, it is crucial that practicing specialists perform objective testing of all patients suspected of pSS, instead of relying on symptoms. Without objective testing, the physician cannot ensure the diagnosis of pSS and that the existence of significant damage is not overlooked and left untreated.
干燥综合征（SS）是一种常见的自身免疫性疾病，主要影响眼睛和口腔。由于没有单一的金标准测试用于其诊断，因此准确识别 SS 患者仍然具有挑战性。我们旨在评估干燥的眼部和口腔症状与客观测量之间的相关性，以便在临床实践中评估原发性 SS（pSS）筛查的可靠性。
我们对多伦多大学健康网络多学科干燥症诊所评估的经过预筛选的 pSS 和干燥症对照患者进行了横断面分析。使用标准化方案前瞻性记录每位患者的口腔和眼部干燥和损伤的体征、症状和客观测量。
总的来说，干眼病和口干症的主观严重程度与客观严重程度相关。口腔症状与客观发现的相关性强于眼部症状。许多眼睛症状很少或没有明显症状的患者有严重的眼部干燥和损伤。同样，一些口腔干燥症状很少或没有的患者有严重的唾液腺功能减退。没有症状并不能排除严重的眼睛和口腔干燥或损伤。
尽管口干的客观测量可能不适用于一般人群的筛查，但实践专家对所有疑似 pSS 的患者进行客观检查至关重要，而不是仅依赖症状。如果没有客观检查，医生就不能确保诊断为 pSS，并且不能忽视存在显著损伤而不进行治疗。
