Fiorentini Elisa, Bernardini Pamela, Zeka Dorilda, Capassoni Marco, Novelli Luca, Palomba Annarita, Tofani Lorenzo, Cometi Laura, Guiducci Serena
Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, AOU Careggi, 50134 Florence, Italy.
Department of Services, Laboratory of Pathological Histology and Molecular Diagnostics, University of Florence, AOU Careggi, 50134 Florence, Italy.
Int J Mol Sci. 2025 Jul 4;26(13):6463. doi: 10.3390/ijms26136463.
Sicca syndrome is a common condition that draws the attention of rheumatologists, and is frequently related to Sjögren's disease (SjD). This study analyzed 164 patients with sicca syndrome (clinically suspected for SjD) who underwent minor salivary gland biopsy (mSGB). Patients completed the Xerostomia Inventory (XI) and Standard Patient Evaluation of Eye Dryness (SPEED) questionnaires to assess Patient-Reported Outcome Measures (PROMs), and biopsies were graded using the Chisholm and Mason system. Patients were classified as seropositive (SSA, SSB, Ro52, Ro60 positive) or seronegative, and also divided into three groups by age. Positive biopsies (60.37%) were more common in older patients (61-80) and associated with confirmed SjD, more severe xerostomia, and stronger lymphocytic infiltrates. Among these, 37.37% were seropositive, showing higher disease activity, hypergammaglobulinemia, and elevated IgG. Seronegative patients had a heavier symptom burden, confirmed by the PROMs, and more fibrosis and fatty replacement in biopsies. Age-stratified analysis showed younger patients (18-40) were more affected by ocular dryness, while older patients had worse xerostomia and more severe histological and ultrasound changes. Younger individuals had higher IgG/IgA, more anemia, and reduced C3. Hydroxychloroquine was used more in younger and seropositive groups; older patients used more topical therapies. These results highlight mSGB's diagnostic value, especially in seronegative cases, and stress the importance of combining clinical, histological, imaging, and patient-reported outcomes for optimal care.
干燥综合征是一种常见病症，引起了风湿病学家的关注，且常与干燥综合征（SjD）相关。本研究分析了164例接受小唾液腺活检（mSGB）的干燥综合征患者（临床疑似SjD）。患者完成了口干症量表（XI）和干眼标准患者评估（SPEED）问卷，以评估患者报告结局指标（PROMs），并使用奇泽姆和梅森系统对活检结果进行分级。患者分为血清阳性（抗SSA、抗SSB、Ro52、Ro60阳性）或血清阴性，也按年龄分为三组。阳性活检结果（60.37%）在老年患者（61 - 80岁）中更为常见，且与确诊的SjD、更严重的口干症以及更强的淋巴细胞浸润相关。其中，37.37%为血清阳性，表现出更高的疾病活动度、高球蛋白血症和IgG升高。血清阴性患者的症状负担更重，这通过PROMs得到证实，且活检中有更多纤维化和脂肪替代。年龄分层分析显示，年轻患者（18 - 40岁）受眼干影响更大，而老年患者口干更严重，组织学和超声变化更明显。年轻个体的IgG/IgA更高，贫血更多，C3降低。羟氯喹在年轻和血清阳性组中使用更多；老年患者更多使用局部治疗。这些结果突出了mSGB的诊断价值，尤其是在血清阴性病例中，并强调了结合临床、组织学、影像学和患者报告结局以实现最佳治疗的重要性。
