Bonafede R P, Downey D C, Bennett R M
Department of Medicine and School of Dentistry, Oregon Health Sciences University, Portland.
J Rheumatol. 1995 Jan;22(1):133-6.
Fibromyalgia patients often describe the presence of dry eyes and dry mouth. Conversely there is an increasing recognition that many patients with Sjögren's syndrome (SS) have fibromyalgia (FM). We decided to investigate this association.
Seventy-two patients with FM were screened with a Schirmer's test. All patients with an abnormal test had a minor salivary gland biopsy.
Thirty-eight percent (n = 28) had a Schirmer's test of < 15 mm wetting at 5 minutes, however sicca symptoms were noted in only 19% of patients. Salivary gland biopsy in these 28 patients showed a focus score of > or = 1 in 5; a positive antinuclear antibody test (ANA) was found in 4, a positive rheumatoid factor in 3 and anti-SSA SSB antibodies in 2. Another 8 patients had abnormal salivary gland lymphocytic foci, but there were < 50 cells or the density was < 1 focus/4 mm2; all 8 of these patients had a positive ANA. None of these patients have developed systemic features of SS over a 6 year period of followup.
There is a subgroup of patients presenting with FM who, on further testing, have findings consistent with primary SS. The prevalence of this association was 6.9% for probable SS and 11% for possible SS. These figures are probably an overestimation due to tertiary center referral bias. The etiologic and management implications of these observations are unclear.
纤维肌痛患者常描述有干眼和口干症状。相反，越来越多的人认识到许多干燥综合征（SS）患者患有纤维肌痛（FM）。我们决定研究这种关联。
对72例FM患者进行了Schirmer试验筛查。所有试验异常的患者均进行了小唾液腺活检。
38%（n = 28）的患者在5分钟时Schirmer试验湿润度< 15 mm，但只有19%的患者有口干眼干症状。这28例患者的唾液腺活检显示，5例患者的灶性评分≥1；4例抗核抗体试验（ANA）阳性，3例类风湿因子阳性，2例抗SSA SSB抗体阳性。另外8例患者唾液腺淋巴细胞灶异常，但细胞数< 50个或密度< 1个灶/4 mm2；这8例患者ANA均阳性。在6年的随访期内，这些患者均未出现SS的全身症状。
有一组以FM就诊的患者，进一步检查发现其结果与原发性SS一致。可能的SS的这种关联患病率为6.9%，可能的SS为11%。由于三级中心转诊偏倚，这些数字可能被高估了。这些观察结果的病因学和管理意义尚不清楚。
