Correlação entre sinais e sintomas de olho seco em pacientes portadores da síndrome de Sjögren

Barboza, Marcello Novoa Colombo; Barboza, Guilherme Novoa Colombo; Melo, Gustavo Mendonça de; Sato, Élcio Hideo; Dantas, Maria Cristina Nishiwaki; Dantas, Paulo E.C.; Felberg, Sérgio

doi:10.1590/s0004-27492008000400015

Cited by 19 publications

(11 citation statements)

References 16 publications

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“…The chronic pain and persistent inflammation that are mediated by humoral factors and neurotransmitters associate autoimmunity and neuropathy in several target organs, including the hippocampus and lacrimal functional unit (LFU) in SS [27,34,38,39,40,41]. The dissociation between signs and symptoms in dry eye and dry mouth disease, including SS, delays and makes the diagnosis more difficult [5,42,43,44,45,46,47,48]. The lower intensity of signs that are associated with depression and diffusely spread painful symptoms in the body suggest a mechanism involving integrative systems, such as the autonomic nervous system, immune, and endocrine systems (Figure 1) [42,45,49].…”

Section: Autoimmunity Neuropathy and Chronic Painmentioning

confidence: 99%

Neurological and Inflammatory Manifestations in Sjögren’s Syndrome: The Role of the Kynurenine Metabolic Pathway

Oliveira

Fantucci

Adriano

et al. 2018

IJMS

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For decades, neurological, psychological, and cognitive alterations, as well as other glandular manifestations (EGM), have been described and are being considered to be part of Sjögren’s syndrome (SS). Dry eye and dry mouth are major findings in SS. The lacrimal glands (LG), ocular surface (OS), and salivary glands (SG) are linked to the central nervous system (CNS) at the brainstem and hippocampus. Once compromised, these CNS sites may be responsible for autonomic and functional disturbances that are related to major and EGM in SS. Recent studies have confirmed that the kynurenine metabolic pathway (KP) can be stimulated by interferon-γ (IFN-γ) and other cytokines, activating indoleamine 2,3-dioxygenase (IDO) in SS. This pathway interferes with serotonergic and glutamatergic neurotransmission, mostly in the hippocampus and other structures of the CNS. Therefore, it is plausible that KP induces neurological manifestations and contributes to the discrepancy between symptoms and signs, including manifestations of hyperalgesia and depression in SS patients with weaker signs of sicca, for example. Observations from clinical studies in acquired immune deficiency syndrome (AIDS), graft-versus-host disease, and lupus, as well as from experimental studies, support this hypothesis. However, the obtained results for SS are controversial, as discussed in this study. Therapeutic strategies have been reexamined and new options designed and tested to regulate the KP. In the future, the confirmation and application of this concept may help to elucidate the mosaic of SS manifestations.

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Section: Autoimmunity Neuropathy and Chronic Painmentioning

confidence: 99%

Neurological and Inflammatory Manifestations in Sjögren’s Syndrome: The Role of the Kynurenine Metabolic Pathway

Oliveira

Fantucci

Adriano

et al. 2018

IJMS

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“…Fluorophotometry also did not correlate with clinical symptoms as measured by OSDI. Although there is some evidence showing OSDI can measure the severity of dry eye, the non-correlation was unsurprising since DED signs and symptoms are poorly correlated, compounded by variability between seasons, time of day, and findings among eye examinations, suggesting that symptoms may not truly reflect the whole dry eye state in patients [ 14 , 15 ]. Though the cornea may be damaged, patients may still be asymptomatic.…”

Section: Discussionmentioning

confidence: 99%

“…Though the cornea may be damaged, patients may still be asymptomatic. One possible explanation is that with damage to the ocular surface, the central cornea sensitivity decreases, making the patient less symptomatic [ 14 , 16 ]. Similarly, the cornea may be healthy even as patients report multitude of symptoms.…”

Section: Discussionmentioning

confidence: 99%

Corneal permeability changes in dry eye disease: an observational study

et al. 2016

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BackgroundDiagnostic tests for dry eye disease (DED), including ocular surface disease index (OSDI), tear breakup time (TBUT), corneal fluorescein staining, and lissamine staining, have great deal of variability. We investigated whether fluorophotometry correlated with previously established DED diagnostic tests and whether it could serve as a novel objective metric to evaluate DED.MethodsDry eye patients who have had established signs or symptoms for at least 6 months were included in this observational study. Normal subjects with no symptoms of dry eyes served as controls. Each eye had a baseline fluorescein scan prior to any fluorescein dye. Fluorescein dye was then placed into both eyes, rinsed with saline solution, and scanned at 5, 10, 15, and 30 min. Patients were administered the following diagnostic tests to correlate with fluorophotometry: OSDI, TBUT, fluorescein, and lissamine. Standard protocols were used. P < 0.05 was considered significant.ResultsFifty eyes from 25 patients (DED = 22 eyes, 11 patients; Normal = 28 eyes, 14 patients) were included. Baseline scans of the dry eye and control groups did not show any statistical difference (p = 0.84). Fluorescein concentration of DED and normal patients showed statistical significance at all time intervals (p < 10−5, 0.001, 0.002, 0.049 for 5, 10, 15, & 30 min respectively). Fluorophotometry values converged towards baseline as time elapsed, but both groups were still statistically different at 30 min (p < 0.01). We used four fluorophotometry scoring methods and correlated them with OSDI, TBUT, fluorescein, and lissamine along with adjusted and aggregate scores. The four scoring schemes did not show any significant correlations with the other tests, except for correlations seen with lissamine and 10 (p = 0.045, 0.034) and 15 min (p = 0.013, 0.012), and with aggregate scores and 15 min (p = 0.042, 0.017).ConclusionsFluorophotometry generally did not correlate with any other DED tests, even though it showed capability of differentiating between DED and normal eyes up to 30 min after fluorescein dye instillation. There may be an aspect of DED that is missed in the current regimen of DED tests and only captured with fluorophotometry. Adding fluorophotometry may be useful in screening, diagnosing, and monitoring patients with DED.

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“…Esta associação foi positiva tanto quando se considerou a simples presença do olho seco e de um teste positivo como quando se considerou valores numéricos do Schirmer para pacientes com e sem queixas (Figura 1). Existem dados na literatura que demonstram haver uma fraca associação entre estas duas variá-veis (18) . Tal fato pode ser explicado pelo fato de alguns autores considerarem um valor de cut off para o teste de Schirmer de 10 mm ao invés de 5 mm com o utilizado na presente amostra.…”

Section: Discussionunclassified

Olho seco e Sjögren secundário na artrite reumatóide

Gehlen¹,

Skare²,

Silva³

et al. 2012

Rev. bras.oftalmol.

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RESUMOObjetivo: Examinar a prevalência de ceratoconjuntivite seca e de Síndrome de Sjögren (SS) secundária em pacientes com AR do sul do Brasil e analisar suas relações com duração e atividade da AR e classe funcional do paciente. Pacientes com artrite reumatóide (AR) podem ter ceratoconjuntivite seca, que é considerada uma manifestação extra-articular dessa doença. Métodos: Estudaram-se 82 pacientes com AR para sintomas de secura, Schirmer teste, DAS-28 ( índice de atividade da AR) e classe funcional. Resultados: Sintomas de secura ocular estavam presentes em 57,3%, Schirmer positivo em 41,2% e SS secundária em 24.3%. A presença de um teste positivo para o Schirmer ou da SS secundária não teve associação com duração de doença (p=0,65 and 0,80), atividade da AR (p=0,42 and 0,25) nem com a classe funcional do paciente (p= 0.84 and 0,79). Conclusão: Existe uma alta prevalência de síndrome sicca nos pacientes com AR; ¼ deles tem SS secundário. O aparecimento de SS secundário e da síndrome sicca é independentes de atividade, tempo de duração e do dano cumulativo gerado pela AR subjacente .Descritores: Olho seco/etiologia; Síndrome de Sjögren/etiologia; Artrite reumatóide/complicações ABSTRACT Objective: To examine the prevalence of keratoconjuntivitis sicca and secondary Sjögren syndrome (SS) in patients with RA from Southern Brazil and to analyze their relationship with RA duration, activity and patient's functional class. Patients with rheumatoid arthritis (RA) may have keratoconjuntivitis sicca that can be considered an extra articular manifestation of this disease. Methods: We studied 82 RA patients for sicca symptoms, Schirmer test, DAS-28 (RA activity index) and functional class. Results: There were eye sicca symptoms in 57.3%, positive Schirmer test in 41.2% and Secondary SS in 24.3%. The presence of a positive Schirmer test or the secondary SS had no relation with disease duration (p=0.65 and 0.80), RA activity (p=0,42 and 0,25) and neither with the patient's functional class (p= 0.84 and 0.79). Conclusion: There is a high prevalence of sicca syndrome in RA patients; one fourth of them have secondary SS. Secondary SS and sicca syndrome occurrence is independent of underlying RA activity, duration and cumulative damage.

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Correlação entre sinais e sintomas de olho seco em pacientes portadores da síndrome de Sjögren

Cited by 19 publications

References 16 publications

Neurological and Inflammatory Manifestations in Sjögren’s Syndrome: The Role of the Kynurenine Metabolic Pathway

Neurological and Inflammatory Manifestations in Sjögren’s Syndrome: The Role of the Kynurenine Metabolic Pathway

Corneal permeability changes in dry eye disease: an observational study

Olho seco e Sjögren secundário na artrite reumatóide

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