Current concepts on Sjögren's syndrome – classification criteria and biomarkers

Abstract

Sjögren's syndrome is a lymphoproliferative disease with autoimmune features characterized by mononuclear cell infiltration of exocrine glands, notably the lacrimal and salivary glands. These lymphoid infiltrations lead to dryness of the eyes (keratoconjunctivitis sicca), dryness of the mouth (xerostomia), and, frequently, dryness of other surfaces connected to exocrine glands. Sjögren's syndrome is associated with the production of autoantibodies because B-cell activation is a consistent immunoregulatory abnormality. The spectrum of the disease extends from an organ-specific autoimmune disorder to a systemic process and is also associated with an increased risk of B-cell lymphoma. Current treatments are mainly symptomatic. As a result of the diverse presentation of the syndrome, a major challenge remains to improve diagnosis and therapy. For this purpose an international set of classification criteria for primary Sjögren's syndrome has recently been developed and validated and seems well suited for enrolment in clinical trials. Salivary gland biopsies have been examined and histopathology standards have been developed, to be used in clinical trials and patient stratification. Finally, ultrasonography and saliva meet the need of non-invasive imaging and sampling methods for discovery and validation of disease biomarkers in Sjögren's syndrome.

Salivary Redox Biomarkers in Selected Neurodegenerative Diseases

“…The most researched salivary biomarkers include immunoglobulins (e.g., IgA), matrix metalloproteinases [2], mucins [3], cytokines [4], human αand β-defensins [5], as well as oxidative stress products [6]. Literature data showed the use of salivary biomarkers in the diagnosis of periodontitis, oral cancers [7][8][9][10], and Sjögren's syndrome [11,12]. Interestingly, microorganisms, electrolytes, proteins, and peptides that are derived from saliva are utilized for dental caries diagnosis [13,14].…”

A Novel Proposal of Salivary Lymphocyte Detection and Phenotyping in Patients Affected by Sjogren’s Syndrome

“…Another non-invasive method for PSG assessment is ultrasonography which was supposed to be useful for early diagnosis of SS and evaluating of treatment effects [53,54]. Since the ultrasonographic studies demonstrated the correlation with minor SG and PSG biopsies [55] it would be interesting to evaluate possible correlations between salivary lymphocytes detection and parotid ultrasonography.…”

Saliva and Oral Diseases

“…Histopathology, in some cases with direct immunofluorescence, remains the gold standard for the diagnosis of oral disease. In fact, it is often necessary to perform a biopsy to confirm the diagnosis of bullous diseases (together with DIF) [47], Sjögren's syndrome [48], and for all lesions suspected for malignancy [49].…”