Lower frequency of focal lip sialadenitis (focus score) in smoking patients. Can tobacco diminish the salivary gland involvement as judged by histological examination and anti-SSA/Ro and anti-SSB/La antibodies in Sjogren's syndrome?

Abstract

Objectives-Prospectively collected computer database information was previously assessed on a cohort of 300 patients who fulfilled the Copenhagen classification criteria for primary Sjögren's syndrome. Analysis of the clinical data showed that patients who smoked had a decreased lower lip salivary gland focus score (p<0.05). The aim of this original report is to describe the tobacco habits in patients with primary Sjögren's syndrome or stomatitis sicca only and to determine if there is a correlation between smoking habits and focus score in lower lip biopsies as well as ciculating autoantibodies and IgG. Methods-All living patients with primary Sjögren's syndrome or stomatitis sicca only, who were still in contact with the Sjögren's Syndrome Research Centre were asked to fill in a detailed questionnaire concerning present and past smoking habits, which was compared with smoking habits in a sex and age matched control group (n=3700) from the general population. In addition, the patients previous lower lip biopsies were blindly re-evaluated and divided by the presence of focus score (focus score = number of lymphocyte foci per 4 mm 2 glandular tissue) into those being normal (focus score ≤ 1) or abnormal (focus score > 1). Furthermore the cohort was divided into three groups; 10-45, 46-60 and > 61 years of age. Finally the focus score was related to the smoking habits. Seroimmunological (ANA; anti-SSA/Ro antibodies; anti-SSB/La antibodies; IgM-RF and IgG) samples were analysed routinely. Results-The questionnaire was answered by 98% (n=355) of the cohort and the percentage of current smokers, former smokers and historical non-smokers at the time of lower lip biopsy was not statistically different from that of the control group.

Mortality and causes of death in primary Sjögren's syndrome: A prospective cohort study

“…Point estimates for SMR tended to be higher for the AECC patients than for those not fulfilling this criteria set, but confidence intervals overlapped ( Table 2). The difference between the 2 groups may be weakened by the fact that patients who present with classic focal sialadenitis are more likely to be nonsmokers compared with those who do not have autoimmune sialadenitis, as we have shown earlier (18).…”

“…In contrast, we did not detect any increased cardiovascular mortality, either in the subgroup fulfilling the AECC (the subgroup most similar to SLE patients) or in the non-AECC sicca subgroup, despite an observation time of up to 17 years. Possible explanations include the lower frequencies of smoking and steroid use in SS patients compared with SLE patients (18).…”

Professional Antigen Presenting Cells in Minor Salivary Glands in Sjögren's Syndrome: Potential Contribution to the Histopathological Diagnosis?

“…Our study thus urges for a systematic, prospective, and well-controlled investigation of the presence of CD1a ϩ and RFD9 ϩ cells in a large cohort of patients to see if these markers can indeed be helpful in the histopathological diagnosis of Sjögren's syndrome and thus replace the tedious focal scoring. To further illustrate the necessity for critically viewing the outcome of the focal scoring, it has recently been described that smoking habits of patients might invalidate the use of the focus score in a MSG, because smoking lowers the focus score by reducing the accumulation of lymphocytes in the salivary glands (Manthorpe et al, 2000). Reduction of either the number or the size of lymphocytic infiltrates increases the problem of false negative MSG.…”

Imaging diagnostics of Sjögren’s syndrome

“…w 1984 r. stwierdzili, że obecność ognisk zapalenia w materiale biopsyjnym (focus score ≥ 1) jest wystarczającym dowodem potwierdzającym ZS [10,11]. Wiadomo, że stan zapalny może nie mieć charakteru ogniskowego zapalenia ślinianki, na wystąpienie zespołu suchości mogą zaś mieć wpływ czynniki zewnętrzne, takie jak palenie tytoniu czy przyjmowanie leków [12]. Z kolei ogniska zapalne bez towarzyszących objawów suchości, mogą wystąpić w przebiegu zakażenia wirusem HCV, HIV, EBV oraz w myastenia gravis, pierwotnym włóknieniu przewodów gruczołów śli-nowych czy zespole odrzucenia przeszczepu (rejection syndrome) [13].…”