Sjogren’s syndrome: An update on disease pathogenesis, clinical manifestations and treatment

Vivino, Frederick B.; Bunya, Vatinee Y.; Massaro-Giordano, Giacomina; Johr, Chadwick R.; Giattino, Stephanie L.; Schorpion, Annemarie; Shafer, Brian M.; Peck, Ammon B.; Sivils, Kathy L.; Rasmussen, Astrid; Chiorini, John A.; He, Jing; Ambrus, Julian L.

doi:10.1016/j.clim.2019.04.009

Cited by 143 publications

(133 citation statements)

References 479 publications

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“…Given the importance of saliva, it is not surprising that salivary hypofunction is considered a predisposing factor to OC. This state of absent or diminished saliva is often a side effect of conditions that cause salivary gland dysfunction, such as head-and-neck radiation or Sjögren's syndrome, a chronic inflammatory autoimmune disorder [86,127]. Salivary gland function was also reported to be affected in HIV + and AIDS individuals who often suffer from recurrent episodes of OC; interestingly, a clinical study demonstrated significantly reduced salivary histatin-5 levels in an HIV + patient population [87,128].…”

Section: Host Immune Responsementioning

confidence: 99%

Oral Candidiasis: A Disease of Opportunity

Vila

Sultan

Montelongo-Jauregui

et al. 2020

JoF

307

241

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Oral candidiasis, commonly referred to as “thrush,” is an opportunistic fungal infection that commonly affects the oral mucosa. The main causative agent, Candida albicans, is a highly versatile commensal organism that is well adapted to its human host; however, changes in the host microenvironment can promote the transition from one of commensalism to pathogen. This transition is heavily reliant on an impressive repertoire of virulence factors, most notably cell surface adhesins, proteolytic enzymes, morphologic switching, and the development of drug resistance. In the oral cavity, the co-adhesion of C. albicans with bacteria is crucial for its persistence, and a wide range of synergistic interactions with various oral species were described to enhance colonization in the host. As a frequent colonizer of the oral mucosa, the host immune response in the oral cavity is oriented toward a more tolerogenic state and, therefore, local innate immune defenses play a central role in maintaining Candida in its commensal state. Specifically, in addition to preventing Candida adherence to epithelial cells, saliva is enriched with anti-candidal peptides, considered to be part of the host innate immunity. The T helper 17 (Th17)-type adaptive immune response is mainly involved in mucosal host defenses, controlling initial growth of Candida and inhibiting subsequent tissue invasion. Animal models, most notably the mouse model of oropharyngeal candidiasis and the rat model of denture stomatitis, are instrumental in our understanding of Candida virulence factors and the factors leading to host susceptibility to infections. Given the continuing rise in development of resistance to the limited number of traditional antifungal agents, novel therapeutic strategies are directed toward identifying bioactive compounds that target pathogenic mechanisms to prevent C. albicans transition from harmless commensal to pathogen.

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Section: Host Immune Responsementioning

confidence: 99%

Oral Candidiasis: A Disease of Opportunity

Vila

Sultan

Montelongo-Jauregui

et al. 2020

JoF

307

241

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“…Sjögren's syndrome (SS) is an autoimmune rheumatic disease of unknown aetiology, that affects women more commonly than men, with one of the main manifestations being salivary gland hypofunction (Vivino et al, ). The effect of low salivary flow on oral function, including taste, is still not completely understood.…”

Section: Introductionmentioning

confidence: 99%

Is the taste acuity affected by oral dryness in primary Sjögren’s syndrome patients?

2020

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Objectives Taste disturbance is a symptom of primary Sjögren's syndrome (pSS) of unknown aetiology. This study's objectives were (a) to compare taste function in pSS vs. healthy subjects; (b) to establish whether there is an association between the taste acuity and oral dryness and/or the neurosensory threshold; and (c) to assess the impact of taste dysfunction on the quality of life (QoL). Methodology This study was conducted on 65 pSS females and 62 healthy volunteers. The gustatory function was tested with taste strips test. Visual analogue scale was used for self‐assessment of taste function. The electrogustometer was used to assess the neurosensory threshold. The oral dryness was assessed by the Clinical Oral Dryness Score, salivary flow rate and Xerostomia Inventory. The general and oral health‐related QoL and mental health well‐being were assessed using validated questionnaires. Results The pSS group had significantly impaired taste function, but this was not correlated with oral dryness. There was an association between taste acuity and the neurosensory threshold (β = −0.5, 95% CI = −0.2 to −0.1). The QoL was not impacted by taste dysfunction (p > .5). Conclusion The results suggest that taste impairment in pSS is associated with neurosensory dysfunction and is unlikely to be due to oral dryness.

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“…Decreased salivary gland function can lead to oral dryness, which is a major clinical characteristic of patients with pSS. Saliva is a complex fluid containing various proteins, lipids, electrolytes, immunoglobulin A, hormones, and buffers [3]. The main functions of saliva include balancing the oral microbiota, providing lubrication and protection of the oral mucosa and tongue, facilitating carbohydrate digestion in the mouth, providing acid-base buffering and mineral salts, acting as a physical obstacle, and involving in wound healing mediated by epidermal growth factor (EGF) and vascular endothelial growth factor (VEGF) [4].…”

Section: Introductionmentioning

confidence: 99%

Increased risk of developing dental diseases in patients with primary Sjögren’s syndrome—A secondary cohort analysis of population-based claims data

Chuang

Hsu

et al. 2020

PLoS ONE

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Background Although it is known that patients with primary Sjö gren's syndrome (pSS) have impaired dental conditions, incidence rates and incidence rate ratios of various dental diseases in these patients are not clear. The aim of this study was to investigate the frequency and prevalence of dental diseases in patients with pSS, and to evaluate the risk of common dental diseases in these patients. Methods A population-based retrospective cohort study was conducted using the data from the Taiwan's National Health Insurance Research Database. A total of 709 patients with newly diagnosed pSS between 2000 and 2012 were identified to form the pSS cohort. A comparison cohort of patients without pSS was assembled based on frequency matching for sex, 5year age interval, and index year at a ratio of 10:1. All participants were followed until the end of the follow-up period or when the outcome of interest occurred. The incidence of dental caries, pulpitis, gingivitis, periodontitis, oral ulceration, and stomatitis were calculated using multiple Poisson regression models. Results A significantly higher prevalence (74.6% vs. 63.0%, P = 0.001) and frequency (median 5.37 vs. 1.45 per year, P < 0.001) dental visits were observed in patients with pSS compared with patients in the comparison cohort. The risk of dental caries (adjusted incidence rate ratio [aIRR] 1.64, P < 0.001), pulpitis (aIRR 1.42, P < 0.001), gingivitis (aIRR 1.43, P < 0.001), periodontitis (aIRR 1.44, P < 0.001), oral ulceration (aIRR 1.98, P < 0.001), and stomatitis (aIRR 2.06, P < 0.001) were significantly higher in patients with pSS.

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Sjogren’s syndrome: An update on disease pathogenesis, clinical manifestations and treatment

Cited by 143 publications

References 479 publications

Oral Candidiasis: A Disease of Opportunity

Oral Candidiasis: A Disease of Opportunity

Is the taste acuity affected by oral dryness in primary Sjögren’s syndrome patients?

Increased risk of developing dental diseases in patients with primary Sjögren’s syndrome—A secondary cohort analysis of population-based claims data

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