Sjögren's Syndrome symptoms seen in Multiple Sclerosis

 The following is a summary of research done at various university departments in Brazil into dryness symptoms seen in both Sjögren's Syndrome and Multiple Sclerosis. 

THE HIGHLIGHTS OF THE STUDY:

The association between Multiple Sclerosis and Sjogren's syndrome remains to be answered

Multiple Sclerosis patients may have symptoms of dryness

Multiple Sclerosis patients may fulfill primary Sjogren's syndrome criteria

In medical literature the frequency of primary Sjogren's syndrome among Multiple Sclerosis patients is variable. 

Introduction

The relationship between Sjögren syndrome and demyelinating diseases is still not well understood. These diseases seem to coexist amidst autoimmunity, raising questions about clinical characteristics, relationship with immunomodulatory treatment, and possible common immunological background underlying their pathogenesis.

Objective

To calculate the frequency of dry oral and ocular manifestations and autoantibodies characteristic of primary Sjögren's Syndrome (pSS) in Multiple Sclerosis.

Methods

202 patients with multiple sclerosis answered a questionnaire to identify complaints of xerostomia and xerophthalmia, according to diagnostic criteria for primary Sjögren's syndrome; 

• 43 answered positively to at least one question; 
• 27 had comorbidities or used drugs that cause dry symptoms and were excluded; 
• 16 patients were selected for examinations for oral, ocular and serum anti-Ro/SS-A autoantibody evaluation.

Xerophthalmia is dry eyes.

Xerostomia is abnormal dryness of the mouth due to insufficient salivary secretions.

Results

Eleven (68.75%) patients complained of xerostomia; 

14 (87.5%) of xerophthalmia. 

Sialometry < 0.1 ml/min was observed in three (18.8%); 

13 patients underwent minor salivary gland biopsy and histopathological examination: focal score > 1 in three (23.1%). 

Schirmer test was < 5millimeters/5minutes in four (25%). 

Lyssamine green/fluorescein dye score was > 5 in three (18.8%). 

Anti-Ro/SS-A > 10 UI/milimeters in two (12.5%). 

Three (1.49%) patients met the current criteria for primary Sjögren's syndrome.

Conclusions

Patients with MS may report xerostomia and/or xerophthalmia even in the absence of comorbidities and use of medications capable of causing these symptoms, which may fulfill the diagnostic criteria for pSS. 

In this study, the frequency of pSS according to current criteria was within the range observed in the literature with older criteria. But the question remains whether the association between these diseases is fortuitous or whether there is a pathogenic link.

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