Patients of early onset Sjogren's syndrome may present with features of no or low dryness of mouth

Sjogren's syndrome, an autoimmune disorder primarily known for causing dryness in the mouth and eyes, may present differently in a subset of patients. A recent study from a French tertiary reference center has shed light on a distinct group of Sjögren's syndrome patients who exhibit little to no dryness symptoms. This study was published in BMC Rheumatic and Musculoskeletal Diseases by Alexandra Kachaner and colleagues.

The Study Findings:

Researchers at the French referral center included 509 patients diagnosed with Sjögren's syndrome according to established criteria.

The patients were divided into groups based on the presence and severity of subjective and objective dryness symptoms.

Patients with low or no subjective dryness (53 individuals) were compared with those reporting high subjective dryness (456 patients).

Patients with low objective dryness (113 individuals) were compared with those displaying high objective dryness (359 patients).

Key Results:

• Age and Diagnosis Time: Patients with low or no subjective dryness were significantly younger at a median age of 49, compared to 58 in the high subjective dryness group. They were also diagnosed earlier, with a median time from symptom onset to diagnosis of 2 years, in contrast to 4 years in the high subjective dryness group.
• Autoantibodies: Patients without high subjective dryness displayed a higher frequency of anti-SSA positivity (83%) compared to those with high dryness symptoms (64%).
  
• Minor Salivary Gland Biopsy: Among patients without high subjective dryness, 69% showed less focal sialadenitis in minor salivary gland biopsy, while 83% of those with high dryness features exhibited it.
  
• Objective Dryness: Similar trends were observed in patients without high objective dryness, including younger age (median age of 51), a higher percentage of anti-SSA positivity (79%) compared to the group with high objective dryness.
  
• Disease Activity: No significant difference was observed in disease activity between the two groups.
  

Conclusions:

The study revealed a distinct profile among Sjögren's syndrome patients who lack pronounced dryness symptoms. These individuals tend to be younger, receive a faster diagnosis, are more frequently anti-SSA positive, and exhibit less focal sialadenitis in minor salivary gland biopsy. Importantly, their disease activity remains comparable to those with high dryness features.

These findings highlight the complex and varied nature of Sjögren's syndrome and emphasize the need for healthcare providers to consider atypical presentations when diagnosing and managing the condition. Further research is warranted to explore the underlying mechanisms and long-term outcomes in this unique subset of Sjögren's patients.

In summary, this study challenges the conventional understanding of Sjögren’s syndrome and underscores the importance of a comprehensive approach to diagnosis and treatment that accommodates the diversity of patient experiences.

Reference:

Kachaner, A., Bergé, E., Desmoulins, F., Le Pajolec, C., Rousseau, A., Labetoulle, M., Nocturne, G., Mariette, X., & Seror, R. Comparison between primary Sjögren’s disease patients with high or low level of dryness. RMD Open,2023;9(4):e003291. https://doi.org/10.1136/rmdopen-2023-003291