Toshikazu Kurumagawa, MD(*); Hideo Kobayashi, MD,FCCP and Kazuo Motoyoshi, MD. Third Department of Internal Medicine, National Defense Medical College, Tokorozawa, Saitama, Japan.
PURPOSE: Sjogren's syndrome is a chronic inflammatory disease characterized pathologically by lymphocytic infiltration to the exocrine glands. It has also been found to affect the respiratory system in many forms. Therefore, patients with diffuse lung disease might have Sjogren's syndrome, even if no clinical sicca syndrome. We explored the potential involvement of Sjogren's syndrome as associated pathogenesis of diffuse lung disease.
METHODS: A prospective clinical study was performed with measurement of saliva production using the Saxon test. Patients, who were suspected diffuse lung disease and did not exhibit obvious xerosis, were examined from 7/97 to 3/00. Patients treated parasympathomimetic blocking or psychotropic agents, or had already been diagnosed Sjogren's syndrome were excluded from this study. Patients with decreased saliva production, which was determined by the value under 2 g/min, in the Saxon test, followed by the Schirmer test, fluorescent test, salivary gland scintigram, sialography, labial biopsy, and serologic tests (Ro/SSA, La/ SSB). Medical records were also reviewed.
RESULTS: The eligible cases were 149 (male: 64, female: 85) and Mean [+ or -] SD age was 55.3 [+ or -] 14.8 year-old (from 25 to 80). The group included 64 patients with sarcoidosis, 30 with various interstitial pneumonias, 15 with bronchial lesion, 10 with non-tuberculosis mycobacterial infection, 8 with COPD, 4 with primary pulmonary lymphoma, 3 with chronic eosinophilic pneumonia, and 15 with miscellaneous diseases. Decreased saliva production was detected in 29 (19.5%), 17 out of 29 cases had accomplished subsequent further examinations after the Saxon test, then Sjogren's syndrome was diagnosed in 8 (5.4%), and suspected in 4(2.7%). Cases diagnosed Sjogren's syndrome revealed 2 sarcoidosis, 2 interstitial pneumonia, primary pulmonary lymphoma, bronchiolitis, pulmonary hypertension, and undetermined interstitial lesion.
CONCLUSION: Prevalence of Sjogren's syndrome was higher among patients with diffuse lung disease in this study than the historical studies (0.05-3.3%). Sjogren's syndrome was accompanied by diffuse lung disease, frequently.
CLINICAL IMPLICATIONS: In patients with diffuse lung diseases, it is always important to differentiate Sjogren's syndrome, even if the sicca syndrome was not apparent. In our study, the Saxon test proved an effective screening procedure for this purpose.
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