Clinical follow up study of 87 patients with sicca symptoms (dryness of eyes or mouth, or both)

doi:10.1136/ard.58.7.423

Annals of the Rheumatic Diseases 1999;58:423-427; doi:10.1136/ard.58.7.423

Ann Rheum Dis 1999;58:423-427 ( July )

Extended reports

Clinical follow up study of 87 patients with sicca symptoms (dryness of eyes or mouth, or both) Marja Pertovaara^a, Markku Korpela^a, Hannu Uusitalo^b, Juhani Pukander^c, Ari Miettinen^d, Heikki Helin^e, Amos Pasternack^c

^a Department of Internal Medicine, Tampere University Hospital, Finland, ^b Department of Ophthalmology, Tampere University Hospital, Finland, ^c Medical School, University of Tampere, Finland, ^d Clinical Microbiology Unit, Tampere University Hospital, Finland, ^e Pathology Unit, Tampere University Hospital, Finland

Correspondence to: Dr M Pertovaara, Department of Internal Medicine, Section of Rheumatology, Tampere University Hospital, PO Box 2000, FIN-33521 Tampere, Finland.

Accepted for publication 18 March 1999

OBJECTIVE $---$ To assess the prognosis of patients with sicca symptoms and to identify the clinical and immunological factors that most sensitivelypredict the later development of primary Sjögren's syndrome (SS)or other connective tissuediseases.
METHODS $---$ Eighty seven patients (72 female, 15 male) with sicca symptoms were re-evaluated after a median follow up time of 11 years(range 8-17). The clinical examination included ophthalmologicalexamination (Schirmer's test, break up time and Rose-Bengal staining).Labial salivary gland biopsy was performed and histological findingsgraded according to the Chisholm-Mason scale. The immunoserologicaltests included determination of rheumatoid factor (RF), antinuclearantibodies (ANA), anti-extractable nuclear antigen-antibodies(ENA), serum immunoglobulins IgA, IgG, and IgM, and serum $beta$ ₂-microglobulin( $beta$ ₂m).
RESULTS $---$ At follow up 31 patients (36%) fulfilled modified Californian criteria (salivary flow measurements were not performed andChisholm-Mason grades 3-4 were regarded as diagnostic histologicalfindings) for possible or definite SS. Likewise, a significantprogression of the histological findings was observed. Labialsalivary gland re-biopsy was performed in 42 patients with grade0-2 findings at baseline, progression to grades 3-4 being observedin 21 (50%) at follow up. The patients who later developed SSwere at baseline significantly older (mean (SD) 52 (9) v 44 (14)years, p $=<$ 0.005) compared with those not fulfilling the SS criteriaat follow up; they also had significantly higher serum $beta$ ₂m (p $=<$ 0.0005)and IgG concentrations (p $=<$ 0.005), and they had positive ANA morefrequently (p $=<$ 0.01).
CONCLUSION $---$ These results suggest that high age, increased values of serum $beta$ ₂m, ANA positivity and increased concentrations of serum IgG,might be useful indicators for the subsequent development of SSin patients with sicca symptoms. The prognosis of patients withthese symptoms was favourable, and the clinical course was benigneven in the 36% of patients who developed SS. No cases of lymphomawereobserved.

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