Background Minor salivary gland (MSG) biopsy has assumed greater importance in the classification of patients with Sjögren's syndrome fter publication of the ACR criteria1. In addition, germinal center (GC) like structures on MSG biopsy, have been reported to predict future risk of lymphoma2. Sjögren patients in India are younger and have more extraglandular features compared to western cohorts.3 There has been no data regarding biopsy findings and ACR criteria utility in Indian patients.
Objectives Determine utility of MSG biopsy in Indian Sjögren patients. Determine correlation of biopsy findings with extraglandular manifestations of Sjögren's syndrome.
Methods After Institutional Ethics Committee approval, a retrospective review was done to determine all minor salivary gland biopsies in our hospital from July 2013 to Sept 2015.Among the biopsy specimens, patients diagnosed as Sjögren's were selected and their slides were reviewed by pathologist.Clinical characteristics were determined by retrospective chart review.
Results A cohort of 26 patients emerged. Nearly all were female (25/26) and fulfilled the ACR criteria (25/26). The mean age was 56.9 years.Twenty one patients had an extra glandular manifestation.Arthritis was seen in 14 patients,2 patients had renal involvement 2 patients had vaculitis,3 patients had interstitial lung disease,1 patient had pulmonary artery hypertension, and hematological involvement was seen in 7 patients.Salivary gland biopsy was positive in 20. ANA was positive in 23 of 26 patients, RF in 16/25, anti-Ro antibody in 8/18 & anti-La in 7 of 18 patients.The mean focus score was 1.7/mm2 with a maximum score of 9.57/mm2.There was no statistical difference in proportion of positivity of biopsy (4/5) or mean focus score (2.01/mm2)between patients with extra glandular involvement and those without (16/21 and 1.71/mm2).Mean focus score and proportion of positive MSG biopsy was also similar between patients with arthritis and those without. Only 2 patients (7.7%) had germinal centers (GC) like structures in the biopsy.Both patients with GC like structures had extra glandular features, were biopsy positive and had a focus score of 6.175/mm2. Among patients without GC like structures 19 out of 24 had extra articular features, 18 out of 24 were biopsy positive and the mean focus score was 1.41/mm2. These patients are under follow up for possible progression to lymphoma.
Conclusions In this small cohort of Indian Sjögren's patients who had undergone biopsy the ACR criteria was sensitive enough to be fulfilled in nearly all patients.Similar to previous Indian series, extra glandular features were more frequently observed compared to western cohort. Only two patients had germinal centers.(c.f. ∼25% in Theander et al.2).Among patients with GC like structures there seemed to higher focus score and more extraglandular features.However, biopsy findings did not appear to correlate with extraglandular manifestations.
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Theander E et al.Ann Rheum Dis. 2011;70:1363–8.
Sandhya P,et al.The Open Rheumatology Journal. 2015;9:36–45.
Acknowledgement Dr Raghavendra,Dr Jayashree,Dr Sanjeev Katti (pathology department) & Ms Dhivya (rheumatology department)
Disclosure of Interest None declared