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Prevalence of Sjögren syndrome among Nagasaki atomic bomb survivors
  1. A Hida1,
  2. M Akahoshi1,
  3. Y Takagi3,
  4. K Ashizawa1,
  5. M Imaizumi1,
  6. M Soda1,
  7. R Maeda1,
  8. E Nakashima2,
  9. H Ida4,
  10. A Kawakami4,
  11. T Nakamura3,
  12. K Eguchi4
  1. 1
    Department of Clinical Studies, Radiation Effects Research Foundation, Nagasaki, Japan
  2. 2
    Department of Statistics, Radiation Effects Research Foundation, Hiroshima, Japan
  3. 3
    Department of Radiology and Cancer Biology, Nagasaki University School of Dentistry, Nagasaki, Japan
  4. 4
    First Department of Internal Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
  1. A Hida, Department of Clinical Studies, Radiation Effects Research Foundation, 1-8-6 Nakagawa, Nagasaki 850-0013, Japan; ayumih{at}


Objectives: Through a comprehensive epidemiological study, we determined Sjögren syndrome (SS) prevalence and examined the association between SS and ionising radiation dose.

Methods: A total of 1008 atomic bomb survivors in Nagasaki agreed to undergo the tests comprising a questionnaire for xerophthalmia and xerostomia, Schirmer-I test, Saxon test, and tests of anti-SS-A/Ro and anti-SS-B/La antibodies, and, if necessary, Rose Bengal stain test, salivary ultrasonographic and MRI examination from November 2002 through October 2004. Diagnosis of SS was based on the American–European Consensus Group criteria, or a modified version thereof.

Results: Among the 1008 participants (male 398, female 610, average age 71.6 years), 154 participants (15.3%) complained of xerophthalmia, and 264 (26.2%) of xerostomia. Reduced tear flow as assessed by the Schirmer-I test was detected in 371 of 992 participants (37.4%) and reduced saliva flow as assessed by the Saxon test in 203 of 993 participants (20.4%). Among all participants, 38 (3.8%) and 10 (1.0%) participants tested positive for anti-SS-A/Ro and anti-SS-B/La antibodies, respectively. Taking into consideration all the results, 23 participants were diagnosed with SS (primary 20, secondary 3), yielding a prevalence of 2.3%. Although the association between SS and radiation dose was not significant, radiation dose was significantly associated with hyposalivation.

Conclusions: The present comprehensive epidemiological study reveals that the prevalence of SS was 2.3% among Nagasaki atomic bomb survivors and was not associated with radiation dose. The association between radiation dose and hyposalivation supported the possibility that radiation exposure damaged salivary gland function.

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  • Funding: The Radiation Effects Research Foundation (RERF), Hiroshima and Nagasaki, Japan is a private, non-profit foundation funded by the Japanese Ministry of Health, Labour and Welfare (MHLW) and the US Department of Energy (DOE), the latter through the National Academy of Sciences (NAS). This publication was supported by RERF Research Protocol B-27, and Grant-in-Aid No. 15790516 from the Japanese Ministry of Education, Culture, Sports, Science and Technology.

  • Competing interests: None declared.

  • Ethics approval: This study was reviewed and approved by an institutional ethics committee at RERF, the Human Investigation Committee, and written informed consent was obtained from all participants.

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