Name: Ana Paula Espíndula Gianordoli
Type: MSc dissertation
Publication date: 19/08/2019
Advisor:

Namesort descending Role
Valéria Valim Cristo Advisor *

Examining board:

Namesort descending Role
Érica Vieira Serrano External Alternate *
Liliana Aparecida Pimenta de Barros Internal Examiner *
Maria Bernadete Renoldi de Oliveira Gavi Internal Alternate *
Valéria Valim Cristo Advisor *

Summary: Systemic lupus erythematosus (SLE) and Sjögren’s syndrome (SS) may overlap and they have clinical and immunological conditions that make diagnosis difficult. Few and heterogeneous studies evaluated SS prevalence in SLE and no one used new classification for SS. Objectives: To evaluate dry symptoms, to describe histology of salivary glands and to study prevalence of SS in SLE, according to ACR-EULAR 2016 and AECG 2002 classification criteria. Methods: Cross-sectional study of 117 patients with SLE from Rheumatology outpatient clinic of university hospital from 2016-2018. Patients were undergone to dryness questionnaire, whole unstimulated salivary gland, ocular surface tests (fluoresceine/lisamine), Schirmer I test, and labial salivary gland biopsy. Results: Most were adults, female (94%) 49,6% miscigenous ethnicity, and 92,2% fulfilled SLICC 2012 to SLE, 93,1% positive FAN, 31,6% anti-DNAds. The frequency of symptoms of dryness evaluated was 70.1% of visual turbidity, 66.7% of xeroderma, 65% of photophobia, 61.5% of xerostomia, 51.3% skin pruritis, 44.4% used to drink toswollow, 40.2% caries, 39.3% vagina dryness, 38.5% airway/nasal dryness, 26.2% parotid gland edema, 24.1% no tears to cry. Glandular dysfunction was FS &#8804; 0.1ml/min 48.3%, Schirmer I &#8804; 5mm 30% and OSS &#8805; 5 28.5%. Anti-Ro + was observed in 49.6%. The prevalence of SS was 35% based on the ACR-EULAR 2016 criteria and 23% based on the AECG 2002 criteria. The ESSDAI in SS + was 8.9 ± 7.6. The anatomopathological study of BGSL showed non specific chronic sialoadenitis in 49.6% of patients with SLE and focal lymphocyte sialoadenitis with focal score &#8805;1 in 17.2%, 56.8% had acinar atrophy, 71.5% ductal dilation, 55,8% adipose infiltration. Of the 18 patients with biopsy with focal score &#8805;1,4 (22%) presented lymphoepithelial lesion. The predictive factors (p< 0.05) for SS were the presence of anti-Ro, with OR= 17.6 (6.7, 47); focal lymphocytic sialoadenitis with focal score &#8805;1 OR = 3.7 (1.8 = 7.3); OSS &#8805; 5 OR = 7.5 (2.6,21.7); Schirmer test I OR= 2.67 (1.028,6.8) and non-stimulated salivary flow &#8804; 1.5 ml/min OR 4.1 (1.7.10.2). The symptoms of oral and ocular dryness were not associated with the diagnosis of SS. Conclusion: The prevalence of SS in SLE was 35% basedonthe ACR-EULAR 2016 criteriaand 23% basedonthe AECG 2002 criteria. Agreement between both was good. The presence of anti-Ro and glandular dysfunction, but not symptoms, were predictors for SS in SLE.
Key-words: Systemic Lupus Erythematosus. Sj&#1255;gren’s Syndrome. Labial salivary gland biopsy. American European Consensus Group.

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