Reappraisal of Respiratory Abnormalities in Primary and Secondary Sjogren's Syndrome: A Controlled Study

doi:10.1378/chest.90.3.370

Chest

Volume 90, Issue 3, September 1986, Pages 370-374

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In order to appraise the significance of respiratory abnormalities in primary and secondary Sjogren's syndrome (pSS and sSS), we evaluated 40 patients with pSS, 26 with sSS, 40 with rheumatoid arthritis (RA) but no SS, and 100 age- and sex-matched control subjects. The most common functional abnormality was diffuse interstitial lung disease (DILD) in patients with pSS (37.5 percent) and obstructive ventilatory defect in RA and sSS patients (40 and 19 percent, respectively). DILD was also present in the last two groups (11.8 percent in sSS and 27.5 percent in RA), while obstructive defect was rare in pSS (2.5 percent). Abnormalities suggesting small airways disease were present in all patient groups and also in the control group with similar frequency.

Patients with extraglandular pSS had most often DILD (52 percent). Patients with pSS and cryoglobulinemia had low C3 and C4 levels and decreased Dco, suggesting that interstitial lung disease may be a result of immune complex deposition. Clinical input of the functional abnormalities was minimal, expressed as dry cough and mild dyspnea. Pneumonia was not frequent, while pleurisy was present only in patients with sSS and RA. We suggest that, even though pulmonary abnormalities can frequently be detected with sensitive tests in patients with SS, they are not significant if compared with control subjects and are clinically negligible.

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MATERIALS AND METHODS

Sixty-six patients with SS diagnosed and followed-up at the Rheumatology Department of Ioannina General Hospital were prospectively evaluated for respiratory involvement. Diagnosis of SS was based on the presence of two out of three of the following findings: keratoconjunctivitis sicca (positive Schirmer's test <5 mm/5 min and/or slit lamp examination), xerostomia (parotid flow rate <1 ml/5 min) and recurrent parotid gland enlargement. The diagnosis was confirmed by positive minor salivary

RESULTS

Anthropometric and clinical characteristics of patients and control subjects are presented in Table 1. Statistical analysis by chi-square did not reveal any significant difference.

There was a predominance of women in all groups. It must be noted, however, that most of the patients belonging to either of the above groups who were excluded from this study due to a smoking habit were men.

Analysis of the sera of all groups tested revealed that rheumatoid factor and cryoglobulins were present in all

DISCUSSION

In an attempt to further understand pulmonary involvement in SS, we have undertaken the present study of pulmonary function in non-smoking patients with pSS and sSS separately, and compared their results with that of a group of unmatched non-smoking control subjects. Never before has a control population been included in the evaluation of pulmonary involvement in SS patients. In addition, a group of patients with RA, with no signs of SS and normal minor labial salivary gland biopsy results, was

ACKNOWLEDGMENTS

We are grateful to Drs. A. G. Tzioufas and M. Manoussakis for performing immunologic studies, and to Ms. E. E. Papanikolaou for excellent secretarial assistance.

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: Manuscript received December 27; revision accepted March 17.

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