Article Figures & Data
Figures
- Figure 1.
Tongue atrophy scoring. The lingual dorsum is divided into posterior, middle, and anterior parts, and the grade of atrophy of the filiform and fungiform papillae is scored from 0 to 2 for each tertile. This scoring system results in a maximum (max.) final tongue atrophy score (filiform and fungiform papillae for the entire tongue) of 12.
- Figure 2.
Representative tongue images of pSS patients with (A) normal, nonatrophic lingual papillae and nonfissured tongue (maximum final tongue atrophy score = 0/12); (B) fissured (scrotal) tongue with flattened or rounded filiform papillae and flattened fungiform papillae in all 3 tongue tertiles (maximum final tongue atrophy score = 7/12); (C) dry, lobulated, and shiny atrophic tongue appearance because of loss of filiform and fungiform papillae, especially in the anterior and middle tongue tertiles (maximum final tongue atrophy score = 11/12). pSS: primary Sjögren syndrome.
Tables
- Table 1.
Clinical manifestations and histopathological/laboratory/serological features in the 2 groups of patients. Values are n (%).
Variables pSS non-MALT, n = 57 pSS-MALTδ, n = 19 p Clinical manifestations Oral dryness (subjective) 46/57 (81) 18/19 (95) 0.274 Ocular dryness (subjective) 43/57 (75) 17/19 (89) 0.330 SGE 13/57 (23) 11/19 (58) 0.009 Raynaud phenomenon 13/57 (23) 7/19 (37) 0.243 Palpable purpura 5/57 (9) 2/19 (10) 1.000 Arthralgias/myalgias 35/55 (64) 14/19 (73) 0.576 Arthritis 10/57 (17) 4/19 (21) 0.740 Lymphadenopathy 3/57 (5) 5/19 (26) 0.020 Histopathological/laboratory/serological features MSG biopsy focus score ≥ 1 29/57 (51) 17/19 (89) 0.003 MSG biopsy Tarpley score > 2 17/57 (30) 17/19 (89) < 0.001 Leukopenia* 6/56 (11) 2/19 (10) 1.000 ANA-positive† 36/57 (63) 16/19 (84) 0.153 C4 hypocomplementemia◊ 27/51 (53) 9/17 (53) 1.000 Anti-Ro/SSA- and/or anti-La/SSB-positive 36/57 (63) 14/19 (74) 0.235 RF-positive 26/57 (46) 16/19 (84) 0.001 Monoclonal gammopathy 0/44 (0) 5/17 (29) 0.001 ↵δ pSS-MALT: pSS patients with MALT lymphoma, matched 1:3 for age, sex, and disease duration with pSS non-MALT patients.
↵* Defined as white blood cells < 3000/mm3 on 3 separate occasions.
↵† Titers > 1:160.
↵◊ Defined as serum C4 levels < 20 mg/dl on 3 separate occasions. Values in bold face are statistically significant. pSS: primary Sjögren syndrome; MALT: mucosa-associated lymphoid tissue; SGE: salivary gland enlargement; MSG: minor salivary gland; ANA: antinuclear antibodies; RF: rheumatoid factor.
Oral Examination Findings pSS non-MALT, n = 57 pSS-MALTδ, n = 19 p UWSF ≤ 1.5 ml/15 min 14/57 (25) 16/19 (84) < 0.001 Presence of tongue atrophy 17/57 (30) 13/19 (68) 0.006 Fissured tongue 19/57 (33) 17/19 (89) < 0.001 ↵δ pSS-MALT: pSS patients with MALT lymphoma, matched 1:3 for age, sex, and disease duration with pSS non-MALT patients. Values in bold face are statistically significant. pSS: primary Sjögren syndrome; MALT: mucosa-associated lymphoid tissue; UWSF: unstimulated whole salivary flow.
- Table 3.
Multivariate analysis. Independent oral and clinical findings associated with MALT lymphoma in patients with pSS.
Independent Variables OR (95% CI) p Oral findings UWSF ≤ 1.5 ml/15 min 0.09 (0.015–0.560) 0.010 Fissured tongue 0.11 (0.017–0.711) 0.020 Presence of tongue atrophy 2.364 (0.401–14.500) 0. 352 Oral and clinical findings UWSF ≤ 1.5 ml/15 min 0.169 (0.033–0.867) 0.033 Fissured tongue 0.070 (0.007–0.669) 0.021 Lymphadenopathy 0.071 (0.005–1.031) 0.050 SGE 0.249 (0.058–1.079) 0.063 Values in bold face are statistically significant. MALT: mucosa-associated lymphoid tissue; pSS: primary Sjögren syndrome; UWSF: unstimulated whole salivary flow; SGE: salivary gland enlargement.
- Table 4.
Clinical manifestations and histopathological/laboratory/serological features in the pSS-MALT patients with and without tongue atrophy. Values are n (%).
Variables pSS-MALT without Tongue Atrophy, n = 6 pSS-MALT with Tongue Atrophy, n = 13 p Clinical manifestations Oral dryness (subjective) 6/6 (100) 12/13 (92) 1.000 Ocular dryness (subjective) 6/6 (100) 11/13 (85) 1.000 SGE 4/6 (67) 7/13 (54) 1.000 Raynaud phenomenon 1/6 (17) 6/13 (46) 0.333 Palpable purpura 1/6 (17) 1/13 (7) 1.000 Arthralgias/myalgias 4/6 (67) 10/13 (77) 1.000 Arthritis 2/6 (33) 2/13 (15) 0.557 Lymphadenopathy 0/6 (0) 5/13 (38) 0.128 Histopathological/laboratory/serological features MSG biopsy focus score ≥ 1 5/6 (83) 11/13 (85) 1.000 MSG biopsy Tarpley score > 2 6/6 (100) 11/13 (85) 1.000 Leukopenia* 0/6 (0) 2/13 (15) 1.000 ANA-positive† 5/6 (83) 11/13 (85) 1.000 C4 hypocomplementemia◊ 1/5 (20) 8/12 (67) 0.131 Anti-Ro/SSA and/or anti-La/SSB positive 2/5 (40) 12/13 (92) 0.015 RF-positive 4/4 (100) 12/12 (100) 1.000 Monoclonal gammopathy 2/5 (40) 3/12 (25) 0.600 ↵* Defined as white blood cells < 3000/mm3 on 3 separate occasions.
↵† Titers > 1:160.
↵◊ Defined as serum C4 levels < 20 mg/dl on 3 separate occasions. Values in bold face are statistically significant. pSS: primary Sjögren syndrome; MALT: mucosa-associated lymphoid tissue; SGE: salivary gland enlargement; MSG: minor salivary gland; ANA: antinuclear antibody; RF: rheumatoid factor.
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