i133 Cardiovascular and lung disease in Sjögren’s syndrome (original) (raw)
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2016
Dennis Lendrem , Nadia Howard Tripp , Xavier Mariette , Svein Joar A. Johnsen , Jessica Tarn , Katie Hackett , Bridget Griffiths , Sheryl Mitchell , Alain Saraux , Valerie Devauchelle , Katrine Norheim , John D. Isaacs , Peter McMeekin , Simon Bowman , Roald Omdal , Jacques-Eric Gottenberg and Wan-Fai Ng , Newcastle upon Tyne, Newcastle University, Newcastle upon Tyne, United Kingdom, Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, United Kingdom, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, United Kingdom, Université Paris-Sud, AP-HP, Hôpitaux Universitaires Paris-Sud, Paris, France, Clinical Immunology Unit, Department of Internal Medicine, Stavanger University Hospital, Stavanger, Norway, Newcastle University, Newcastle-upon-Tyne, United Kingdom, Rheumatology, Freeman Hospital, Newcastle Upon Tyne, United Kingdom, Freeman Hospital, Newcastle upon Tyne, United Kingdom, Rheumatology Department, CHU de la Cavale Blanche, Brest C...
Consensus Guidelines for Evaluation and Management of Pulmonary Disease in Sjögren’s
Chest, 2021
in collaboration with the Consensus Expert Panel (CEP) Members* BACKGROUND: Pulmonary disease is a potentially serious yet underdiagnosed complication of Sjögren's syndrome, the second most common autoimmune rheumatic disease. Approximately 16% of patients with Sjögren's demonstrate pulmonary involvement with higher mortality and lower quality of life. RESEARCH QUESTION: Clinical practice guidelines for pulmonary manifestations of Sjögren's were developed by the Sjögren's Foundation after identifying a critical need for early diagnosis and improved quality and consistency of care. STUDY DESIGN AND METHODS: A rigorous and transparent methodology was followed according to American College of Rheumatology guidelines. The Pulmonary Topic Review Group (TRG) developed clinical questions in the PICO (Patient, Intervention, Comparison, Outcome) format and selected literature search parameters. Each article was reviewed by a minimum of two TRG members for eligibility and assessment of quality of evidence and strength of recommendation. Guidelines were then drafted based on available evidence, expert opinion, and clinical importance. Draft recommendations with a clinical rationale and data extraction tables were submitted to a Consensus Expert Panel for consideration and approval, with at least 75% agreement required for individual recommendations to be included in the final version. RESULTS: The literature search revealed 1,192 articles, of which 150 qualified for consideration in guideline development. Of the original 85 PICO questions posed by the TRG, 52 recommendations were generated. These were then reviewed by the Consensus Expert Panel and 52 recommendations were finalized, with a mean agreement of 97.71% (range, 79%-100%). The recommendations span topics of evaluating Sjögren's patients for pulmonary manifestations and assessing, managing, and treating upper and lower airway disease, interstitial lung disease, and lymphoproliferative disease. INTERPRETATION: Clinical practice guidelines for pulmonary manifestations in Sjögren's will improve early identification, evaluation, and uniformity of care by primary care physicians, rheumatologists, and pulmonologists. Additionally, opportunities for future research are identified.
Sjögren's syndrome: Where do we stand, and where shall we go?
Journal of Autoimmunity, 2014
Primary Sjögren's syndrome (pSS) is one of the most frequent autoimmune systemic diseases, mainly characterized by ocular and oral dryness due to the progressive destruction of lachrymal and salivary glands by an inflammatory process. A noteworthy proportion of patients also features extraglandular manifestations, sometimes severe and life-threatening. Until now, its management relies mostly on symptomatic interventions, long-term monitoring, and, in patients with severe systemic complications, immunosuppressive drugs can be provided. However, recent years have seen great progresses in the understanding of the pathological processes of the disease. The central role of regulatory lymphocytes, the implication of the type 1 interferon pathway in some patients or the importance of epigenetics have been highlighted. New classification criteria have been recently published and have shed in light an international attempt for a better recognition of the patients, probably thanks to the development of new diagnostic procedures such as salivary gland ultrasonography. To facilitate the detection of treatment efficacy in clinical trials and to help in determining which subgroups of patients would have benefits from intensive therapies, a better definition of activity scores and the availability of new prognostic markers are urgent. Thereby, the development of future therapies should be based on specific molecular signatures that will enable a personalized management of each patient. This review focuses on the most striking advances in the fields of pathophysiology, diagnosis and treatment of pSS, which generate a great hope for pSS patients.
Management of Sjögren's Syndrome: Present Issues and Future Perspectives
Frontiers in Medicine
In view of the new possibilities for the treatment of primary Sjögren's syndrome (pSS) given by the availability of new biotechnological agents targeting the various molecular and cellular actors of the pathological process of the disease, classification criteria aimed at selecting patients to be enrolled in therapeutic trials, and validated outcome measures to be used as response criteria to these new therapies, have been developed and validated in the last decades. Unfortunately, the therapeutic trials so far completed with these new treatments have yielded unsatisfactory or only partially positive results. The main issues that have been evoked to justify the poor results of the new therapeutic attempts are: (i) the extreme variability of the disease phenotypes of the patients enrolled in the trials, which are dependent on different underlying patterns of biological mechanisms, (ii) the fact that the disease has a long indolent course, and that most of the enrolled patients mi...
Sjogren's syndrome: Review of the aetiology, Pathophysiology a Potential therapeutic interventions
Journal of Clinical and Experimental Dentistry, 2017
Background: Sjogren's syndrome (SS) is an autoimmune disorder characterised by lymphocytic infiltration of exocrine glands, resulting in glandular dysfunction. Objectives: This study aims to review the aetiology of Sjogren's syndrome, highlight aspects that contribute to the pathophysiology of the disease and explore treatment options that target different mediators of pathogenesis. Material and Methods: The MEDLINE/PubMed and Google Scholar databases were searched systematically with the terms "Sjogren's syndrome"; "clinical"; "treatment"; "management". Eligible studies had to meet a predefined inclusion criteria. Results: 912 identified studies were evaluated against the inclusion criteria. 25 eligible studies were included for review. Sjogren's syndrome is a multifactorial condition with genetic, environmental and hormonal factors playing a role in establishing the condition. B-cell activating factor (BAFF) is an important mediator in the induction and perpetuation of this condition. Elevated BAFF levels, found in patients with SS, promote growth of B-cells and subsequent production of autoantibody; anti-SSA/Ro. BAFF inhibitors are important potential therapeutic drugs that may be effective in patients with Sjogren's syndrome. Other potential targets include CD20 and CD22 that cause B-cell depletion. Conclusions: The pathophysiology of this exocrinopathy has not fully been elucidated. Potential therapeutic interventions include BAFF inhibitors and anti-CD20 and anti-CD22 therapy. However, no clinical trials have been conducted on subjects with Sjogren's syndrome to support existing research.
The 10th International Symposium on Sjögren's Syndrome - 1-3 October 2009, Brest, France
Immunotherapy, 2010
The International Symposium on Sjögren's syndrome (SS), launched by Rolf Manthorpe (Sjögren's syndrome Research Center, Sweden) in 1986, is held every 3 years. The main thrust of Pierre Youinou, chairman of the 10th International Symposium on SS, was to avoid superficial discussion whilst trying to cover the entire disease spectrum, and rather to encourage lively debate. Five sessions were organized. These were dedicated to etiology, clinics and biology, pathophysiology, and treatment and epidemiology, through introductions by experts who argued for and against theories based on their own clinical and basic data. The symposium took place in Brest, France, with over 350 participants from 42 countries. In parallel with guided visits around posters (232 abstracts were submitted), four informal working discussions were organized during lunchtime and in the late afternoon.
Of the major autoimmune connective tissue diseases, Sjören's syndrome (SS) is perhaps the least well understood. Both primary and secondary forms of SS occur, but their phenotypes are not well defined. No less than 10 sets of diagnostic/classification criteria for SS have been applied since 1965 (1–11), but none have been universally adopted or accepted by the American College of Rheumatology. These criteria have often identified patients with similar clinical features, but not necessarily with a common disease process. There is scant longitudinal data on SS. The absence of recognized classification criteria contributes to delays in diagnosis for individual patients and hampers research into SS due to small sample sizes and heterogeneously diagnosed patient populations. To address these issues, the ongoing Sjören's International Collaborative Clinical Alliance (SICCA) was funded under a US National Institutes of Health contract beginning in 2003. The SICCA project has the goals of 1) designing and implementing an international SS registry for collecting and storing clinical data and biospecimens; 2) developing standardized classification/diagnostic criteria for SS that are universally applicable; and 3) providing these resources for future studies of SS funded by the NIH or comparable agencies.
Novel Therapeutic Strategies in Primary Sjögren's Syndrome
The Israel Medical Association journal : IMAJ, 2017
Primary Sjögren's syndrome (pSS) is a chronic autoimmune disease mainly affecting exocrine glands. However, a subgroup of patients experiences extraglandular manifestations which worsens disease prognosis. To date evidence based guidelines for the management of pSS are lacking, hence the therapeutic approach is mainly based on expert opinion and data from other connective tissue diseases. In recent years, several studies have explored the efficacy and safety of biologic agents in pSS and after the failure of tumor necrosis factor inhibitors, the attention has been focused on compounds directly targeting B or T lymphocytes. The aim of this review article is to provide an overview of available data about B and T cell targeting in pSS and of future directions based on ongoing trials.
Increased bronchial responsiveness in primary and secondary Sjögren's syndrome
The European respiratory journal, 1990
We examined one group of 33 patients with primary Sjögren's syndrome, one group of 17 patients with secondary Sjögren's syndrome, i.e. associated with other connective tissue diseases, and one group of 14 patients with connective tissue diseases but without Sjögren's syndrome. In each patient we obtained chest radiographs and measured lung volumes, carbon monoxide diffusing capacity and airway responsiveness to methacholine. We observed no difference in chest radiograph abnormalities, in lung volumes and in carbon monoxide diffusing capacity among the three groups. However, we found a slight but significant increase of bronchial responsiveness in patients with primary and secondary Sjögren's syndrome compared with patients with connective tissue disorders but without Sjögren's syndrome. Thus PD20FEV1 methacholine was 1.07 mg (1.2) (geometric mean and GSEM) in primary Sjögren's syndrome, 0.91 mg (1.4) in secondary Sjögren's syndrome (NS), and 2.24 mg (1.09...