title: Oral and ocular manifestations in Sjögren's syndrome.
abstract: OBJECTIVE
  Little is known about the relationship between lachrymal and salivary gland involvement in Sjögren's syndrome (SS). It is also of interest to know which eye test contributes most to the diagnosis of SS. We investigated the performance of different tear tests and how these tests relate to common serologic and salivary tests in SS.
  
  
  METHODS
  In patients suspected of SS, the tear breakup time and the tear mucus score were evaluated in addition to the routine tests. Eighty consecutive patients were included, categorized into primary SS (pSS), secondary SS (sSS), and negative for SS.
  
  
  RESULTS
  The tear breakup time and mucus score both performed insufficiently in diagnosing SS, in contrast to the Rose Bengal score. In pSS and sSS patients, a clear correlation was noted between tear and saliva quality and secretion rate, and between the Rose Bengal score and parotid sialography. Increased Rose Bengal scores also correlated significantly with hyperglobulinemia and presence of SSB antibodies in serum, with duration of subjective eye dryness, and with decreased tear gland function.
  
  
  CONCLUSIONS
  The Rose Bengal score remains the eye test of choice having the highest specificity for SS. Hyperglobulinemia and especially positive SSB serology may warrant close monitoring of the eyes, since these serum findings appear to relate to the severity of ocular surface damage. Theoretically, a positive evaluation of either the ocular or oral component, in addition to positive serology or histopathology, could be sufficient to diagnose the syndrome for clinical purposes.
authors.affiliation: Department of Oral and Maxillofacial Surgery, University Hospital Groningen, The Netherlands. w.w.i.kalk@kchir.azg.nl
authors.forename: Wouter W I
authors.initials: WW
authors.lastname: Kalk
authors.forename: Khaled
authors.initials: K
authors.lastname: Mansour
authors.forename: Arjan
authors.initials: A
authors.lastname: Vissink
authors.forename: Fred K L
authors.initials: FK
authors.lastname: Spijkervet
authors.forename: Hendrika
authors.initials: H
authors.lastname: Bootsma
authors.forename: Cees G M
authors.initials: CG
authors.lastname: Kallenberg
authors.forename: Jan L N
authors.initials: JL
authors.lastname: Roodenburg
authors.forename: Arie V
authors.initials: AV
authors.lastname: Nieuw Amerongen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000974:Antibodies, Antinuclear / Q000097:blood; D018450:Disease Progression; D015352:Dry Eye Syndromes / Q000175:diagnosis* / Q000209:etiology / Q000276:immunology; D005260:Female; D005456:Fluorescent Dyes; D006801:Humans; D007781:Lactoferrin / Q000032:analysis; D008297:Male; D008875:Middle Aged; D009093:Mucus; D012395:Rose Bengal; D012466:Salivary Gland Diseases / Q000175:diagnosis* / Q000209:etiology / Q000276:immunology; D012680:Sensitivity and Specificity; D012859:Sjogren's Syndrome / Q000150:complications / Q000175:diagnosis* / Q000276:immunology; D013666:Tears / Q000737:chemistry
chemical_list: D000974:Antibodies, Antinuclear; D005456:Fluorescent Dyes; C035357:SS-B antibodies; D012395:Rose Bengal; D007781:Lactoferrin