title: Comparison of lacrimal and salivary gland involvement in Sjögren's syndrome.
abstract: OBJECTIVE
  To determine the performance of different tear and salivary tests applied in Sjögren's syndrome (SS) and to disclose how these tests relate to common serologic tests in SS.
  
  
  METHODS
  In addition to the routine ocular and oral tests for diagnosing SS (Schirmer test, rose bengal score, unstimulated whole saliva flow, and parotid sialography), tear breakup time and flow rate of glandular saliva (parotid and submandibular-sublingual [SM/SL]) were evaluated in patients referred for diagnosis of SS. Patients were categorized into primary SS, secondary SS, and non-SS groups according to the revised European classification criteria for SS.
  
  
  METHODS
  Referral center.
  
  
  METHODS
  Referred sample of 80 consecutive patients.
  
  
  METHODS
  Correlation between ocular and salivary measures.
  
  
  RESULTS
  Breakup time performed insufficiently in diagnosing SS, as opposed to the rose bengal score. In patients with primary and secondary SS, 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 SS-B antibodies in serum, with duration of subjective eye dryness, and with decreased tear-gland function. With regard to the oral tests, whole, parotid, and SM/SL salivary flow decreased significantly with increasing duration of oral complaints, with the stimulated SM/SL flow rate showing the strongest decrease and being more specific in diagnosing SS. Also, parotid sialography was more specific in excluding patients without SS than the commonly applied diagnostic criterion of secretion of unstimulated whole saliva.
  
  
  CONCLUSIONS
  The rose bengal score remains the eye test of choice, as it has the highest specificity for SS. Hyperglobulinemia and especially positive serologic findings for SS-B may warrant close monitoring of the eyes, since these serum findings appear to relate to the severity of ocular surface damage. Parotid sialography and stimulated secretion of SM/SL saliva are more specific in diagnosing SS than unstimulated secretion of whole saliva.
authors.affiliation: Department of Oral and Maxillofacial Surgery, University Hospital Groningen, Groningen, The Netherlands. A.Vissink@kchir.azg.nl
authors.forename: Arjan
authors.initials: A
authors.lastname: Vissink
authors.forename: Wouter W I
authors.initials: WW
authors.lastname: Kalk
authors.forename: Khaled
authors.initials: K
authors.lastname: Mansour
authors.forename: Fred K L
authors.initials: FK
authors.lastname: Spijkervet
authors.forename: Hendrika
authors.initials: H
authors.lastname: Bootsma
authors.forename: Jan L N
authors.initials: JL
authors.lastname: Roodenburg
authors.forename: Cees G M
authors.initials: CG
authors.lastname: Kallenberg
authors.forename: Arie V
authors.initials: AV
authors.lastname: Nieuw Amerongen
mesh_terms: D000906:Antibodies / Q000097:blood; D018118:Chloride Channels / Q000097:blood; D005260:Female; D006801:Humans; D007765:Lacrimal Apparatus / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D012469:Salivary Glands / Q000503:physiopathology*; D012859:Sjogren's Syndrome / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology*; D012964:Sodium / Q000097:blood
chemical_list: D000906:Antibodies; D018118:Chloride Channels; D012964:Sodium