title: Novel aspects of Sjögren's syndrome in 2012.
abstract: Sjögren's syndrome (SS) is a systemic progressive autoimmune disease characterized by a complex pathogenesis requiring a predisposing genetic background and involving immune cell activation and autoantibody production. The immune response is directed to the exocrine glands, causing the typical 'sicca syndrome', but major organ involvement is also often seen. The etiology of the disease is unknown. Infections could play a pivotal role: compared to normal subjects, patients with SS displayed higher titers of anti-Epstein-Barr virus (EBV) early antigens, but lower titers of other infectious agent antibodies such as rubella and cytomegalovirus (CMV) suggest that some infections may have a protective role against the development of autoimmune disease. Recent findings seem to show that low vitamin D levels in patients with SS could be associated with severe complications such as lymphoma and peripheral neuropathy. This could open new insights into the disease etiology. The current treatments for SS range from symptomatic therapies to systemic immunosuppressive drugs, especially B cell-targeted drugs in cases of organ involvement. Vitamin D supplementation may be an additional tool for optimization of SS treatment.
authors.affiliation: Rheumatology and Clinical Immunology Unit, Spedali Civili, Piazzale Spedali Civili 1, 25100 Brescia, Italy. tincani@med.unibs.it
authors.forename: Angela
authors.initials: A
authors.lastname: Tincani
authors.forename: Laura
authors.initials: L
authors.lastname: Andreoli
authors.forename: Ilaria
authors.initials: I
authors.lastname: Cavazzana
authors.forename: Andrea
authors.initials: A
authors.lastname: Doria
authors.forename: Marta
authors.initials: M
authors.lastname: Favero
authors.forename: Maria-Giulia
authors.initials: MG
authors.lastname: Fenini
authors.forename: Franco
authors.initials: F
authors.lastname: Franceschini
authors.forename: Andrea
authors.initials: A
authors.lastname: Lojacono
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Nascimbeni
authors.forename: Amerigo
authors.initials: A
authors.lastname: Santoro
authors.forename: Francesco
authors.initials: F
authors.lastname: Semeraro
authors.forename: Paola
authors.initials: P
authors.lastname: Toniati
authors.forename: Yehuda
authors.initials: Y
authors.lastname: Shoenfeld
mesh_terms: D000914:Antibodies, Viral / Q000097:blood; D001323:Autoantibodies / Q000097:blood; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008223:Lymphoma / Q000517:prevention & control; D010523:Peripheral Nervous System Diseases / Q000517:prevention & control; D012859:Sjogren's Syndrome / Q000150:complications / Q000209:etiology* / Q000473:pathology / Q000628:therapy*; D014807:Vitamin D / Q000627:therapeutic use
chemical_list: D000914:Antibodies, Viral; D001323:Autoantibodies; D007166:Immunosuppressive Agents; D014807:Vitamin D
references.citation: Arthritis Rheum. 2010 Apr;62(4):960-8
references.pmid: 20131246
references.citation: Lupus. 2002;11(11):716-21
references.pmid: 12475001
references.citation: Arthritis Res Ther. 2004;6(1):R33-R38
references.pmid: 14979935
references.citation: J Clin Gastroenterol. 2012 Jan;46(1):25-30
references.pmid: 22157220
references.citation: Best Pract Res Clin Rheumatol. 2012 Feb;26(1):105-17
references.pmid: 22424197
references.citation: Isr Med Assoc J. 2008 Jan;10(1):13-9
references.pmid: 18300564
references.citation: Curr Opin Rheumatol. 2012 Mar;24(2):193-200
references.pmid: 22249352
references.citation: Rheumatology (Oxford). 2010 Jun;49(6):1164-72
references.pmid: 20299380
references.citation: Arch Intern Med. 2008 Apr 14;168(7):771-2
references.pmid: 18413561
references.citation: Nat Rev Rheumatol. 2012 May 01;8(7):399-411
references.pmid: 22549247
references.citation: Ocul Surf. 2004 Apr;2(2):124-30
references.pmid: 17216083
references.citation: Clin Rev Allergy Immunol. 2008 Feb;34(1):124-8
references.pmid: 18270866
references.citation: J Autoimmun. 2012 Aug;39(1-2):15-26
references.pmid: 22575069
references.citation: Autoimmun Rev. 2013 Jan;12(3):416-20
references.pmid: 22889617
references.citation: Ann N Y Acad Sci. 2007 Jun;1108:418-25
references.pmid: 17894006
references.citation: Arthritis Care Res (Hoboken). 2012 Apr;64(4):475-87
references.pmid: 22563590
references.citation: Trends Immunol. 2009 Aug;30(8):409-14
references.pmid: 19643667
references.citation: J Autoimmun. 2010 Feb;34(1):55-8
references.pmid: 19897339
references.citation: Ann Rheum Dis. 2007 Mar;66(3):351-7
references.pmid: 16950808
references.citation: Ann Rheum Dis. 2003 Sep;62(9):897-900
references.pmid: 12922967
references.citation: Autoimmunity. 2005 Feb;38(1):55-63
references.pmid: 15804706
references.citation: J Rheumatol. 2007 Jun;34(6):1283-92
references.pmid: 17552056
references.citation: Ann Rheum Dis. 2005 Jun;64(6):913-20
references.pmid: 15550531
references.citation: Rheumatol Int. 2011 Aug;31(8):1045-9
references.pmid: 20309693
references.citation: Autoimmun Rev. 2011 Apr;10(6):305-10
references.pmid: 21224015
references.citation: ScientificWorldJournal. 2006 Jan 26;6:125-39
references.pmid: 16493517
references.citation: Rheumatology (Oxford). 2008 Aug;47(8):1244-9
references.pmid: 18565986
references.citation: Arthritis Rheum. 2003 Jun 15;49(3):394-8
references.pmid: 12794796
references.citation: Cancer Causes Control. 1997 Mar;8(2):201-4
references.pmid: 9134244
references.citation: Autoimmun Rev. 2011 Jan;10(3):123-5
references.pmid: 20833272
references.citation: J Diabetes Complications. 2005 Sep-Oct;19(5):247-53
references.pmid: 16112498
references.citation: Clin Rheumatol. 2006 Nov;25(6):891-4
references.pmid: 16283417
references.citation: Autoimmun Rev. 2012 Feb;11(4):281-7
references.pmid: 22001416
references.citation: J Autoimmun. 2012 Aug;39(1-2):57-63
references.pmid: 22289719
references.citation: CLAO J. 1995 Oct;21(4):221-32
references.pmid: 8565190
references.citation: Ophthalmology. 2011 Jul;118(7):1242-52
references.pmid: 21459453
references.citation: Nephrol Dial Transplant. 2001 Dec;16(12):2328-36
references.pmid: 11733624
references.citation: Autoimmun Rev. 2007 Jan;6(3):190-5
references.pmid: 17289556
references.citation: Scand J Rheumatol. 2005;34(1):45-8
references.pmid: 15903025
references.citation: Clin Rheumatol. 2008 Apr;27(4):511-3
references.pmid: 18172572
references.citation: Semin Arthritis Rheum. 2011 Jun;40(6):547-51
references.pmid: 20864144
references.citation: J Autoimmun. 2012 Sep;39(3):234-9
references.pmid: 22835660
references.citation: J Autoimmun. 2010 Nov;35(3):219-24
references.pmid: 20685080
references.citation: Hum Immunol. 1993 Apr;36(4):235-42
references.pmid: 8340232
references.citation: J Autoimmun. 1999 Sep;13(2):225-32
references.pmid: 10479391
references.citation: Am J Ophthalmol. 2010 Mar;149(3):405-15
references.pmid: 20035924
references.citation: Arthritis Rheum. 2007 Mar 15;57(2):310-7
references.pmid: 17330280
references.citation: J Autoimmun. 2012 Aug;39(1-2):4-8
references.pmid: 22326205
references.citation: Arthritis Rheum. 2007 Dec;56(12):3995-4004
references.pmid: 18050196
references.citation: Rheumatology (Oxford). 2010 May;49(5):844-53
references.pmid: 20147445
references.citation: J Autoimmun. 2012 Aug;39(1-2):34-42
references.pmid: 22178199
references.citation: Autoimmun Rev. 2012 Feb;11(4):252-8
references.pmid: 22001522
references.citation: J Autoimmun. 2012 Sep;39(3):229-33
references.pmid: 22709856
references.citation: Ocul Surf. 2007 Apr;5(2):75-92
references.pmid: 17508116
references.citation: Autoimmun Rev. 2011 Jul;10(9):527-35
references.pmid: 21527361
references.citation: BMJ. 2012 Jun 14;344:e3821
references.pmid: 22700787
references.citation: Arthritis Rheum. 2006 Jul;54(7):2243-9
references.pmid: 16802363
references.citation: Autoimmun Rev. 2007 Sep;6(8):553-8
references.pmid: 17854748
references.citation: Semin Arthritis Rheum. 2000 Apr;29(5):296-304
references.pmid: 10805354
references.citation: Curr Opin Neurol. 2010 Oct;23(5):509-13
references.pmid: 20689426
references.citation: Autoimmun Rev. 2010 Mar;9(5):A305-10
references.pmid: 19903539
references.citation: Autoimmun Rev. 2011 Jul;10(9):509-13
references.pmid: 21447407
references.citation: Rheumatology (Oxford). 2009 Jul;48(7):796-9
references.pmid: 19433433
references.citation: Autoimmun Rev. 2010 Jul;9(9):595-9
references.pmid: 20457283
references.citation: Autoimmun Rev. 2007 Sep;6(8):529-36
references.pmid: 17854744
references.citation: J Rheumatol. 2007 Nov;34(11):2253-8
references.pmid: 17937465
references.citation: Ann N Y Acad Sci. 2009 Sep;1173:640-8
references.pmid: 19758210
references.citation: Acta Med Austriaca. 2002;29(2):52-6
references.pmid: 12050946
references.citation: Clin Exp Rheumatol. 2010 Jul-Aug;28(4):468-76
references.pmid: 20525449
references.citation: J Clin Rheumatol. 2012 Jan;18(1):28-32
references.pmid: 22157271
references.citation: Ann Rheum Dis. 2012 Jan;71(1):84-7
references.pmid: 21926185
references.citation: Medicine (Baltimore). 2002 Jul;81(4):270-80
references.pmid: 12169882
references.citation: Nat Clin Pract Rheumatol. 2008 Sep;4(9):454-5
references.pmid: 18648339
references.citation: Lupus. 2008 Aug;17(8):727-32
references.pmid: 18625650
references.citation: Bull Rheum Dis. 1963 Feb;13:301-4
references.pmid: 13974644
references.citation: Eur J Intern Med. 2012 Mar;23(2):e67-8
references.pmid: 22284260
references.citation: J Autoimmun. 2012 Aug;39(1-2):27-33
references.pmid: 22318209
references.citation: J Autoimmun. 2010 Sep;35(2):160-70
references.pmid: 20673622
references.citation: J Autoimmun. 2012 Aug;39(1-2):97-102
references.pmid: 22365784
references.citation: Rheumatol Int. 2009 Jun;29(8):853-60
references.pmid: 19152092
references.citation: Cochrane Database Syst Rev. 2011 Dec 07;(12):CD008934
references.pmid: 22161442
references.citation: Lupus. 2009 Nov;18(13):1149-53
references.pmid: 19880561
references.citation: Rheumatology (Oxford). 2012 Jun;51(6):1081-5
references.pmid: 22302061
references.citation: Cancer Invest. 2009 Nov;27(9):942-51
references.pmid: 19832043
references.citation: Eur J Obstet Gynecol Reprod Biol. 1995 Nov;63(1):49-53
references.pmid: 8674565
references.citation: Pain Med. 2008 Nov;9(8):979-84
references.pmid: 18346069
references.citation: Lupus. 2005;14(10):837-41
references.pmid: 16302679
references.citation: Semin Arthritis Rheum. 2006 Apr;35(5):312-21
references.pmid: 16616154
references.citation: Autoimmun Rev. 2011 Jan;10(3):150-4
references.pmid: 20854935
references.citation: J Autoimmun. 2012 Aug;39(1-2):49-56
references.pmid: 22300712
references.citation: Ann Rheum Dis. 2012 Mar;71(3):334-40
references.pmid: 21953338
references.citation: Ann Rheum Dis. 2012 Nov;71(11):1881-7
references.pmid: 22615459
references.citation: Ann N Y Acad Sci. 2009 Sep;1173:658-63
references.pmid: 19758212
references.citation: Rheumatology (Oxford). 2005 Apr;44(4):449-55
references.pmid: 15590764
references.citation: Arthritis Rheum. 2005 Sep;52(9):2740-50
references.pmid: 16142737
references.citation: J Autoimmun. 2012 May;38(2-3):J197-208
references.pmid: 22204899
references.citation: J Cutan Med Surg. 2011 Jan-Feb;15(1):8-14
references.pmid: 21291650
references.citation: J Neurotrauma. 2008 Oct;25(10):1247-56
references.pmid: 18986226
references.citation: Ann Rheum Dis. 2002 Jun;61(6):554-8
references.pmid: 12006334
references.citation: Ann Oncol. 2006 Apr;17(4):713-8
references.pmid: 16556850
references.citation: Invest Ophthalmol Vis Sci. 1983 Oct;24(10):1442-3
references.pmid: 6618809
references.citation: Rheumatology (Oxford). 2004 Aug;43(8):1050-3
references.pmid: 15187246
references.citation: Best Pract Res Clin Rheumatol. 2007 Dec;21(6):989-1010
references.pmid: 18068857
references.citation: Ann Rheum Dis. 2005 Jul;64(7):1062-4
references.pmid: 15958760
references.citation: Am J Med. 1974 Jul;57(1):78-85
references.pmid: 4134767
references.citation: Ann Rheum Dis. 2008 Nov;67(11):1541-4
references.pmid: 18276741
references.citation: J Autoimmun. 2012 Dec;39(4):354-8
references.pmid: 22695186
references.citation: Arthritis Rheum. 2007 Dec;56(12):3977-88
references.pmid: 18050195
references.citation: Presse Med. 2011 Jan;40(1 Pt 2):e49-64
references.pmid: 21194883
references.citation: Autoimmun Rev. 2008 Jan;7(3):192-7
references.pmid: 18190877
references.citation: Br J Cancer. 1993 Oct;68(4):668-72
references.pmid: 8398690
references.citation: J Autoimmun. 2012 Aug;39(1-2):112-6
references.pmid: 22297145
references.citation: Autoimmun Rev. 2011 Jan;10(3):175-9
references.pmid: 20923710
references.citation: Autoimmun Rev. 2011 Jun;10(8):503-8
references.pmid: 21397735
references.citation: Medicine (Baltimore). 2008 Jul;87(4):210-219
references.pmid: 18626304
references.citation: J Autoimmun. 2012 Aug;39(1-2):9-14
references.pmid: 22209352
references.citation: Arthritis Res Ther. 2006;8(4):R129
references.pmid: 16859536
references.citation: J Autoimmun. 2012 Sep;39(3):161-7
references.pmid: 22749831
references.citation: Autoimmun Rev. 2013 Jan;12(3):363-73
references.pmid: 22743033
references.citation: J Autoimmun. 2012 Sep;39(3):199-205
references.pmid: 22749530