Parotid gland swelling in primary Sjögren's syndrome: activity and other sialadenosis causes.

OBJECTIVE: To assess the prevalence of parotid gland swelling (PGS) and its association with features of SS and other causes of sialadenosis in a Latin-American cohort of primary SS. METHODS: We included 668 patients from Argentina, Brazil, Mexico and Paraguay. We retrospectively registered demographics, disease duration, oral/ocular symptoms, serology and scored the basal ESSDAI. We defined PGS as a recurrent or persistent increase of volume of any parotid glands during adulthood (self-reported and/or physical examination). We registered the presence of diabetes mellitus, dyslipidaemia, body mass index and alcohol consumption. We used logistic regression analysis reporting odds ratio (OR) and 95% CI. RESULTS: PGS was present in 242 patients (36.2%): 78 previous to SS diagnosis, 86 concomitantly, 73 during follow-up and five unknown. At the multivariate analysis, PGS was associated with RF (OR 2.47, 95% CI: 1.1, 6.5, P = 0.0001), basal articular ESSDAI domain (OR 1.63, 95% CI: 1.01, 2.6, P = 0.04) and alcohol consumption (OR 2.42, 95% CI: 1.41, 4-15). Patients with PGS during the follow-up had a higher prevalence of alcohol consumption (45.3%) compared with the remaining PGS cases (26.8%; OR 2.41 95% CI: 1.2, 4.7), or patients without parotid gland swelling (15.6%; OR 3.8 95% CI: 1.7, 8.2) in all the adjusted models. CONCLUSION: PGS generally precedes or presents concomitantly with SS diagnosis, and is related to RF and articular activity. Alcohol consumption is an additional factor in PGS, especially during follow-up. The meaning of this last finding as well as its prognostic implications remains to be elucidated and deserves further evaluation in prospective studies.

Enfermedad relacionada con IgG4 / IgG4-related disease

Resumen: Se describe el caso de dos pacientes de 67 y 68 años de edad, ambos tenían como antecedente de importancia tabaquismo e iniciaron su padecimiento con organomegalia y globulinas séricas elevadas. El primer paciente tuvo parotidomegalia, xerostomía, xeroftalmia, uveítis de repetición y neumonitis intersticial; mediante biopsia de glándula salival menor se estableció el diagnóstico de enfermedad sistémica relacionada con IgG4 (ER-IgG4). El segundo paciente tuvo crecimiento tiroideo generalizado y tiroides de consistencia pétrea, se realizó tiroidectomía y el resultado de biopsia fue tirotiditis de Riedel (enfermedad órgano-específica de tiroides relacionada con IgG4). La manifestación inicial de la ER-IgG4 puede ser muy inespecífica. Los casos que se comunican tenían manifestaciones que pudieran confundirse con síndrome de Sjögren o sarcoidosis (caso 1) y con cáncer tiroideo (caso 2).

Abstract: This paper reports the case of two patients of 67 and 68 years old, both had a history of smoking and they started suffering with organomegaly and elevated serum globulins. The first patient presented parotidomegaly, xerostomia, xerophthalmia, recurrent uveitis and interstitial pneumonitis; a minor salivary gland biopsy was performed, which confirmed the diagnosis of systemic disease related to IgG4. The second patient presented a stony thyroid tumor, thyroidectomy was performed and the result of biopsy was Riedel's thyroditis (organ-specific thyroid disease related to IgG4). The initial presentation of the disease by IgG4 can be very nonspecific. The manifestations presented by the patients can be confused with Sjögren's syndrome or sarcoidosis (case 1) and with malignancy (case 2).