Contribution of DNA methylation to the pathogenesis of Sjögren's syndrome: A review.

Sjögren's syndrome (SS) is a chronic systemic disease characterised by salivary and lacrimal gland dysfunction with severe implications for the well-being of bearing individuals. Although its origin has not yet been fully elucidated, it is known that genetic, environmental, and epigenetic factors are important contributors to the pathogenesis of this syndrome. DNA methylation is a relevant, widely studied epigenetic factor that is possibly related to the establishment of SS. The aim of the present study was to perform a systematic review of the literature to compile studies on the contribution of DNA methylation to the pathogenesis of SS. A literature search was performed in 4 databases (PubMed, Web of Science, Lilacs, and Scopus) using previously selected Medical Subject Headings (MESH) descriptors, and article selection considered observational studies only. After a full-text reading of the selected articles, 15 studies were in accordance with the eligibility criteria for data extraction. Methylation detection approaches included global methylation, genome-wide assessment of differentially methylated regions, and site-specific methylation. Fourteen articles reported associations of DNA methylation profiles in SS patients, both globally and in several genes in salivary glands and blood cells. Thus, DNA methylation may contribute to the pathogenesis of SS. The findings reinforce the importance of epigenetic markers in the dynamics of SS and may direct efforts toward the development of new diagnostic and therapeutic approaches.

Abdominal symptoms during Sjogren's syndrome: a pilot study

Abstract Background: Abdominal symptoms in patients with primary Sjögren syndrome (pSS) are poorly documented. The objective of the study was to describe the abdominal symptoms of patients with pSS and to assess their association with characteristics of the disease. Methods: One hundred and fifty patients with pSS were evaluated using a composite global symptom score for abdominal symptoms and their severity. Data concerning the clinical and biological characteristics of pSS and abdominal disorders were also collected. Results: Of the patients with pSS, 95% suffered from abdominal symptoms (median global symptom score 7.5 ±5.5 points out of 30). More than half of the patients experienced abdominal tension (68%), upper abdominal pain (54%), abdominal discomfort (58%) and/or constipation (54%). Regarding the pSS activity, in relation to European League Against Rheumatism (EULAR) Sjogren syndrome disease activity index score items, general and central nervous system involvement wereassociated with a high global symptom score. The EULAR Sjogren Syndrome Patient Reported Index (ESSPRI) symptom score was positively correlated with the global symptom score (p < 0.01). Multivariate analysis showed a significant association between a high global symptom score and SSA seronegativity, gastroparesis, and ESSPRI score (p < 0.01 for each). Conclusions: The majority of patients with pSS suffered abdominal symptoms. There is currently no therapeutic recommendation because of the lack of information on the underlying pathophysiological mechanisms. Trial registration: NCT03157011. Date of registration: July 17, 2017.(AU)

Disfunción temporomandibular en pacientes con síndrome de Sjögren / Temporomandibular dysfunction in patients with Sjögren's syndrome

Introducción: El síndrome de Sjögren es una enfermedad reumática, inflamatoria y crónica caracterizada por dolor articular y resequedad de las mucosas. La articulación temporomandibular (ATM) y las glándulas parótidas y salivales suelen estar afectadas. Objetivo: Determinar la prevalencia de la afectación de la articulación temporomandibular en pacientes con síndrome de Sjögren. Métodos: Estudio básico, no experimental, descriptivo y de corte transversal que incluyó a 78 pacientes con diagnóstico de síndrome de Sjögren atendidos en la Unidad Móvil número 2 de Alausi entre 2017 y 2019. Para identificar la afectación de la ATM se realizaron ecosonografías. Se usó la prueba de correlación de Pearson para establecer la relación entre las características de la enfermedad y la presencia de afectación articular. Resultados: El promedio de edad fue de 46,18 años. Predominaron los pacientes entre 40 y 60 años (62,82 por ciento), el sexo femenino (85,90 por ciento), y el tiempo de evolución de la enfermedad entre 3 y 5 años (50,00 por ciento). El 79,49 por ciento presentó síndrome de Sjögren secundario, y la artritis reumatoide fue la causa más frecuente (54,84 por ciento). El 65,38 por ciento tenía algún tipo de afectación de la ATM, y el hallazgo más común fue la disminución del espacio articular (56,86 por ciento). Conclusiones: Existió una elevada prevalencia de afectación de la ATM en los pacientes con síndrome de Sjögren, y el hallazgo principal fue la disminución del espacio articular. Se encontró una correlación positiva media entre el tiempo de evolución de la enfermedad y la presencia de afectación de la ATM(AU)

Introduction: Sjögren's syndrome is a rheumatic, inflammatory and chronic disease characterized by the presence of joint pain and dryness of the mucous membranes. The temporomandibular joint and the parotid and salivary glands usually have a high frequency of involvement. Objective: To determine the prevalence of temporomandibular involvement in patients with Sjögren's syndrome. Methods: Descriptive, correlational and explanatory study that included 78 patients diagnosed with Sjögren's syndrome treated in the mobile unit number 2 of Alausi. Echocardiography of the temporomandibular joints was performed to identify the involvement of the joint. Pearson's correlation test was used to establish a relationship between the characteristics of the disease and the presence of joint involvement. Results: Average age of 46.18 years with a predominance of patients between 40 and 60 years of age (62.82 percent), of the female sex (85.90 percent) and with time of evolution of the disease between 3 and 5 years (50.00 percent). 79.49 percent of the cases presented secondary Sjögren's syndrome, rheumatoid arthritis being the most frequent disease (54.84 percent). 65.38 percent of the patients presented some type of involvement of the temporomandibular joint, with the decrease in joint space being the most frequent finding (56.86 percent). Conclusions: There was a high prevalence of temporomandibular joint involvement in patients with Sjögren's syndrome, with the decrease in joint space being the finding that was most frequently identified. A positive average correlation was found between the time of evolution of the disease and the presence of temporomandibular joint involvement(AU)

Expression of BAFF and BAFF receptors in primary Sjögren's syndrome patients with ectopic germinal center-like structures.

B cell-activating factor (BAFF) is an essential cytokine in primary Sjögren's syndrome (pSS) physiopathology. It has been reported that pSS patients develop germinal center-like (GC-like) structures in their minor salivary glands (MSGs). BAFF, BAFF-R, TACI, and BCMA expression was analyzed in MSGs from 29 subjects (nonspecific chronic sialadenitis and focal lymphocytic sialadenitis with the presence [pSS-GC(+)] or absence [pSS-GC(-)] of GC-like structures). Twenty-four percent of patients showed ectopic GC-like structures and a high focus score [p < 0.001 vs pSS-GC(-)]. BAFF serum levels (sBAFF) were high in pSS patients (p = 0.025 vs healthy subjects). However, the pSS-GC(-) group showed higher sBAFF levels than pSS-GC(+) patients. BAFF and BAFF-R glandular expression levels were higher in pSS-GC(+) patients, without significant differences compared to pSS-GC(-) patients. Soluble levels of BAFF correlated with anti-La/SSB antibodies and disease duration. Our results showed that BAFF could contribute to focal lymphocytic infiltration. The role of BAFF-binding receptors in MSGs is proposed as a mechanism for the possible establishment of ectopic GC-like structures and disease progression in some patients. In conclusion, this study supports previous evidence that considers the active BAFF system role in the pathogenesis of pSS and the need for strong biomarkers in this disease.

Synaptotagmin-1 overexpression under inflammatory conditions affects secretion in salivary glands from Sjögren's syndrome patients.

Sjögren's syndrome (SS) is an autoimmune exocrinopathy associated with severe secretory alterations by disruption of the glandular architecture integrity, which is fundamental for a correct function and localization of the secretory machinery. Syt-1, PI(4,5)P2 and Ca2+ are significant factors controlling exocytosis in different secretory cells, the Ca2+ role being the most studied. Salivary acinar cells from SS-patients show a defective agonist-regulated intracellular Ca2+ release together with a decreased IP3R expression level, and this condition may explain a reduced water release. However, there are not reports where Syt-1, PI(4,5)P2 and Ca2+ in acinar cells of SS patients had been studied. In the present study, we analyzed the expression and/or localization of Syt-1 and PI(4,5)P2 in acinar cells of labial salivary gland biopsies from SS-patients and control individuals. Also, we evaluated whether the overexpression of Syt-1 and the loss of cell polarity induced by TNF-α or loss of interaction between acinar cell and basal lamina, alters directionality of the exocytosis process, Ca2+ signaling and α-amylase secretion in a 3D-acini model stimulated with cholinergic or ß-adrenergic agonists. In addition, the correlation between Syt-1 protein levels and clinical parameters was evaluated. The results showed an increase of Syt-1 mRNA and protein levels, and a high number of co-localization points of Syt-1/STX4 and PI(4,5)P2/Ezrin in the acinar basolateral region of LSG from SS-patients. With regard to 3D-acini, Syt-1 overexpression increased exocytosis in the apical pole compared to control acini. TNF-α stimulation increased exocytic events in the basal pole, which was further enhanced by Syt-1 overexpression. Additionally, altered acinar cell polarity affected Ca2+ signaling and amylase secretion. Overexpression of Syt-1 was associated with salivary gland alterations revealing that the secretory dysfunction in SS-patients is linked to altered expression and/or localization of secretory machinery components together with impaired epithelial cell polarity. These findings provide a novel insight on the pathological mechanism implicated in ectopic secretory products to the extracellular matrix of LSG from SS-patients, which might initiate inflammation.

Athetoid Movements as Initial Manifestation of Primary Sjögren Syndrome.

Background: Primary Sjögren syndrome (pSS) is an autoimmune disorder characterized by exocrine gland and extraglandular symptoms. We present a case report of pSS with an initial presentation of athetoid movements. Case Report: A 74-year-old female presented with a 2-month history of slow undulating movements in her trunk and thighs that eventually spread to her neck and lower extremities. She also reported dry eyes, dry mouth, as well as pain in her shoulders and thighs. Her proinflammatory markers and rheumatologic profile were positive. Her salivary gland biopsy revealed a Focus score > 2. Brain magnetic resonance imaging was normal. A diagnosis of pSS was made. The patient's symptoms improved with hydroxychloroquine, pilocarpine, gabapentin, and clonazepam. Discussion: Clinicians should consider and screen for primary autoimmune disorders as a cause of subacute athetoid movements in elderly patients. Although aggressive treatment has been recommended, treatment should be tailored to each patient's specific needs.

Sjögren's Syndrome Associated with Fanconi's Syndrome and Osteomalacia.

BACKGROUND Sjögren's syndrome is a chronic inflammatory autoimmune disease, which is also known as sicca syndrome, due to the symptoms of dry eyes and dry mouth, and is associated with other connective tissue diseases and autoimmune diseases. Sjögren's syndrome can also be associated with renal involvement. Fanconi's syndrome is associated with impaired reabsorption in the proximal renal tubule associated with tubulointerstitial nephritis and is associated with renal tubular acidosis and hypophosphatemia. Osteomalacia is a rare association with Sjögren's syndrome, which may result from renal disease. CASE REPORT We report the case of a 34-year-old woman who presented with xerostomia, xerophthalmia, bone fractures, and osteomuscular pain. A Schirmer test showed reduced tear production, and a biopsy of a minor salivary gland of the lip, with high titers of antinuclear antibodies (ANA), and positive anti-SSA/Ro and anti-SSB/La antibodies confirmed the diagnosis of Sjögren's syndrome. Serum and urinary laboratories tests and clinical manifestations confirmed Fanconi's syndrome associated with osteomalacia. The patient was treated with potassium supplements, 25-hydroxyvitamin D (25(OH)D), hydroxychloroquine, mycophenolate mofetil, and prednisone, with a favorable response. CONCLUSIONS This case is of a rare association between Sjögren's syndrome, Fanconi's syndrome, and osteomalacia. Even though these are rare clinical associations, early detection can improve the quality of life and prevent further complications.

Manifestaciones bucales del síndrome de Sjögren. Presentación de un caso / Oral manifestations of the Sjögren's syndrome. Presentation of a case

El síndrome de Sjögren es una enfermedad autoinmunitaria, caracterizada por la infiltración linfoplasmocitaria de las glándulas exocrinas con destrucción epitelial, provocando un síndrome seco. El objetivo de esta presentación de caso fue profundizar en el conocimiento de la enfermedad, ya que constituye la clave para su diagnóstico oportuno. Se presentó a una paciente femenina de 54 años, con antecedentes de lupus eritematoso sistémico. El interrogatorio, el examen clínico general y bucal, los estudios de laboratorio e histológico, así como la sospecha clínica de la enfermedad, permitieron realizar el diagnóstico del síndrome de Sjögren asociado a lupus eritematoso sistémico. En esta paciente concurrieron las siguientes manifestaciones bucales: xerostomía, halitosis, sensación de sed constante, dificultades para la deglución y para hablar, labios secos y pálidos, lengua depapilada, ardor bucal, intolerancia al uso de la prótesis, queilitis angular y candidiasis bucal. El manejo de la enfermedad tiene un enfoque multidisciplinario; el estomatólogo cumple un papel esencial en su diagnóstico y tratamiento, lo cual permite mejorar la calidad de vida de estos pacientes.

The Sjögren’s syndrome is an auto-immune disease, characterized by the limpho-plasmocytic infiltration of the exocrine glands with epithelial destruction, provoking a dry syndrome. The objective of this case presentation was deepening in this disease knowledge, because it is the key for its opportune diagnosis. We presented a female patient, aged 54 years, with antecedents of systemic lupus erythematosus. The anamnesis, oral and general examination, histological and laboratory studies, and also the clinical suspicion, allowed arriving to the diagnosis of Sjögren’s syndrome associated to systemic lupus erythematosus. This patient showed the following oral manifestations: xerostomia, halitosis, sensation of constant thirst, difficulties for deglutition and speaking, dry and pale lips, depapillated tongue, oral burning, intolerance to prosthesis usage, angular cheilitis and oral candidiasis. The disease management has a multidiscipline approach; the dentist plays an essential role in the disease’s diagnosis and treatment, allowing improving the life quality of these patients.

Manifestaciones bucales del síndrome de Sjögren. Presentación de un caso / Oral manifestations of the Sjögrens syndrome. Presentation of a case

El síndrome de Sjögren es una enfermedad autoinmunitaria, caracterizada por la infiltración linfoplasmocitaria de las glándulas exocrinas con destrucción epitelial, provocando un síndrome seco. El objetivo de esta presentación de caso fue profundizar en el conocimiento de la enfermedad, ya que constituye la clave para su diagnóstico oportuno. Se presentó a una paciente femenina de 54 años, con antecedentes de lupus eritematoso sistémico. El interrogatorio, el examen clínico general y bucal, los estudios de laboratorio e histológico, así como la sospecha clínica de la enfermedad, permitieron realizar el diagnóstico del síndrome de Sjögren asociado a lupus eritematoso sistémico. En esta paciente concurrieron las siguientes manifestaciones bucales: xerostomía, halitosis, sensación de sed constante, dificultades para la deglución y para hablar, labios secos y pálidos, lengua depapilada, ardor bucal, intolerancia al uso de la prótesis, queilitis angular y candidiasis bucal. El manejo de la enfermedad tiene un enfoque multidisciplinario; el estomatólogo cumple un papel esencial en su diagnóstico y tratamiento, lo cual permite mejorar la calidad de vida de estos pacientes. (AU)

The Sjögrens syndrome is an auto-immune disease, characterized by the limpho-plasmocytic infiltration of the exocrine glands with epithelial destruction, provoking a dry syndrome. The objective of this case presentation was deepening in this disease knowledge, because it is the key for its opportune diagnosis. We presented a female patient, aged 54 years, with antecedents of systemic lupus erythematosus. The anamnesis, oral and general examination, histological and laboratory studies, and also the clinical suspicion, allowed arriving to the diagnosis of Sjögrens syndrome associated to systemic lupus erythematosus. This patient showed the following oral manifestations: xerostomia, halitosis, sensation of constant thirst, difficulties for deglutition and speaking, dry and pale lips, depapillated tongue, oral burning, intolerance to prosthesis usage, angular cheilitis and oral candidiasis. The disease management has a multidiscipline approach; the dentist plays an essential role in the diseases diagnosis and treatment, allowing improving the life quality of these patients. (AU)

Analysis of IL10 haplotypes in primary Sjögren's syndrome patients from Western Mexico: Relationship with mRNA expression, IL-10 soluble levels, and autoantibodies.

Primary Sjögren's syndrome (pSS) is an autoimmune disease characterized by lymphocytic infiltration of salivary and lacrimal glands. Interleukin-10 (IL-10) plays a role in autoimmune diseases by promoting B-cell activation and autoantibodies production. IL10-1082A>G, -819C>T, -592C>A polymorphisms and their haplotypes have been associated with IL-10 production. The aim of this study was to associate IL10 haplotypes with mRNA expression and soluble IL-10 levels with susceptibility to pSS in 111 Mexican patients and 111 healthy subjects (HS). Primary Sjögren's syndrome patients showed high levels of sIL-10 (p=0.0001 vs HS) correlating with anti-Ro and anti-La antibodies (p<0.05). In addition, IL10 mRNA expression in pSS was higher than HS (0.8 vs 0.1, p=0.1537). However, no difference was observed in sIL-10 levels between haplotypes. Patients carriers of GCC haplotype showed higher mRNA expression than ACC+ATA (1.4 vs 0.6, p=0.2424) and high foci number (p=0.04 vs ACC). Our results suggest a strong relationship of IL10 with pSS which is demonstrated by the increased mRNA expression and also high sIL-10 levels positively correlated with autoantibodies. Besides that, the GCC haplotype carriers expressed high mRNA. However, IL10 haplotypes were not associated with sIL-10 in pSS from Western Mexico which suggest that diverse biological factors may regulate the IL10 expression in pSS.

Pleural Effusion In A Patient With Primary Sjögren's Syndrome Successfully Treated With Corticosteroids.

Sjögren's syndrome is a systemic autoimmune disorder characterized by salivary insufficiency and lymphocytic infiltration of the exocrine glands. Bronchiolitis and bronchiectasis are common airway manifestations but interstitial pneumonitis, and lymphocytic interstitial pneumonitis may also occur. It rarely presents with pleuritis. We report a woman with primary Sjögren's syndrome who developed pleuritis with moderately large effusions and antibody levels for SS-A and SS-B in the serum without evidence of infection, malignancy or other collagen diseases. After the initial treatment, daily administration of 20 mg of oral prednisone has effectively controlled the serious manifestations of the disease with minimal side effects.

Update on infections and vaccinations in systemic lupus erythematosus and Sjögren's syndrome.

PURPOSE OF REVIEW: To provide an update on infections in systemic lupus erythematosus (SLE) and Sjögren's syndrome, particularly addressing their role as triggers of autoimmunity, their impact on mortality, the main microorganisms, the approaches to differential diagnosis with disease flares and recommendations for vaccination. RECENT FINDINGS: New mechanisms for autoimmunity triggered by Epstein-Barr virus and human commensal microbiota have been described. The increased risk for tuberculosis was recently demonstrated for the first time in Sjögren's syndrome. C-reactive protein was reported to be a more sensitive and specific marker for bacterial infections in SLE than procalcitonin and phagocyte-specific S100A8/A9 protein. Inactivated vaccines are well tolerated and efficacy was demonstrated for influenza vaccine. Immunogenicity is generally reduced but adequate in SLE. Prednisone or immunosuppressants are associated with decreased vaccine serological response, whereas hydroxicloroquine seems to improve vaccine immunogenicity. Other infection-preventive measures for these diseases include antimalarials and prophylaxis for tuberculosis or Pneumocystis jirovecii. SUMMARY: Advances in the role of infectious agents as triggers for SLE and Sjögren's syndrome have provided new insights into disease development. Knowledge on vaccine immunogenicity, safety and efficacy has improved with evidence of a generally reduced but adequate response for inactivated vaccines in SLE. Other preventive measures comprise infection prophylaxis and antimalarials.

Frequency of complications and usefulness of the minor salivary gland biopsy.

UNLABELLED: Findings of specific antibodies and histopathology data are essential for the diagnosis of Sjögren syndrome (SS). Although the minor salivary gland biopsy (MSGB) is technically simple, it needs to be performed in a medical institution to avoid complications. OBJECTIVE: To determine the frequency of complications and the usefulness of this technique. MATERIALS AND METHODS: Patients who underwent a minor salivary gland biopsy for a possible diagnosis of SS at Rivadavia Hospital between October 2007 and May 2010 where included. The patients were seen a week and a month after the procedure for follow up. RESULTS: Frequency of acute complications (n=186): 15 patients; 8.1%, 95% CI: 4.7-13.2 (Bleeding 7.5%, syncope 3.2%, hematoma 2.7%. No accidents occurred). Medium term complications (n=164): 16 patients: 9.75%, 95% CI: 5.9-15.6 (pain 7.32%, inflammation 3.66%, sensitivity disorders 3.05%, granuloma 1.22%,). No infections or suture dehiscence occurred. Microscopic results: 154 biopsy reports were received: glandular 90.9%, 95% CI: 85-95 (typical, sialadenitis, grade III and IV infiltration). CONCLUSIONS: MSGB has very low frequency of medium term and acute complications and it has high usefulness.

Secondary Sjögren's syndrome and disease activity of rheumatoid arthritis.

OBJECTIVE: To study the relationship of the presence of secondary SS with disease activity, duration in RA. METHODS: Eighty two patients with RA were submitted to Schirmer test, minor salivary gland biopsy, questionnaire on sicca symptoms, DAS-28 4v determination. RESULTS: In this population, 20 (24.3%) patients fulfilled the American-European classification criteria for secondary SS. No relation could be found between the presence of secondary SS and disease activity (p = 0.31) and RA duration (p = 0.95). CONCLUSION: Appearance of Secondary SS in RA patients is independent of RA duration or activity.

Secondary Sjögren's syndrome and disease activity of rheumatoid arthritis / Síndrome de Sjögren secundária e atividade da artrite reumatoide

OBJECTIVE: To study the relationship of the presence of secondary SS with disease activity, duration in RA. METHODS: Eighty two patients with RA were submitted to Schirmer test, minor salivary gland biopsy, questionnaire on sicca symptoms, DAS-28 4v determination. RESULTS: In this population, 20 (24.3 percent) patients fulfilled the American-European classification criteria for secondary SS. No relation could be found between the presence of secondary SS and disease activity (p = 0.31) and RA duration (p = 0.95). CONCLUSION: Appearance of Secondary SS in RA patients is independent of RA duration or activity.

OBJETIVO: Estudar a associação entre presença de SS secundária e atividade e duração da artrite reumatoide. MÉTODOS: Oitenta e dois pacientes com artrite reumatoide foram submetidos ao teste de Schirmer, biópsia de glândula salivar menor, questionários acerca de sintomas de secura e determinação do DAS28 4v. RESULTADOS: Nesta população, 20 (24,3 por cento) dos pacientes preenchiam os Critérios Americanos Europeus para classificação de SS Secundário. Nenhuma associação foi encontrada entre presençade SS secundário e atividade da doença (p = 0.31) e duração da doença (p = 0.95). CONCLUSÃO: O aparecimento de SS secundário em AR é independente da duração e atividade da AR.

Clinical manifestations in individuals with recent diagnosis of HTLV type I infection.

BACKGROUND: Human T-lymphotropic virus type 1 (HTLV-1) is known to cause HTLV-associated myelopathy (HAM)/tropical spastic paraparesis and adult T cell leukemia. A growing body of evidence links HTLV-1 infection with an increasing spectrum of disease, including uveitis, periodontal disease, arthropathy, sicca syndrome, and neurologic deficits. OBJECTIVES: Despite recent findings, the natural history of HTLV-1 infection remains poorly defined. This study was designed to better characterize initial clinical and neurological findings in individuals diagnosed with HTLV-1 infection. STUDY DESIGN: We conducted a cross-sectional study of 71 individuals recently diagnosed with HTLV-1 and 71 uninfected age- and sex-matched blood donors in Salvador, Brazil. Subjects were administered a standardized questionnaire and underwent physical exam. RESULTS: HTLV-1 infected subjects were significantly more likely than controls to report complaints of hand and foot numbness (OR=5.3; 95% CI: 1.8-15.3; p=0.002 and OR=4.0; 95% CI: 1.3-12; p=0.013 respectively), difficulty running (OR=4.0; 95% CI: 1.1-14.2; p=0.032), nocturia (OR=5.0; 95% CI: 1.1-22.8; p=0.038), arthralgia (OR=3.3; 95% CI: 1.4-7.7; p=0.006), and photophobia (OR=3.3; 95% CI: 1.4-7.7; p=0.006). CONCLUSIONS: Neurologic, ocular and rheumatologic complaints may be the first manifestations of HTLV-1 infection. Therefore, all patients presenting with initial diagnosis should be rigorously screened for these symptoms.

Síndrome de Sjögren / Sjögren syndrome

Se realiza una revisión de las bases de datos a las que se puede acceder a través de Internet sobre temas de medicina, así como de las principales revistas y sitios que tratan sobre afecciones reumatológicas buscando los conceptos más actuales que se presentan sobre el síndrome de Sjögren (SS), elementos de su cuadro clínico y complicaciones que pudieran ser útiles para el personal médico que labora en todos los niveles de salud donde se puedan presentar pacientes con esta entidad, logrando recuperar 71 citas de los últimos años útiles para nuestros fines, de las que exponemos los elementos más actuales encontrados en cuanto a los mecanismos etiopatogénicos presentes en su evolución, cuadro clínico, terapéutica y complicaciones más frecuentes(AU)

Authors made a review of databases to which it is possible to enter in Internet on medicine subjects, as well as of leading journals and sites related to Rheumatology affections to search the more updated concepts on Sj÷gren syndrome, elements of its clinical picture and complications that could be useful for medical staff working at all health levels where may be patients presenting with this entity, achieving to recover 71 quotations of past years essential for our aims showing the more updated elements found as regards the etiopathogeny mechanism present in its course, clinical picture, therapeutics and more frequent complications(AU)

Síndrome de Sjögren / Sjögren syndrome

Se realiza una revisión de las bases de datos a las que se puede acceder a través de Internet sobre temas de medicina, así como de las principales revistas y sitios que tratan sobre afecciones reumatológicas buscando los conceptos más actuales que se presentan sobre el síndrome de Sjögren (SS), elementos de su cuadro clínico y complicaciones que pudieran ser útiles para el personal médico que labora en todos los niveles de salud donde se puedan presentar pacientes con esta entidad, logrando recuperar 71 citas de los últimos años útiles para nuestros fines, de las que exponemos los elementos más actuales encontrados en cuanto a los mecanismos etiopatogénicos presentes en su evolución, cuadro clínico, terapéutica y complicaciones más frecuentes

Authors made a review of databases to which it is possible to enter in Internet on medicine subjects, as well as of leading journals and sites related to Rheumatology affections to search the more updated concepts on Sj÷gren syndrome, elements of its clinical picture and complications that could be useful for medical staff working at all health levels where may be patients presenting with this entity, achieving to recover 71 quotations of past years essential for our aims showing the more updated elements found as regards the etiopathogeny mechanism present in its course, clinical picture, therapeutics and more frequent complications