Background/Purpose: The xerostomia and/or xerophtalmia (SICCA syndrome: items I and II of 2002 AECG criteria) are conspicuous characteristics of primary Sjögren´s syndrome (pSS). pSS diagnostic criteria include anti-SSA and anti-SSB antibodies, keratoconjunctivitis SICCA and characteristic findings in minor salivary gland biopsy (MSGB). Up to 40% of the cases with negative autoantibodies have been cataloged as pSS based on MSGB results.

Objective
The aim of this study was to compare the clinical and serological characteristics associated with inflammatory or non-inflammatory findings in the MSGB.

Methods: It is a cohort study of cases of SICCA syndrome attending the Rheumatology Department. At the time of patient inclusion an interview was conducted and clinical charts reviewed, obtaining the follow information; sex, age, evolution time of symptoms, history of mumps, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), antinuclear antibodies (ANA), Schirmer´s test and histopathological (Chilshom and Mason) study of MSGB.

Results: One hundred fifty-one females and one male patients were included. Mean age was 51.9±9.2 years. Patients were classified into inflammatory subgroup (n=110) when they presented MSGB focus score ≥1, or non-inflammatory subgroup (n=42) when displayed a MSGB focus score < 1. According with AECG 2002 inside of the inflammatory subgroup 57 patients (52%) fulfilled criteria for pSS and only 5 (12%) in the non-inflammatory subgroup (p=0.0001), additionally it was found that 11 patients (10%) had parotitis in the inflammatory subgroup while no patients in the non-inflammatory subgroup (p=0.03).
No differences were found in both groups for the following variables: age (years) 52±9.7 vs 51.6±8.1 (p=0.8), time of evolution (months) 71.6±55.4 vs 70.3±8.6 (p=0.99), arthralgia 98 patients (89%) vs 36 (86%) (p=0.58), Schirmer´s positive test 66 (70%) vs 32 (91%) (p=0.01), ESR > 20 in 67 (63%) vs 25 (59%) (p=0.85); positive CRP 30 (29%) vs 15 (36%) (p=0.43), positive RF 33 (31%) vs 20 (48%) (p=0.058), positive ANA in 41 (42%) vs 21 (49%) (p=0.46), fibrosis in MSGB 13 patients (12%) vs 6 (14%) (p=0.78).

Conclusion: In patients with SICCA, MSGB is essential to confirm the diagnosis, majorly in those who lack evidence for systemic autoimmunity, such as the relevant autoantibodies or concomitant autoimmune diseases. It should also be performed for this purpose when the sole evidence for systemic autommunity by the performance of anti-La/SSB or anti-Ro/SSA antibodies is not available. In these clinical settings, the test has particular utility if the results would influence the choice of therapies for non SICCA manifestations, such as fatigue, arthritis, or another systemic symptom.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/histological-characteristics-in-sicca-syndrome-clinical-and-serological-association/