Background/Purpose:

Several studies have reported a protective effect of smoking with regard to risk for primary Sjögren’s syndrome (pSS) and minor salivary gland inflammation. To our knowledge, there are no studies investigating major salivary gland ultrasonography (SGUS) findings in smokers with pSS. The aim of this study was to investigate the frequency of smokers in a cohort of pSS, and to determine the possible impact of smoking on minor salivary gland histopathology, major salivary gland ultrasonography, and secretory function of the salivary and lacrimal glands.

Methods:

Patients with pSS (n=98) were recruited from the Department of Rheumatology, Haukeland University Hospital, Bergen, Norway. All patients had undergone clinical examination and SGUS using a simplified scoring system for glandular homogeneity and hypoechogenic areas. The parotid and submandibular salivary gland scans were graded 0-3; grades 0-1 considered corresponding to normal/non-specific changes and grades 2-3 to SS-like pathological changes. In addition, routine clinical and serological parameters, information regarding focus score, sicca symptoms, secretory function, fatigue, and smoking habits were available for retrospective analysis. All patients fulfilled the 2002 AECG criteria for pSS.

Results:

The majority of patients in this pSS cohort (n=59) were non-smokers, the remaining consisted of former smokers (n=27) and current smokers (n=12). Pathological SGUS findings were found in 38/59 (64 %) of the non-smokers, 13/27 (48 %) of the former smokers, and in 7/12 (58 %) of the current smokers.

Data on focus score (FS) was available in 83 patients, and correlated with SGUS score (p=0.010, r=0.283). Interestingly, 49/54 (91 %) non-smokers, 17/21 (81 %) former smokers and 3/8 (38 %) current smokers had FS≥1 (p<0.010, r=0.283). Mean focus score was 2.0 for non-smokers, 2.1 for former smokers, and 0.6 for current smokers; the difference between current and former smokers was significant (p=0.023).

Oral sicca symptoms correlated with SGUS score (p<0.001, r=0.378). Unstimulated salivary secretion was ≤1.5 ml/15 min in 42/57 (74 %) non-smokers, 18/26 (69 %) former smokers, and 7/12 (58 %) current smokers. Stimulated saliva was ≤3.5 ml/5 min in 27/57 (47 %) non-smokers, 12/26 (46 %) former smokers, and 4/12 (33 %) current smokers. Schirmer’s I-test levels (right and left eye, respectively) for current smokers were 9.3 and 11.3 mm, former smokers 4.9 and 3.8 mm, and non-smokers 7.7 and 7.9 mm. Differences were significant for the left eye when comparing current smokers and former smokers (p=0.021), and non-smokers and former smokers (p=0.048).

Interestingly, anti-Ro/SSA titers were elevated in 9/12 (75 %) current smokers and 20/27 (74 %) former smokers, compared to 35/58 (60 %) non-smokers. A similar trend was observed for anti-La/SSB titers in 6/12 (50 %) current smokers, 12/27 (44 %) former smokers, and 19/58 (33 %) non-smokers.

Conclusion:

In this cohort, smokers with pSS had a lower degree of minor salivary gland inflammation and pathological imaging findings in the major salivary glands. The sub-group also presented with better secretory function compared to non-smokers and former smokers.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/minor-salivary-gland-histopathology-major-salivary-gland-ultrasonography-and-secretory-function-in-smoking-patients-with-primary-sjogrens-syndrome/