Background/Purpose:

The glandular cell apoptosis in Epstein-Barr virus (EBV) infection may play role in primary Sjögren’s Syndorme (pSS) development, possibly causing progressive gland damage and dysfunction, reflected by the reduced secretion and classic clinical symptoms. The aim of the study was to investigate: (i) EBV infection status in healthy individuals and patients with confirmed pSS or isolated dryness symptoms; (ii) searching for differences in salivary gland imaging among these individuals.

Methods:

We evaluated 3 groups of individuals: (i) 58 patients with established diagnosis of pSS (mean age 52±15), that included 49 (84%) female (F) and 9 (16%) males (M); (ii) 36 subjects with symptoms of eye or/and mouth dryness [mean age 55±12; 34 (94%) F, 2 (6%) M] and (iii) 20 healthy volunteers [mean age 45±11; 15 (75%) F and 5(25%)M]. Profile of IgM/IgG antibodies specific to EBV proteins was determined by ELISA test, allowing indication of recent/past EBV infection or reactivation. Sjögren’s specific antibodies A (SS-A) and B (SS-B), anti-nuclear antibodies (ANA), rheumatoid factor (RF) were also identified. The ocular tests included Schirmer test and corneal staining (fluorescein and lissamine green). In 93(88%) patients the salivary gland ultrasonography (SGUS) examination was performed. Differences between groups were analyzed using the χ2-square test (categorical variables) or U Mann-Whitney test (continuous variables). Statistical significance was set at p<0.05. The study was approved by Ethics Committee; subjects gave informed consent.

Results:

The majority of patients with pSS (n=44; 76%) had reactivation of EBV infection, with 11 (19%) having markers of past infection, 2 (3%) of primary infection, and only 1(2%) was without EBV exposure. By contrast, in healthy volunteers EBV reactivation was stated in 40% (n=8), past infection was found in 50%(n=10), one person (5%) had primary infection and another one was not exposed to EBV. The differences in EBV infection status between pSS and healthy control group were statistically significant (p-value >0,031). All patients with dryness symptoms without pSS, were exposed to EBV and 83%(n=30) had EBV reactivation, 11% (n=4) past infection, 6% (n=2) primary infection. There were no statistically significant differences between patients with pSS with EBV reactivation and ones with past EBV infection as to the presence of SS-A/SS-B antibodies or RF, the ocular test values or the degree of focus score in histopathological evaluation. Parenchymal heterogeneity was more frequent in pSS group than in patients with symptoms of dryness alone: 77% vs 23% (p<0,001). There was no change in SGUS allowing differentiation of patients with EBV infection or reactivation.

Conclusion:

EBV reactivation is significantly more often observed in individuals with pSS or dryness symptoms, than in healthy volunteers. There were no differences in SGUS in patients with past exposure or reactivation of EBV. SGUS of pSS patients confirmed previous observations of parenchymal heterogeneity as most common abnormality. 

The study was supported by National Science Center; grant no. 2012/05/N/NZ5/02838. 

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/not-only-sjogrens-syndrome-ebv-infection-reactivation-as-a-risk-factor-of-the-dryness-symptome-development/