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The non-invasive diagnosis of SS can be said to develop rapidly~
Sjogren's syndrome (SS) is a chronic autoimmune disease that mainly involves the tear and salivary glands, and sicrenia keratoconjunctivitis, xerostomia and recurrent salivary gland enlargement are its typical clinical symptoms
.
Epidemiological investigation shows that SS is one of the autoimmune diseases with the highest prevalence in China, with a prevalence of about 0.
77% in China, affecting more than 8 million people
.
SS not only has a large number of patients, but also has the characteristics of low survival rate and difficult diagnosis and treatment [1].
Therefore, early diagnosis and treatment of SS is crucial for the involvement and prognosis of SS system
.
Professor He Jing of Peking University People's Hospital shared "Progress in Non-invasive Diagnosis and Treatment of Sjogren's Syndrome", let's learn together~
It is important to find more and reliable non-invasive diagnoses
Professor Ho Jing shared: "Sjogren's syndrome is a relatively young disease, and pathological biopsy has remained the gold standard for SS diagnosis throughout the decades from 1965 to the present, but it has also been accompanied by some diagnostic changes
.
Among them, the most variable is the serum antibody test
.
The specificity and sensitivity of traditional serum antibody markers are sometimes inappropriate, and lip gland biopsy is invasive despite its
specificity.
Therefore, it is critical
to find more reliable non-invasive diagnoses.
”
New biomarkers are emerging
Professor He Jing shared that as early as 1999, there were related studies
on the diagnostic significance of peptide antibodies such as anti-α-lining protein and M3 in the serum of SS patients.
In recent years, some tissue-related specific autoantibodies such as CA2, SP-1, PSP, CA6, anti-SSA, SSB antibodies have gradually been discovered, which are not only associated with early dry symptoms, but also have a relatively good positive diagnosis rate for antibody-negative patients, and are highly expressed in saliva [2].
With the development of imaging technology and the deepening of SS pathophysiology, imaging technology has been gradually applied
in the diagnosis and evaluation of pSS activity and progression.
Salivary gland ultrasound is a simple, non-invasive, irradiation-free, inexpensive and reproducible technique that improves performance, diagnostic accuracy and feasibility by incorporating it into the pSS ACR-EULAR classification criteria, and Professor He Jing shared that salivary gland ultrasound can increase diagnostic sensitivity from 95.
9% to 97.
3% [3].
Professor He Jing, an ophthalmological examination
of SS patients, mentioned that the corneal nerves of normal people are evenly distributed and have a smooth surface, while the corneal nerves of SS patients are actually very incomplete
.
Examination of the patient's corneal nerves using confocal microscopy can help in the differential diagnosis
of SS.
In addition, the abnormality of keratoconjunctival blotting cytology is not only proportional to the patient's dry eye, but also strongly correlates
with the production of immunologic antibodies and immunoglobulins in SS patients.
Professor He Jing shared that the eye is a window for immune diseases, which can reflect systemic immune system abnormalities and is also of great significance for disease diagnosis[2].
Treatment progress: Starting
from the challenges, Professor He Jing shared that whether in the outpatient clinic or the ward, the real treatment of SS has two main challenges: one is to solve the patient's dry symptoms; The other is systemic involvement
in controlling the patient.
In view of the dry eye symptoms of SS, Professor He Jing cooperated with ophthalmologists to conduct relevant RCTs
based on the mechanism.
Professor He Jing introduced that the dry eye symptoms of SS are actually caused by the invasion of inflammatory cells and caused symptomatic and tissue damage
.
When SS patients use cyclosporine eye drops, the remission rate of dry eye symptoms is significantly improved, and the remission rate is much higher than that of artificial tears
.
At present, cyclosporine eye drops are also becoming more and more widely
used in patients.
Professor He Jing shared that in the 2019 EULAR guidelines, many hormones, immunologics and biologics are
proposed.
With the progress and application of treatment, rituximab has gradually been introduced to second-line therapy in updated guidelines, even first-line treatment
for refractory Sjogren syndrome.
In particular, patients have severe cutaneous vasculitis, or renal involvement, neurologic involvement, or haematological involvement
.
Therefore, Professor He Jing proposed that we need to evaluate the patient's situation, study, adopt research and guidelines, and carry out individualized treatment
according to the patient's own situation.
In addition, as a treasure of Chinese culture, traditional Chinese medicine also plays an important role
in the treatment of SS patients.
Many clinicians will recommend that patients combine with traditional Chinese medicine, which may have a good relief effect on some symptoms of SS
.
Many related mechanism studies of traditional Chinese medicines are also gradually advancing, such as goji berry polysaccharides, artemisinin, Kunming mountain begonia and other traditional Chinese medicine related studies have confirmed their effect on stabilizing immune balance and have good efficacy
.
small
knot
At the end of the meeting, Professor He Jing concluded: So far, SS has made rapid progress, but it still poses many questions and challenges to clinicians:1.
A variety of new and specific autoantibodies, peptides, cytokines, metabolites, at different times and stages have some good hints for us, to be developed for clinical application.
As a diagnostic marker for SS with different stratification at different times
.
2.
In addition, it is necessary to pay attention to the important non-invasive diagnostic methods of ophthalmology, ultrasound and stomatology, which are very important
for the assessment and prognosis of patients with organ involvement.
3.
In terms of treatment, such as low-dose IL-2, drugs with Chinese characteristics, and biological agents can improve the efficacy and reduce adverse reactions
in future SS patients.
References:
[1] Wang B,Chen S,Zheng Q,et al.
Early diagnosis and treatment for Sjogren's syndrome:current challenges,redefined disease stages and future prospects[J].
J Autoimmun,2021,117:102590.
DOI:10.
1016/j.
jaut.
2020.
102590.
[2] Choudhry H S,Hosseini S,Choudhry H S,et al.
Updates in diagnostics,treatments,and correlations between oral and ocular manifestations of Sjogren's syndrome[J].
Ocul Surf,2022,26:75-87.
DOI:10.
1016/j.
jtos.
2022.
08.
001.
[3] Chatzis L,Vlachoyiannopoulos P G,Tzioufas A G,et al.
New frontiers in precision medicine for Sjogren's syndrome[J].
Expert Rev Clin Immunol,2021,17(2):127-141.
DOI:10.
1080/1744666X.
2021.
1879641.
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