Avaliação das características clínicas, histopatológicas e ultrassonográficas de pacientes sicca não-Sjögren e doença de Sjögren

Abstract

Sjögren’s disease (SjD) is a chronic autoimmune disorder that affects salivary and lacrimal glands, causing xerostomia and/or xerophthalmia. A less-studied pathological process is non-SjD sicca, in which patients also present oral and/or ocular dryness, but do not fulfill the classification criteria for SjD, and despite overlapping symptoms, their clinical profile and salivary gland involvement remain insufficiently characterized. The purpose was to investigate the clinical, histopathological and ultrasonographic features of individuals with non-SjD sicca and compared them with SjD patients. A cross-sectional comparative study was conducted in two Brazilian referral centers. Patients underwent clinical evaluation, measurement of unstimulated salivary flow, oral dryness evaluation, serological testing, labial salivary gland biopsy, and major salivary gland ultrasonography according to OMERACT scoring criteria. Classification of SjD was based on the 2016 ACR/EULAR criteria. Data were analyzed descriptively and analytically. Among the 176 patients included (122 with SjD and 54 with non-SjD sicca), hyposalivation (76.2%; p=0.002), presence of germinal centers (12.5%; p=0.017), and minor salivary gland biopsy with moderate–severe inflammation (71.3%; p<0.001) were significantly more frequent in the SjD group. Higher OMERACT ultrasound scores were also observed in SjD. In non-SjD sicca, age was associated with unspecific histological changes, including acinar atrophy, ductal dilation, fibrosis, and adipose tissue infiltration. In conclusion, SjD and non-SjD sicca differ mainly in inflammatory severity and ultrasound findings. Age-related glandular degeneration was more pronounced in non-SjD sicca, indicating potentially distinct clinicopathological profiles.