High-resolution CT imaging of the lung for patients with primary Sjögren’s syndrome
Introduction
Sjögren’s syndrome, known as the triad of dry eyes, dry mouth, and arthritis [1], is a chronic inflammatory autoimmune disorder characterized by infiltration of the exocrine glands by immunglobulin-producing lymphocytes [2]. Affecting mainly women, the prevalence ranges similar to that of rheumatoid arthritis between 1 and 3% [3], [4]. The term primary Sjögren’s syndrome (PSS) indicates the involvement of the lachrymal and salivary glands (sicca syndrome) without any underlying autoimmune condition. If associated with rheumatoid arthritis, systemic lupus erythematosus, scleroderma, or dermatomyositis it is classified as secondary, which comprises one-half to two-thirds of patients with sicca syndrome [5], [6]. Additionally an increased risk of lymphoma in various organs has been reported. PSS has shown a wide spectrum of bronchopulmonary manifestations mainly evaluated on the basis of lung function tests and conventional chest radiography [7], [8], [9], [10]. To our knowledge, a few studies exist assessing lung findings in PSS in a larger population group using high-resolution computed tomography (HRCT) [11], [12], [13], [14], [15], [16], which has shown to be an accurate method for evaluating pulmonary abnormalities in connective tissue disorders [17], [18], [19], [20]. The purpose of this study was to describe the HRCT findings of pulmonary pathologies in PSS.
Section snippets
Study population
The study comprised HRCT examinations of the chest from 24 patients with PSS referred to the Department of Diagnostic Radiology between 1993 and 2003 for further work-up. There were 21 women and 3 men (age range 44–83 years, mean age 63.5 years). All patients fulfilled the European criteria for the diagnosis of PSS [21]. Patients with other associated autoimmune diseases, a history of smoking and with bronchopulmonary abnormalities not necessarily related to PSS were excluded from the study.
CT scanning
Results
Among the 24 patients evaluated 19 showed positive findings, and in five patients the HRCT scan was judged to be normal. In seven patients, up to three findings were present, in six patients there were between four to six abnormalities, and in six patients seven to nine different pathologies were detected. The patient group with up to three presented pathologies did not show a preference to one finding. There was a predominance of abnormalities in the lower lobes and subpleural areas. None of
Discussion
Pulmonary involvement in systemic autoimmune diseases is common, especially in rheumatoid arthritis and systemic sclerosis [19], [23]. In PSS, the pathophysiology of pulmonary pathology is unknown, as is the etiology of the underlying syndrome. The syndrome is characterized by a lymphocytic infiltration, atrophy, and destruction of exocrine glands. Therefore, the lung is a primary target with its abundant mucosal glands, although glandular structures throughout the entire airway system may be
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