中国原发性干燥综合征的现况调查及特征分析
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摘要
目的本研究旨在建立全国范围的原发性干燥综合征(pSS)患者登记注册数据库平台,行现况调查以分析我国pSS患者的临床特征,分析具有不同流行病学特征、临床表现、病程和免疫表型的亚群所各自具有的特征,分析影响患者就诊及明确诊断的因素,并与国内外研究进行对比,从而更好地了解我国pSS患者的疾病现状,提高该病的诊治水平。
方法对2009年1月至2011年11月于我国16家临床中心诊治,符合2002年pSS国际分类标准的640例患者行现况调查。建立患者登记注册数据库网络平台,收集患者的人口学情况、临床表现、血生化免疫指标、及受累器官的功能、形态和病理等资料。据患者流行病学特征、病程长短、病情轻重、免疫指标不同分为不同亚组,组间比较采用独立样本t检验、非参数检验、χ2检验,多因素分析采用Logistic回归分析和多元线性回归模型。
结果(一)我国pSS患者的特征：女性占95.3%,平均发病年龄44.6±12.0岁。最常见症状为口干(90.9%)和眼干(72.3%)。91.3%出现系统受累,主要累及血液系统45.8%,肺部44.3%,关节40.9%,肾脏33.0%,肝脏27.6%。唾液腺、泪腺受损客观检查和唇腺病理阳性率分别为87.6%、97.1%和86.3%。ANA、抗SSA、抗SSB和RF阳性率分别为78.4%、51.5%、27.2%和64.6%。(二)各亚组的特征：①男性占4.7%,较女性平均发病年龄高,肝脏受累、慢性肾功能不全、IgM增高的阳性率高。②<30岁发病的患者占10.8%,比30-59岁发病者关节炎、间质性肺病(ILD)发病率低。≥60岁发病的患者占10.8%,比30-59岁发病者女性比例低,首诊及确诊时间间隔短,口干、ILD阳性率高,反复腮腺肿大、血WBC降低及抗SSA、SSB抗体阳性率低。≥60岁发病者比<30岁发病的患者口干、肝脏受累、ILD阳性率高,血WBC降低、抗SSA和SSB抗体阳性率低。③14.1%的患者病程≥10年,比病程<10年的患者发病年龄低,首诊及确诊时间间隔久,反复腮腺肿大、发热和血WBC降低的阳性率高,唾液腺受损阳性率低。④8%的患者病灶局限于外分泌腺,眼部体征阳性率低于有系统受累的患者。⑤28.8%的患者出现ILD,继发ILD的患者发病年龄高,口干、唾液腺受损客观检查、肝脏受累、ANA≥1：80及血清IgA升高的阳性率高,抗SSA、抗SSB抗体的阳性率低。多因素分析ANA滴度≥1：80和血清IgA增高是发生ILD的相关因素。⑥43.1%的患者ANA滴度≥1：320。这部分患者首诊及确诊时间间隔久,唾液腺受损客观检查、出现蛋白尿的阳性率低,唇腺病理及RF阳性率高。⑦52%的患者抗SSA抗体阳性。这部分患者平均发病年龄低,口干、眼干、唇腺活检、继发ILD及RF阳性率低,反复腮腺肿大、疲劳、尿蛋白阳性、血WBC降低及抗SSB抗体阳性率高。⑧抗SSB抗体阳性27%。这部分患者平均发病年龄低,ILD阳性率低,尿蛋白阳性、血WBC降低、抗SSA抗体及C4降低的阳性率高。⑨RF阳性64.6%。RF阳性的患者PLT降低和抗SSA抗体阳性率低,ANA滴度≥1：320的阳性率高。⑩85.3%的患者抗SSA抗体、抗SSB抗体、ANA滴度≥1：320和/或RF阳性,这部分患者发病年龄低,血WBC降低、尿蛋白阳性发病率高,唇腺病理阳性率低。(11)86.3%的患者唇腺病理阳性,这部分患者ANA≥1：320的阳性率高,抗SSA抗体阳性率低。(三)患者出现症状至首次就诊和明确诊断的时间间隔分别为15和21个月(中位数)。多元线性回归提示首发紫癜可影响患者首诊和确诊的时间间隔。(四)Logistic回归分析提示有口干的患者出现眼干的几率是无眼干的5.5倍,抗SSA/SSB抗体阳性的几率则是阴性的0.2倍。有眼干的pSS患者出现口干的几率是无口干的5.5倍。抗SSA/SSB抗体阳性的患者出现口干的几率是无口干的0.2倍。(五)与欧洲数据对比,我国患者发病年龄低10岁左右,口眼干阳性率低,肺肾肝等器官受累的阳性率高。
结论我国pSS患者以女性为主,发病年龄较欧洲国家低,以口眼干为突出表现,系统受累阳性率高。具有不同流行病学特征如性别、发病年龄、病程的患者,以及受累器官、免疫学指标或唇腺病理不同的患者在临床症状及免疫学指标方面也具有各自的特征,这些特征的发现有利于早期判断病情转归和预后,制定个体化治疗方案。首发症状会影响患者就诊和确诊的时间间隔。
Objective We conducted the study to establish a nationwide patient registration database platform of primary sjogren's syndrome (pSS), characterize the clinical presentation of pSS in a large cohort of Chinese patients, determine whether epidemiologic, clinical, and analytical features modulate disease expression, analyse factors affecting patient's first treatment and final diagnosis, and compare those data with the domestic and international research groups. From this study we could get a better understanding of the disease status of Chinese pSS patients, and improve the level of diagnosis and treatment of pSS.
Methods A total of640patients with pSS according to the2002revised American European classification criteria from16clinical centers in China were enrolled in the study between January2009and November2011. Patient's registration database platform was established. Patient's epidemiology profile and cumulative clinical and immunologic data were collected. Patients were divided into different subgroups according to their epidemiology feature, course and severity of disease, and immunologic profile.T-test, nonparametric test and Chi-square test were applied to compare data in two groups. Regression analysis and multivariate linear regression analysis models were used to do multivariate analysis.
Results1. Characteristics of Chinese pSS patients:95.3%of the patients were female. Mean age of onset was44.6±12.0. The most common symptom of pSS were dry mouth(90.9%), and dry eye (72.3%).91.3%of pSS patients had systemic involvement, which mainly were blood system(45.8%), lung(44.3%), joints (40.9%), kidney (33.0%) and liver (27.6%).The positive rates of objective tests of salivary gland, lacrimal gland and salivary gland biopsy were87.6%,97.1%and86.3%. The positive rates of ANA, anti SSA, anti SSB and RF were78.4%,51.5%,27.2%and64.6%.2. Characteristics of different subgroups:①4.7%of pSS patients were male. Compared with female, they had older average age of onset, higher positive rates of liver involvement, chronic renal insufficiency, and increased IgM.②The age of onset of10.8%of pSS patients was less than30. Those patients had lower incidence rates of arthritis and interstitial lung disease (ILD) than patients with age of onset30-59.10.8%of pSS patients had age of onset more than60. Compared with patients with age of onset30-59, those patients had less female, shorter period for first treatment and final diagnosis, higher incidence rates of dry mouth and ILD, and lower positive rates of parotid gland enlargement, blood WBC decrease, anti SSA and SSB. Compared with patients with age of onset<30, patients with age of onset≥60had higher incidence rates of dry mouth, liver dysfunction and ILD, lower positive rates of blood WBC decrease, anti SSA and SSB.③The course of disease of14.1%patients was more than10years. Those patients had lower age of onset, longer periods for first treatment and final diagnosis, higher positive rates of parotid gland enlargement, fever and blood WBC decrease, lower positive rate of salivary gland injury.④8%of patients'disease limited in exocrine gland.Those patients had lower positive rate of eye tests.⑤28.8%of patients had ILD. Those patients had older age of onset, higher positive rates of dry mouth, objective tests of salivary gland injury, liver dysfunction,ANA≥1:80and serum IgA increase, and lower positive rates of anti SSA and SSB. Multi factor analysis revealed ANA≥1:80and serum IgA increase were correlative factors of ILD.⑥43.1%of patients had ANA titer≥1:320. Those patients had longer periods for first treatment and final diagnosis, lower positive rates of objective salivary gland injury tests and proteinuria, and higher incidence rates of labial gland biopsy, and RF.⑦52%of patients had positive anti SSA. Those patients had younger age of onset, lower positive rates of dry mouth, dry eye, labial gland pathology, ILD, and RF. And had higher positive rates of patriod gland enlargement, fatigue, proteinuria, blood WBC decrease and anti SSB.⑧27%of patients had positive anti SSB. Those patients had younger age of onset, lower positive rate of ILD, and higher rates of proteinuria, blood WBC decrease, anti SSA and decreased C4.⑨64.6%of patients had positive RF. Those patients had lower rates of PLT decrease and positive anti SSA, and higher positive rate of ANA≥1:320.⑩85.3%of patients had positive anti SSA, anti SSB, ANA≥1:320and/or RF. Those patients had younger age of onset, higher incidence rates of blood WBC decrease and proteinuria, and lower positive rate of labial gland pathology.(11)86.3%of patients had positive labial gland pathology. Those patients had higher rate of ANA≥1:320, while the positive rate of anti SSA was lower than other patients.3. The median period between onset of symptom and first treatment was15 months. Between onset of symptom and final diagnosis was21months. Multiple linear regression showed the factor effected those periods was with purpura as initial symptom.4. Logistic regression analysis showed those with dry mouth were5.5times more likely to have dry eye than no dry eye, and0.2times more likely to have positive anti SSA/SSB than negative anti SSA/SSB. Those with dry eye were5.5times more likely to have dry mouth than no dry mouth, and the patients with anti SSA/SSB positive were0.2times more likely to have dry mouth than no dry mouth, while controlling for other phenotypic features of SS.5. Compared with European studies, this study found that the age of onset was10years younger than European patients. The positive rates of dry mouth and dry eye were lower, and systemic involvement was higher than European patients.
Conclusion The majority of pSS patients in China were female, and the age of onset was younger than European patients. The outstanding performance of pSS was dry mouth and dry eye, while systemic involvement was very common. Epidemiologic, clinical, and analytical features have a significant impact on the clinical presentation of pSS, influencing the results of the main diagnostic tests, the prevalence and diversity of extraglandular involvement, and the frequency of the main immunologic markers.Those findings were conducive to the early estimate of disease prognosis and outcome, and make individualized treatment plan.
方法对2009年1月至2011年11月于我国16家临床中心诊治,符合2002年pSS国际分类标准的640例患者行现况调查。建立患者登记注册数据库网络平台,收集患者的人口学情况、临床表现、血生化免疫指标、及受累器官的功能、形态和病理等资料。据患者流行病学特征、病程长短、病情轻重、免疫指标不同分为不同亚组,组间比较采用独立样本t检验、非参数检验、χ2检验,多因素分析采用Logistic回归分析和多元线性回归模型。
结果(一)我国pSS患者的特征：女性占95.3%,平均发病年龄44.6±12.0岁。最常见症状为口干(90.9%)和眼干(72.3%)。91.3%出现系统受累,主要累及血液系统45.8%,肺部44.3%,关节40.9%,肾脏33.0%,肝脏27.6%。唾液腺、泪腺受损客观检查和唇腺病理阳性率分别为87.6%、97.1%和86.3%。ANA、抗SSA、抗SSB和RF阳性率分别为78.4%、51.5%、27.2%和64.6%。(二)各亚组的特征：①男性占4.7%,较女性平均发病年龄高,肝脏受累、慢性肾功能不全、IgM增高的阳性率高。②<30岁发病的患者占10.8%,比30-59岁发病者关节炎、间质性肺病(ILD)发病率低。≥60岁发病的患者占10.8%,比30-59岁发病者女性比例低,首诊及确诊时间间隔短,口干、ILD阳性率高,反复腮腺肿大、血WBC降低及抗SSA、SSB抗体阳性率低。≥60岁发病者比<30岁发病的患者口干、肝脏受累、ILD阳性率高,血WBC降低、抗SSA和SSB抗体阳性率低。③14.1%的患者病程≥10年,比病程<10年的患者发病年龄低,首诊及确诊时间间隔久,反复腮腺肿大、发热和血WBC降低的阳性率高,唾液腺受损阳性率低。④8%的患者病灶局限于外分泌腺,眼部体征阳性率低于有系统受累的患者。⑤28.8%的患者出现ILD,继发ILD的患者发病年龄高,口干、唾液腺受损客观检查、肝脏受累、ANA≥1：80及血清IgA升高的阳性率高,抗SSA、抗SSB抗体的阳性率低。多因素分析ANA滴度≥1：80和血清IgA增高是发生ILD的相关因素。⑥43.1%的患者ANA滴度≥1：320。这部分患者首诊及确诊时间间隔久,唾液腺受损客观检查、出现蛋白尿的阳性率低,唇腺病理及RF阳性率高。⑦52%的患者抗SSA抗体阳性。这部分患者平均发病年龄低,口干、眼干、唇腺活检、继发ILD及RF阳性率低,反复腮腺肿大、疲劳、尿蛋白阳性、血WBC降低及抗SSB抗体阳性率高。⑧抗SSB抗体阳性27%。这部分患者平均发病年龄低,ILD阳性率低,尿蛋白阳性、血WBC降低、抗SSA抗体及C4降低的阳性率高。⑨RF阳性64.6%。RF阳性的患者PLT降低和抗SSA抗体阳性率低,ANA滴度≥1：320的阳性率高。⑩85.3%的患者抗SSA抗体、抗SSB抗体、ANA滴度≥1：320和/或RF阳性,这部分患者发病年龄低,血WBC降低、尿蛋白阳性发病率高,唇腺病理阳性率低。(11)86.3%的患者唇腺病理阳性,这部分患者ANA≥1：320的阳性率高,抗SSA抗体阳性率低。(三)患者出现症状至首次就诊和明确诊断的时间间隔分别为15和21个月(中位数)。多元线性回归提示首发紫癜可影响患者首诊和确诊的时间间隔。(四)Logistic回归分析提示有口干的患者出现眼干的几率是无眼干的5.5倍,抗SSA/SSB抗体阳性的几率则是阴性的0.2倍。有眼干的pSS患者出现口干的几率是无口干的5.5倍。抗SSA/SSB抗体阳性的患者出现口干的几率是无口干的0.2倍。(五)与欧洲数据对比,我国患者发病年龄低10岁左右,口眼干阳性率低,肺肾肝等器官受累的阳性率高。
结论我国pSS患者以女性为主,发病年龄较欧洲国家低,以口眼干为突出表现,系统受累阳性率高。具有不同流行病学特征如性别、发病年龄、病程的患者,以及受累器官、免疫学指标或唇腺病理不同的患者在临床症状及免疫学指标方面也具有各自的特征,这些特征的发现有利于早期判断病情转归和预后,制定个体化治疗方案。首发症状会影响患者就诊和确诊的时间间隔。
Objective We conducted the study to establish a nationwide patient registration database platform of primary sjogren's syndrome (pSS), characterize the clinical presentation of pSS in a large cohort of Chinese patients, determine whether epidemiologic, clinical, and analytical features modulate disease expression, analyse factors affecting patient's first treatment and final diagnosis, and compare those data with the domestic and international research groups. From this study we could get a better understanding of the disease status of Chinese pSS patients, and improve the level of diagnosis and treatment of pSS.
Methods A total of640patients with pSS according to the2002revised American European classification criteria from16clinical centers in China were enrolled in the study between January2009and November2011. Patient's registration database platform was established. Patient's epidemiology profile and cumulative clinical and immunologic data were collected. Patients were divided into different subgroups according to their epidemiology feature, course and severity of disease, and immunologic profile.T-test, nonparametric test and Chi-square test were applied to compare data in two groups. Regression analysis and multivariate linear regression analysis models were used to do multivariate analysis.
Results1. Characteristics of Chinese pSS patients:95.3%of the patients were female. Mean age of onset was44.6±12.0. The most common symptom of pSS were dry mouth(90.9%), and dry eye (72.3%).91.3%of pSS patients had systemic involvement, which mainly were blood system(45.8%), lung(44.3%), joints (40.9%), kidney (33.0%) and liver (27.6%).The positive rates of objective tests of salivary gland, lacrimal gland and salivary gland biopsy were87.6%,97.1%and86.3%. The positive rates of ANA, anti SSA, anti SSB and RF were78.4%,51.5%,27.2%and64.6%.2. Characteristics of different subgroups:①4.7%of pSS patients were male. Compared with female, they had older average age of onset, higher positive rates of liver involvement, chronic renal insufficiency, and increased IgM.②The age of onset of10.8%of pSS patients was less than30. Those patients had lower incidence rates of arthritis and interstitial lung disease (ILD) than patients with age of onset30-59.10.8%of pSS patients had age of onset more than60. Compared with patients with age of onset30-59, those patients had less female, shorter period for first treatment and final diagnosis, higher incidence rates of dry mouth and ILD, and lower positive rates of parotid gland enlargement, blood WBC decrease, anti SSA and SSB. Compared with patients with age of onset<30, patients with age of onset≥60had higher incidence rates of dry mouth, liver dysfunction and ILD, lower positive rates of blood WBC decrease, anti SSA and SSB.③The course of disease of14.1%patients was more than10years. Those patients had lower age of onset, longer periods for first treatment and final diagnosis, higher positive rates of parotid gland enlargement, fever and blood WBC decrease, lower positive rate of salivary gland injury.④8%of patients'disease limited in exocrine gland.Those patients had lower positive rate of eye tests.⑤28.8%of patients had ILD. Those patients had older age of onset, higher positive rates of dry mouth, objective tests of salivary gland injury, liver dysfunction,ANA≥1:80and serum IgA increase, and lower positive rates of anti SSA and SSB. Multi factor analysis revealed ANA≥1:80and serum IgA increase were correlative factors of ILD.⑥43.1%of patients had ANA titer≥1:320. Those patients had longer periods for first treatment and final diagnosis, lower positive rates of objective salivary gland injury tests and proteinuria, and higher incidence rates of labial gland biopsy, and RF.⑦52%of patients had positive anti SSA. Those patients had younger age of onset, lower positive rates of dry mouth, dry eye, labial gland pathology, ILD, and RF. And had higher positive rates of patriod gland enlargement, fatigue, proteinuria, blood WBC decrease and anti SSB.⑧27%of patients had positive anti SSB. Those patients had younger age of onset, lower positive rate of ILD, and higher rates of proteinuria, blood WBC decrease, anti SSA and decreased C4.⑨64.6%of patients had positive RF. Those patients had lower rates of PLT decrease and positive anti SSA, and higher positive rate of ANA≥1:320.⑩85.3%of patients had positive anti SSA, anti SSB, ANA≥1:320and/or RF. Those patients had younger age of onset, higher incidence rates of blood WBC decrease and proteinuria, and lower positive rate of labial gland pathology.(11)86.3%of patients had positive labial gland pathology. Those patients had higher rate of ANA≥1:320, while the positive rate of anti SSA was lower than other patients.3. The median period between onset of symptom and first treatment was15 months. Between onset of symptom and final diagnosis was21months. Multiple linear regression showed the factor effected those periods was with purpura as initial symptom.4. Logistic regression analysis showed those with dry mouth were5.5times more likely to have dry eye than no dry eye, and0.2times more likely to have positive anti SSA/SSB than negative anti SSA/SSB. Those with dry eye were5.5times more likely to have dry mouth than no dry mouth, and the patients with anti SSA/SSB positive were0.2times more likely to have dry mouth than no dry mouth, while controlling for other phenotypic features of SS.5. Compared with European studies, this study found that the age of onset was10years younger than European patients. The positive rates of dry mouth and dry eye were lower, and systemic involvement was higher than European patients.
Conclusion The majority of pSS patients in China were female, and the age of onset was younger than European patients. The outstanding performance of pSS was dry mouth and dry eye, while systemic involvement was very common. Epidemiologic, clinical, and analytical features have a significant impact on the clinical presentation of pSS, influencing the results of the main diagnostic tests, the prevalence and diversity of extraglandular involvement, and the frequency of the main immunologic markers.Those findings were conducive to the early estimate of disease prognosis and outcome, and make individualized treatment plan.
引文
[1]Zhang NZ, Shi CS, Yao QP. Prevalence of primary Sjogren's syndrome in China. J Rheumatol.1995 Apr;22(4):659-661.
[2]张乃峥,曾庆馀,张凤山,等.中国风湿性疾病流行情况的调查研究.中华风湿病学杂志,1997,1：31-35.
[3]Ramos-Casals M, Tzioufas A, Font J. Primary Sjogren's syndrome:new clinical and therapeutic concepts. Ann Rheum Dis.2005;64:347-354.
[4]Vitali C, Bombardieri S, Jonseon R, et al.Classication criteria for Sjogren's syndrome: a revised version of the European criteria proposed by the American-European Consensus Group. Ann Rheum Dis.2002,61:554-558.
[5]Shiboski SC, Shiboski CH, Criswell LA, et al. American College of Rheumatology Classification Criteria for Sjogren's Syndrome:A Data-Driven, Expert Consensus Approach in the Sjogren's International Collaborative Clinical Alliance Cohort. Arthritis Care & Research(Hoboken),2012,64:475-487.
[6]Kalk WW, Vissink A, Spijkervet FK, et al. Parotid sialography for diagnosing Sjogren syndrome. Oral Surg Oral Med Oral Pathol Oral Radiol Endod.2002 Jul;94(1):131-137.
[7]Bloch KJ, Buchanan WW, Wohl MJ, et al. Sjogren's syndrome. A clinical, pathological and serological study of sixty-two cases. Medicine (Baltimore) 44:187-231.
[8]Alamanos Y, Tsifetaki N, Voulgari PV, Venetsanopoulou AI, Siozos C, Drosos AA. Epidemiology of primary Sjogren's syndrome in north-west Greece,1982-2003. Rheumatology (Oxford).2006;45:187-191.
[9]Daniels TE. Do we need new diagnostic criteria for Sjogren's syndrome? Presse Med. 2012 Sep;41:441-449.
[10]赵岩,颜淑敏,张文.原发性干燥综合征573例临床分析.中华风湿病学杂志,2010；4：223-227.
[11]Daniels T, Greenspan JS, Cox D, et al. Objective measures in Sjogren's syndrome associated with each other but not with sicca symptoms:analysis of 564 enrollees in the SICCA International Registry and Repository. Arthritis Rheum 2007,56 Suppl:S446.
[12]Daniels TE, Criswell LA, Shiboski C, et al. for the Sjogren's International Collaborative Clinical Alliance Research Groups. An early view of the International Sjogren's Syndrome Registry. Arthritis Rheum 2009;61:711-714.
[13]Fox PC, Bowman SJ, Segal B, et al. Oral involvement in primary Sjogren syndrome. J Am Dent Assoc.2008 Dec;139(12):1592-1601.
[14]Manthorpe R.New criteria for diagnosing Sjogren's syndrome:a step forward?-or.. Scand J Rheumatol Suppl.2001;115:14-20.
[15]Lemp MA, Baudouin C, Baum J, et al. The definition and classification of dry eye disease:Report of the Definition and Classification Subcommittee of the International Dry Eye WorkShop (2007). Ocul Surf 2007;5:75-92.
[16]Laszlo M6dis Jr, Eszter Szalai. Dry eye diagnosis and management. Expert Rev. Ophthalmol.2011;6(1),67-79.
[17]Kim KW, Han SB, Han ER, et al. Association between depression and dry eye disease in an elderly population. Invest Ophthalmol Vis Sci.2011 Oct 10;52(11): 7954-7958.
[18]Benitez del Castillo JM, Wasfy MA, Fernandez C & Garcia-Sanchez J:An in vivo confocal masked study on corneal epithelium and sub-basal nerves in patients with dry eye. Invest Ophthalmol Vis Sci.2004; 45:3030-3035.
[19]中华医学会风湿病学分会,干燥综合征诊断及治疗指南,中华风湿病学杂志,2010；11：766-768.
[20]Fauchais AL, Martel C. Immunological profile in primary Sjogren syndrome: clinical significance, prognosis and long-term evolution to other auto-immune disease. Autoimmun Rev.2010 Jul;9(9):595-9.
[21]Haga HJ, Peen E.A study of the arthritis pattern in primary Sjogren's syndrome. Clin Exp Rheumatol.2007 Jan-Feb;25(1):88-91.
[22]Pease CT, Shattles W, Barrett NK.The arthropathy of Sjogren's syndrome. Br J Rheumatol.1993 Jul;32(7):609-613.
[23]Davidson BKS. Primary sjogren's syndrome in the North East of England:a long-term follow-up study.Rheumatology.1999,38:245-253.
[24]Skopouli FN, Dafni U, Ioannidis JP, Moutsopoulos HM. Clinical evolution,and morbidity and mortality of primary Sjogren's syndrome.Semin Arthritis Rheum 29: 296-304.
[25]Gannot G, Lancaster HE, Fox PC. Clinical course of primary Sjogren's syndrome: Salivary, oral, and serologic aspects. J Rheumatol 27:1905-1909.
[26]Naruse Y, Inui N, Yasui H, et al. case of rapid progressive interstitial pneumonia associated with primary sjogren's syndrome. Nihon Kokyuki Gakkai Zasshi.2006 Oct;44(10):721-726.
[27]Parambil JG, Myers JL, Lindell RM, Matteson EL, Ryu JH:Interstitial lung disease in primary sjogren's syndrome. Chest 2006; 1305:1489-1495.
[28]Kurumagawa T, Kobayashi H, Motoyoshi K. Potential involvement of subclinieal sjogren's syndrome in various lung diseases. Respirology,2005,10:86-91.
[29]Adan FU, Torun D, Bolat F, et al. Acute renal failure due to mesangial proliferative glomerulonephritis in a pregnant woman with primary sjogren's syndrome. Clin Rheumatol,2006,25:7540.
[30]Ebert EC.Gastrointestinal and hepatic manifestations of sjogren syndrome. J Clin Gastroenterol.2012 Jan;46(1):25-30.
[31]Tzarouchi LC, Tsifetaki N, Konitsiotis S. CNS involvement in primary Sjogren's Syndrome:assessment of gray and white matter changes with MRI and voxel-based morphometry. AJR Am J Roentgenol.2011 Nov;197(5):1207-1212.
[32]Ozgocmen S, Gur A.Treatment of central nervous system involvement associated with primary Sjogren's syndrome. Curr Pharm Des.2008;14(13):1270-1273.
[33]Kruize AA, Hene RJ, van der Heide A, Bodeutsch C, de Wilde PC, von Vijsterdeld OP, de Jong T, Felt Kamp TE, Kater L, Bijlsma JW. Long term follow-up of patients with Sjogren's syndrome. Arthritis Rheum 1996,39:297-303.
[34]Fritzler M, Pauls J, Kinsella T, Bowen T. Antinuclear, anticytoplasmic, and anti-Sjogren's syndrome antigen A (SS-A/Ro) antibodies in female blood donors. Clin Immunol Immunopathol.1985;36:120-128.
[35]Butterworth M, McClellan B, Allansmith M. Influence of sex in immunoglobulin levels. Nature.1967;214:1224-1225.
[36]Eidinger D, Garrett T. Studies of the regulatory effects of the sex hormones on antibody formation and stem cell differentiation. J Exp Med.1972;136:1098-1116.
[37]Ramos-Casals M, Cervera R, Font J. Do male patients with primary Sjogren's syndrome have a higher frequency of autoantibodies? J Rheumatol.2005;32:1634-1635.
[38]Anaya J, Liu G, D'Souza E, Ogawa N, Luan X, Talal N. Primary Sjogren's syndrome in men. Ann Rheum Dis.1995;54:748-751.
[39]Brennan M, Sankar V, Leakan R, et al. Risk factors for positive minor salivary gland biopsy findings in Sjogren's syndrome and dry mouth patients. Arthritis Rheum. 2002;47:189-195.
[40]Cervera R, Font J, Ramos-Casals M, et al. Primary Sjogren's syndrome in men: clinical and immunological characteristics. Lupus.2000;9:61-64.
[41]Molina R, Provost T, Arnett F, et al. Primary Sjogren's syndrome in men. Clinical, serologic, and immunogenetic features. Am J Med.1986;80:23-31.
[42]Saito T, Sato J, Kondo K, et al. Low prevalence of clinicopathologic and sialographic changes in salivary glands of men with Sjogren's syndrome. J Oral Pathol Med.1999;28:312-316.
[43]Ramos-Casals M, Solans R, Rosas J.Primary Sjogren syndrome in Spain:clinical and immunologic expression in 1010 patients. Medicine (Baltimore).2008 Jul;87(4):210-219.
[44]Garcia-Carrasco M.Primary Sjogren syndrome:clinical and immunologic disease patterns in a cohort of 400 patients. Medicine (Baltimore).2002 Jul;81(4):270-280.
[45]Ioannidis J, Vassiliou V, Moutsopoulos H. Long-term risk of mortality and lymphoproliferative disease and predictive classification of primary Sjogren's syndrome. Arthritis Rheum.2002;46:741-747.
[46]Theander E, Manthorpe R, Jacobsson L. Mortality and causes of death in primary Sjogren's syndrome:a prospective cohort study. Arthritis Rheum.2004;50:1262-1269.
[47]Bartunkova J, Sediva A, Vencovsky J, Tesar V. Primary Sjogren's syndrome in children and adolescents:proposal for diagnostic criteria. Clin Exp Rheumatol 1999,17: 381-386.
[48]Haga H, Jonsson R. The influence of age on disease manifestations and serological characteristics in primary Sjogren's syndrome. Scand J Rheumatol.1999;28:227-232.
[49]Tishler M, Yaron I, Shirazi I, Yaron M. Clinical and immunological characteristics of elderly onset Sjogren's syndrome:a comparison with younger onset disease. J Rheumatol.2001;28:795-797.
[50]Ramos-Casals M, Garcia-Carrasco M, Brito M, Lopez-Soto A, Font J. Autoimmunity and geriatrics:clinical significance of autoimmune manifestations in the elderly. Lupus.2003;12:341-355.
[51]Damoiseaux JG, Tervaert JW.From ANA to ENA:how to proceed? Autoimmun Rev.2006 Jan; 5(1):10-17.
[52]Asmussen K, Andersen V, Bendixen G, Schiodt M, Oxholm P. A new model for classification of disease manifestations in primary Sjogren's syndrome:evaluation in a retrospective long-term study. J Intern Med.1996 Jun; 239(6):475-482.
[53]Malladi AS, Sack KE, Shiboski SC,et al. Primary Sjogren's syndrome as a systemic disease:a study of participants enrolled in an international Sjogren's syndrome registry. Arthritis Care Res (Hoboken).2012 Jun;64(6):911-918.
[54]Markusse H, Veldhoven C, Swaak A, Smeenk R. The clinical significance of the detection of anti-Ro/SS-A and anti-La/SS-B autoantibodies using purified recombinant proteins in primary Sjogren's syndrome. Rheumatol Int.1993; 13:147-150.
[55]Wise C, Woodruff R. Minor salivary gland biopsies in patients investigated for primary Sjogren's syndrome. A review of 187 patients. J Rheumatol. 1993;20:1515-1518.
[56]Ramos-Casals M, Brito-Zeron P, Yague J, Akasbi M, Bautista R, Ruano M, Claver G, Gil V, Font J. Hypocomplementaemia as an immunological marker of morbidity and mortality in patients with primary Sjogren's syndrome. Rheumatology (Oxford). 2005;44:89-94.
[57]Ramos-Casals M, Font J. Primary Sjogren's syndrome:current and emergent aetiopathogenic concepts. Rheumatology (Oxford).2005;44:1354-1367.
[58]Troy E. Daniels, Darren Cox, Caroline H, et al. Associations Between Salivary Gland Histopathologic Diagnoses and Phenotypic Features of Sjogren's Syndrome Among 1,726 Registry Participants. ARTHRITIS & RHEUMATISM.2011,63(7): 2021-2030.
[59]厉小梅,徐蓓.原发性干燥综合征患者338例临床分析.实用医学杂志.2011；27(5),827-828.
[60]杜娟丽,杨军锋.原发性干燥综合征52例临床分析.陕西医学杂.2011；40(7),835-83.
[61]张莹莹,李志军.初诊原发性干燥综合征75例临床分析.蚌埠医学院院报.2010；35(4),352-354.
[62]沈友轩,袁锁娟,陆雯俊.原发性干燥综合征93例临床表现.中国微循环.2009；13(4),316.
[63]冯学兵,张华勇,周康兴.初诊原发性干燥综合征86例临床研究.中华风湿病学杂志.2009；1(13),44-47.
[64]罗日强.83例原发性干燥综合征的临床表现.广东医学.2006；27(6),849-850.
[1]Jonsson R, Bowman SJ, Gordon TP. Sjo'gren's syndrome. In:Koopman WJ, Moreland LW, eds. Arthritis and allied conditions, ch.78,15th edn. Lippincott Williams & Wilkins:Philadelphia, USA,2005;1681-1705.
[2]Bowman S, Pillemer S, Jonsson R et al. Revisiting Sjogren's syndrome in the new millennium:perspectives on assessment and outcome measures. Report of a workshop held on 23 March 2000 at Oxford, UK. Rheumatology 2001;40:1180-1188.
[3]Stevens RJ, Hamburger J, Ainsworth JR, Holmes G, Bowman SJ. Flares of systemic disease in primary Sjogren's syndrome. Rheumatology (Oxford) 2005;44:402-403.
[4]Vitali C, Bencivelli W, Isenberg DA, et al. Disease activity in systemic lupus erythematosus:report of the Consensus Study Group of the European Workshop for Rheumatology Research II. Identification of the variables indicative of disease activity and their use in the development of an activity score. The European Consensus Study Group for Disease Activity in SLE. Clin Exp Rheumatol.1992.10:541-547.
[5]Vitali C, Palombi G, Baldini C, et al. Sjogren's Syndrome Disease Damage Index and disease activity index:scoring systems for the assessment of disease damage and disease activity in Sjogren's syndrome, derived from an analysis of a cohort of Italian patients. Arthritis Rheum 2007; 56:2223-2231.
[6]Campar A, Isenberg DA. Primary Sjogren's syndrome activity and damage indices comparison. Eur J Clin Invest.2010 Jul;40(7):636-644.
[7]Bowman SJ, Sutcliffe N, Isenberg DA, et al. Sjogren's Systemic Clinical Activity Index (SCAI)-a systemic disease activity measure for use in clinical trials in primary Sjogren's syndrome. Rheumatology (Oxford) 2007; 46:1845-1851.
[8]Symmons DP, Coppock JS, Bacon PA, et al. Development and assessment of a computerised index of clinical disease activity in systemic lupus erythematosus members of the British Isles Lupus Assessment Group(BILAG). Q J Nucl Med.1988.69:927-937.
[9]Seror R, Ravaud P, Bowman SJ, et al. EULAR Sjogren's syndrome disease activity index:development of a consensus systemic diseaseactivity index for primary Sjogren's syndrome. Ann Rheum Dis.2010 Jun; 69(6):1103-1109.
[10]Barry RJ, Sutcliffe N, Isenberg DA, et al. The Sjogren's Syndrome Damage Index-a damage index for use in clinical trials and observational studies in primary Sjogren's syndrome. Rheumatology (Oxford) 2008; 47:1193-1198.
[11]Hay EM, Thomas E, Pal B, et al. Weak association between subjective symptoms or and objective testing for dry eyes and dry mouth:results from a population based study. Ann Rheum Dis 1998; 57:20-24.
[12]Meijer JM, Vissink A, Meiners PM, et al. Rituximab treatment in primary Sjogren's syndrome:a double-blind controlled trial. Arthritis Rheum 2008;58:S430-431.
[13]Bowman SJ, Booth DA, Platts RG and the UK Sjogren's Interest Group. Measurement of fatigue and discomfort in primary Sjogren's syndrome using a new questionnaire tool. Rheumatology 2004; 43:758-764.
[14]Bowman SJ, Booth DA, Platts RG, Field A, Rostron J, and the UK Sjo'gren's Interest Group. Validation of the Sicca symptoms inventory for clinical studies of Sjogren's syndrome. J Rheumatol 2003; 30:1259-1266.
[15]Bowman SJ, Hamburger J, Richards A, et al. Patient-reported outcomes in primary Sjogren's syndrome:comparison of the long and short versions of the Profile of Fatigue and Discomfort-Sicca Symptoms Inventory. Rheumatology (Oxford).2009 Feb;48(2):140-143.
[16]Seror R, Ravaud P, Mariette X, et al. EULAR Sjogren's Syndrome Patient Reported Index (ESSPRI):development of a consensuspatient index for primary Sjogren's syndrome. Ann Rheum Dis.2011 Jun;70(6):968-972.
[17]Patel AA, Donegan D, Albert T.The 36-item short form. J Am Acad Orthop Surg.2007 Feb;15(2):126-134.
[18]Bjelland I, Dahl AA, Haug TT, Neckelmann D.The validity of the Hospital Anxiety and Depression Scale. An updated literature review. J Psychosom Res.2002 Feb;52(2):69-77.
[19]Theuns P, Hofmans J, Mazaheri M, et al.Cross-national comparability of the WHOQOL-BREF:a measurement invariance approach. Qual Life Res.2010 Mar;19(2):219-224.
[2]张乃峥,曾庆馀,张凤山,等.中国风湿性疾病流行情况的调查研究.中华风湿病学杂志,1997,1：31-35.
[3]Ramos-Casals M, Tzioufas A, Font J. Primary Sjogren's syndrome:new clinical and therapeutic concepts. Ann Rheum Dis.2005;64:347-354.
[4]Vitali C, Bombardieri S, Jonseon R, et al.Classication criteria for Sjogren's syndrome: a revised version of the European criteria proposed by the American-European Consensus Group. Ann Rheum Dis.2002,61:554-558.
[5]Shiboski SC, Shiboski CH, Criswell LA, et al. American College of Rheumatology Classification Criteria for Sjogren's Syndrome:A Data-Driven, Expert Consensus Approach in the Sjogren's International Collaborative Clinical Alliance Cohort. Arthritis Care & Research(Hoboken),2012,64:475-487.
[6]Kalk WW, Vissink A, Spijkervet FK, et al. Parotid sialography for diagnosing Sjogren syndrome. Oral Surg Oral Med Oral Pathol Oral Radiol Endod.2002 Jul;94(1):131-137.
[7]Bloch KJ, Buchanan WW, Wohl MJ, et al. Sjogren's syndrome. A clinical, pathological and serological study of sixty-two cases. Medicine (Baltimore) 44:187-231.
[8]Alamanos Y, Tsifetaki N, Voulgari PV, Venetsanopoulou AI, Siozos C, Drosos AA. Epidemiology of primary Sjogren's syndrome in north-west Greece,1982-2003. Rheumatology (Oxford).2006;45:187-191.
[9]Daniels TE. Do we need new diagnostic criteria for Sjogren's syndrome? Presse Med. 2012 Sep;41:441-449.
[10]赵岩,颜淑敏,张文.原发性干燥综合征573例临床分析.中华风湿病学杂志,2010；4：223-227.
[11]Daniels T, Greenspan JS, Cox D, et al. Objective measures in Sjogren's syndrome associated with each other but not with sicca symptoms:analysis of 564 enrollees in the SICCA International Registry and Repository. Arthritis Rheum 2007,56 Suppl:S446.
[12]Daniels TE, Criswell LA, Shiboski C, et al. for the Sjogren's International Collaborative Clinical Alliance Research Groups. An early view of the International Sjogren's Syndrome Registry. Arthritis Rheum 2009;61:711-714.
[13]Fox PC, Bowman SJ, Segal B, et al. Oral involvement in primary Sjogren syndrome. J Am Dent Assoc.2008 Dec;139(12):1592-1601.
[14]Manthorpe R.New criteria for diagnosing Sjogren's syndrome:a step forward?-or.. Scand J Rheumatol Suppl.2001;115:14-20.
[15]Lemp MA, Baudouin C, Baum J, et al. The definition and classification of dry eye disease:Report of the Definition and Classification Subcommittee of the International Dry Eye WorkShop (2007). Ocul Surf 2007;5:75-92.
[16]Laszlo M6dis Jr, Eszter Szalai. Dry eye diagnosis and management. Expert Rev. Ophthalmol.2011;6(1),67-79.
[17]Kim KW, Han SB, Han ER, et al. Association between depression and dry eye disease in an elderly population. Invest Ophthalmol Vis Sci.2011 Oct 10;52(11): 7954-7958.
[18]Benitez del Castillo JM, Wasfy MA, Fernandez C & Garcia-Sanchez J:An in vivo confocal masked study on corneal epithelium and sub-basal nerves in patients with dry eye. Invest Ophthalmol Vis Sci.2004; 45:3030-3035.
[19]中华医学会风湿病学分会,干燥综合征诊断及治疗指南,中华风湿病学杂志,2010；11：766-768.
[20]Fauchais AL, Martel C. Immunological profile in primary Sjogren syndrome: clinical significance, prognosis and long-term evolution to other auto-immune disease. Autoimmun Rev.2010 Jul;9(9):595-9.
[21]Haga HJ, Peen E.A study of the arthritis pattern in primary Sjogren's syndrome. Clin Exp Rheumatol.2007 Jan-Feb;25(1):88-91.
[22]Pease CT, Shattles W, Barrett NK.The arthropathy of Sjogren's syndrome. Br J Rheumatol.1993 Jul;32(7):609-613.
[23]Davidson BKS. Primary sjogren's syndrome in the North East of England:a long-term follow-up study.Rheumatology.1999,38:245-253.
[24]Skopouli FN, Dafni U, Ioannidis JP, Moutsopoulos HM. Clinical evolution,and morbidity and mortality of primary Sjogren's syndrome.Semin Arthritis Rheum 29: 296-304.
[25]Gannot G, Lancaster HE, Fox PC. Clinical course of primary Sjogren's syndrome: Salivary, oral, and serologic aspects. J Rheumatol 27:1905-1909.
[26]Naruse Y, Inui N, Yasui H, et al. case of rapid progressive interstitial pneumonia associated with primary sjogren's syndrome. Nihon Kokyuki Gakkai Zasshi.2006 Oct;44(10):721-726.
[27]Parambil JG, Myers JL, Lindell RM, Matteson EL, Ryu JH:Interstitial lung disease in primary sjogren's syndrome. Chest 2006; 1305:1489-1495.
[28]Kurumagawa T, Kobayashi H, Motoyoshi K. Potential involvement of subclinieal sjogren's syndrome in various lung diseases. Respirology,2005,10:86-91.
[29]Adan FU, Torun D, Bolat F, et al. Acute renal failure due to mesangial proliferative glomerulonephritis in a pregnant woman with primary sjogren's syndrome. Clin Rheumatol,2006,25:7540.
[30]Ebert EC.Gastrointestinal and hepatic manifestations of sjogren syndrome. J Clin Gastroenterol.2012 Jan;46(1):25-30.
[31]Tzarouchi LC, Tsifetaki N, Konitsiotis S. CNS involvement in primary Sjogren's Syndrome:assessment of gray and white matter changes with MRI and voxel-based morphometry. AJR Am J Roentgenol.2011 Nov;197(5):1207-1212.
[32]Ozgocmen S, Gur A.Treatment of central nervous system involvement associated with primary Sjogren's syndrome. Curr Pharm Des.2008;14(13):1270-1273.
[33]Kruize AA, Hene RJ, van der Heide A, Bodeutsch C, de Wilde PC, von Vijsterdeld OP, de Jong T, Felt Kamp TE, Kater L, Bijlsma JW. Long term follow-up of patients with Sjogren's syndrome. Arthritis Rheum 1996,39:297-303.
[34]Fritzler M, Pauls J, Kinsella T, Bowen T. Antinuclear, anticytoplasmic, and anti-Sjogren's syndrome antigen A (SS-A/Ro) antibodies in female blood donors. Clin Immunol Immunopathol.1985;36:120-128.
[35]Butterworth M, McClellan B, Allansmith M. Influence of sex in immunoglobulin levels. Nature.1967;214:1224-1225.
[36]Eidinger D, Garrett T. Studies of the regulatory effects of the sex hormones on antibody formation and stem cell differentiation. J Exp Med.1972;136:1098-1116.
[37]Ramos-Casals M, Cervera R, Font J. Do male patients with primary Sjogren's syndrome have a higher frequency of autoantibodies? J Rheumatol.2005;32:1634-1635.
[38]Anaya J, Liu G, D'Souza E, Ogawa N, Luan X, Talal N. Primary Sjogren's syndrome in men. Ann Rheum Dis.1995;54:748-751.
[39]Brennan M, Sankar V, Leakan R, et al. Risk factors for positive minor salivary gland biopsy findings in Sjogren's syndrome and dry mouth patients. Arthritis Rheum. 2002;47:189-195.
[40]Cervera R, Font J, Ramos-Casals M, et al. Primary Sjogren's syndrome in men: clinical and immunological characteristics. Lupus.2000;9:61-64.
[41]Molina R, Provost T, Arnett F, et al. Primary Sjogren's syndrome in men. Clinical, serologic, and immunogenetic features. Am J Med.1986;80:23-31.
[42]Saito T, Sato J, Kondo K, et al. Low prevalence of clinicopathologic and sialographic changes in salivary glands of men with Sjogren's syndrome. J Oral Pathol Med.1999;28:312-316.
[43]Ramos-Casals M, Solans R, Rosas J.Primary Sjogren syndrome in Spain:clinical and immunologic expression in 1010 patients. Medicine (Baltimore).2008 Jul;87(4):210-219.
[44]Garcia-Carrasco M.Primary Sjogren syndrome:clinical and immunologic disease patterns in a cohort of 400 patients. Medicine (Baltimore).2002 Jul;81(4):270-280.
[45]Ioannidis J, Vassiliou V, Moutsopoulos H. Long-term risk of mortality and lymphoproliferative disease and predictive classification of primary Sjogren's syndrome. Arthritis Rheum.2002;46:741-747.
[46]Theander E, Manthorpe R, Jacobsson L. Mortality and causes of death in primary Sjogren's syndrome:a prospective cohort study. Arthritis Rheum.2004;50:1262-1269.
[47]Bartunkova J, Sediva A, Vencovsky J, Tesar V. Primary Sjogren's syndrome in children and adolescents:proposal for diagnostic criteria. Clin Exp Rheumatol 1999,17: 381-386.
[48]Haga H, Jonsson R. The influence of age on disease manifestations and serological characteristics in primary Sjogren's syndrome. Scand J Rheumatol.1999;28:227-232.
[49]Tishler M, Yaron I, Shirazi I, Yaron M. Clinical and immunological characteristics of elderly onset Sjogren's syndrome:a comparison with younger onset disease. J Rheumatol.2001;28:795-797.
[50]Ramos-Casals M, Garcia-Carrasco M, Brito M, Lopez-Soto A, Font J. Autoimmunity and geriatrics:clinical significance of autoimmune manifestations in the elderly. Lupus.2003;12:341-355.
[51]Damoiseaux JG, Tervaert JW.From ANA to ENA:how to proceed? Autoimmun Rev.2006 Jan; 5(1):10-17.
[52]Asmussen K, Andersen V, Bendixen G, Schiodt M, Oxholm P. A new model for classification of disease manifestations in primary Sjogren's syndrome:evaluation in a retrospective long-term study. J Intern Med.1996 Jun; 239(6):475-482.
[53]Malladi AS, Sack KE, Shiboski SC,et al. Primary Sjogren's syndrome as a systemic disease:a study of participants enrolled in an international Sjogren's syndrome registry. Arthritis Care Res (Hoboken).2012 Jun;64(6):911-918.
[54]Markusse H, Veldhoven C, Swaak A, Smeenk R. The clinical significance of the detection of anti-Ro/SS-A and anti-La/SS-B autoantibodies using purified recombinant proteins in primary Sjogren's syndrome. Rheumatol Int.1993; 13:147-150.
[55]Wise C, Woodruff R. Minor salivary gland biopsies in patients investigated for primary Sjogren's syndrome. A review of 187 patients. J Rheumatol. 1993;20:1515-1518.
[56]Ramos-Casals M, Brito-Zeron P, Yague J, Akasbi M, Bautista R, Ruano M, Claver G, Gil V, Font J. Hypocomplementaemia as an immunological marker of morbidity and mortality in patients with primary Sjogren's syndrome. Rheumatology (Oxford). 2005;44:89-94.
[57]Ramos-Casals M, Font J. Primary Sjogren's syndrome:current and emergent aetiopathogenic concepts. Rheumatology (Oxford).2005;44:1354-1367.
[58]Troy E. Daniels, Darren Cox, Caroline H, et al. Associations Between Salivary Gland Histopathologic Diagnoses and Phenotypic Features of Sjogren's Syndrome Among 1,726 Registry Participants. ARTHRITIS & RHEUMATISM.2011,63(7): 2021-2030.
[59]厉小梅,徐蓓.原发性干燥综合征患者338例临床分析.实用医学杂志.2011；27(5),827-828.
[60]杜娟丽,杨军锋.原发性干燥综合征52例临床分析.陕西医学杂.2011；40(7),835-83.
[61]张莹莹,李志军.初诊原发性干燥综合征75例临床分析.蚌埠医学院院报.2010；35(4),352-354.
[62]沈友轩,袁锁娟,陆雯俊.原发性干燥综合征93例临床表现.中国微循环.2009；13(4),316.
[63]冯学兵,张华勇,周康兴.初诊原发性干燥综合征86例临床研究.中华风湿病学杂志.2009；1(13),44-47.
[64]罗日强.83例原发性干燥综合征的临床表现.广东医学.2006；27(6),849-850.
[1]Jonsson R, Bowman SJ, Gordon TP. Sjo'gren's syndrome. In:Koopman WJ, Moreland LW, eds. Arthritis and allied conditions, ch.78,15th edn. Lippincott Williams & Wilkins:Philadelphia, USA,2005;1681-1705.
[2]Bowman S, Pillemer S, Jonsson R et al. Revisiting Sjogren's syndrome in the new millennium:perspectives on assessment and outcome measures. Report of a workshop held on 23 March 2000 at Oxford, UK. Rheumatology 2001;40:1180-1188.
[3]Stevens RJ, Hamburger J, Ainsworth JR, Holmes G, Bowman SJ. Flares of systemic disease in primary Sjogren's syndrome. Rheumatology (Oxford) 2005;44:402-403.
[4]Vitali C, Bencivelli W, Isenberg DA, et al. Disease activity in systemic lupus erythematosus:report of the Consensus Study Group of the European Workshop for Rheumatology Research II. Identification of the variables indicative of disease activity and their use in the development of an activity score. The European Consensus Study Group for Disease Activity in SLE. Clin Exp Rheumatol.1992.10:541-547.
[5]Vitali C, Palombi G, Baldini C, et al. Sjogren's Syndrome Disease Damage Index and disease activity index:scoring systems for the assessment of disease damage and disease activity in Sjogren's syndrome, derived from an analysis of a cohort of Italian patients. Arthritis Rheum 2007; 56:2223-2231.
[6]Campar A, Isenberg DA. Primary Sjogren's syndrome activity and damage indices comparison. Eur J Clin Invest.2010 Jul;40(7):636-644.
[7]Bowman SJ, Sutcliffe N, Isenberg DA, et al. Sjogren's Systemic Clinical Activity Index (SCAI)-a systemic disease activity measure for use in clinical trials in primary Sjogren's syndrome. Rheumatology (Oxford) 2007; 46:1845-1851.
[8]Symmons DP, Coppock JS, Bacon PA, et al. Development and assessment of a computerised index of clinical disease activity in systemic lupus erythematosus members of the British Isles Lupus Assessment Group(BILAG). Q J Nucl Med.1988.69:927-937.
[9]Seror R, Ravaud P, Bowman SJ, et al. EULAR Sjogren's syndrome disease activity index:development of a consensus systemic diseaseactivity index for primary Sjogren's syndrome. Ann Rheum Dis.2010 Jun; 69(6):1103-1109.
[10]Barry RJ, Sutcliffe N, Isenberg DA, et al. The Sjogren's Syndrome Damage Index-a damage index for use in clinical trials and observational studies in primary Sjogren's syndrome. Rheumatology (Oxford) 2008; 47:1193-1198.
[11]Hay EM, Thomas E, Pal B, et al. Weak association between subjective symptoms or and objective testing for dry eyes and dry mouth:results from a population based study. Ann Rheum Dis 1998; 57:20-24.
[12]Meijer JM, Vissink A, Meiners PM, et al. Rituximab treatment in primary Sjogren's syndrome:a double-blind controlled trial. Arthritis Rheum 2008;58:S430-431.
[13]Bowman SJ, Booth DA, Platts RG and the UK Sjogren's Interest Group. Measurement of fatigue and discomfort in primary Sjogren's syndrome using a new questionnaire tool. Rheumatology 2004; 43:758-764.
[14]Bowman SJ, Booth DA, Platts RG, Field A, Rostron J, and the UK Sjo'gren's Interest Group. Validation of the Sicca symptoms inventory for clinical studies of Sjogren's syndrome. J Rheumatol 2003; 30:1259-1266.
[15]Bowman SJ, Hamburger J, Richards A, et al. Patient-reported outcomes in primary Sjogren's syndrome:comparison of the long and short versions of the Profile of Fatigue and Discomfort-Sicca Symptoms Inventory. Rheumatology (Oxford).2009 Feb;48(2):140-143.
[16]Seror R, Ravaud P, Mariette X, et al. EULAR Sjogren's Syndrome Patient Reported Index (ESSPRI):development of a consensuspatient index for primary Sjogren's syndrome. Ann Rheum Dis.2011 Jun;70(6):968-972.
[17]Patel AA, Donegan D, Albert T.The 36-item short form. J Am Acad Orthop Surg.2007 Feb;15(2):126-134.
[18]Bjelland I, Dahl AA, Haug TT, Neckelmann D.The validity of the Hospital Anxiety and Depression Scale. An updated literature review. J Psychosom Res.2002 Feb;52(2):69-77.
[19]Theuns P, Hofmans J, Mazaheri M, et al.Cross-national comparability of the WHOQOL-BREF:a measurement invariance approach. Qual Life Res.2010 Mar;19(2):219-224.