Regular Article| Volume 95, ISSUE 11, P904-910, November 2001

Download started.


Inflammation and structural changes in the airways of patients with primary Sjögren's syndrome

      This paper is only available as a PDF. To read, Please Download here.


      The present study aimed to compare the cellular pattern and structural changes in the airways of patients with primary Sjögren's syndrome (pSS) with healthy controls. Bronchial biopsy specimens were obtained from seven subjects with pSS and seven healthy controls. All the patients with pSS had increased bronchial responsiveness to methacholine. In the biopsies inflammatory cells, cytokine-producing cells, tenascin and laminin were visualized by immunostaining. Patients with pSS had a higher number of neutrophils and mast cells than healthy controls, while the number of eosinophils was similar in the two groups. The number of IL-8-positive cells was higher in pSS but the numbers of IL-4-and IL-5-positive cells were not significantly different between pSS and healthy controls. The numbers of T cells in patients with pSS were higher than in healthy controls, while the numbers of CD25-positive cells were similar to the healthy controls. The degree of epithelial integrity in patients with pSS was significantly lower than in the control group and the tenascin and laminin layers were significantly thicker in the pSS group. There was a correlation between the number of mast cells and the thickness of the tenascin and laminin layers in pSS. In conclusion, we found that the cellular pattern in the bronchial mucosa of patients with pSS displayed large numbers of neutrophils, mast cells and T-lymphocytes. These changes in inflammatory cell numbers seemed to relate to the observed increased epithelial damage and structural changes of the subepithelium. The structural findings, but not the pattern of inflammatory cells, are shared with atopic asthma and may relate to the increased bronchial hyper-responsiveness seen in both diseases.




        • Kelly C
        • Gardiner P
        • Pal B
        • Griffiths I
        Lung function in primary Sjögren's syndrome: a cross sectional and longitudinal study.
        Thorax. 1991; 46: 180-183
        • Potena A
        • La Corte R
        • Fabbri LM
        • Papi A
        • Trotta F
        • Ciaccia A
        Increased bronchial responsiveness in primary and secondary Sjögren's syndrome.
        Eur Respir J. 1990; 3: 548-553
        • Gudbjörnsson B
        • Hedenström H
        • Stålenheim G
        • Hallgren R
        Bronchial hyperresponsiveness to methacholine in patients with primary Sjögren's syndrome.
        Ann Rheum Dis. 1991; 50: 36-40
        • Lúdvı́ksdottir D
        • Hedenström H
        • Janson C
        Different airway responsiveness profiles in atopic asthma, non-topic asthma and Sjögren's syndrome.
        Allergy. 1999; 55: 259-265
        • Lúdvı́ksdottir D
        • Janson C
        • Högman M
        Increased nitic oxide in expired air in patients with Sjögren's syndrome.
        Eur Respir J. 1999; 13: 739-743
        • Amin K
        • Lúdvı́ksdóttir D
        • Janson C
        Inflammation and structural changes in the airways of patients with atopic and non-atopic asthma.
        Am J Resp Crit Car Med. 2000; 162: 2295-2301
        • Manthorpe R
        • Asmussen K
        • Oxholm P
        Primary Sjögren's syndrome: diagnostic criteria, clinical features, and disease activity.
        J Rheumatol. 1997; 24: 8-11
        • Nieminen MM
        • Lahdensuo A
        • Kellomaeki L
        • Karvonen J
        • Muittari A
        Methacholine bronchial challenge using a dosimeter with controlled tidal breathing.
        Thorax. 1988; 43: 896-900
        • Britten KM
        • Howarth PH
        • Roche WR
        Immunohistochemistry on resin sections: a comparison of resin embedding techniques for small mucosal biopsies.
        Biotech Histochem. 1993; 68: 271-280
        • Lúdvı́ksdottir D
        • Janson C
        • Högman M
        • Hedenström H
        • Björnsson E
        • Boman G
        Exhaled nitric oxide and its relationship to airway responsiveness and atopy in asthma.
        Respir Med. 1999; 93: 552-556
        • Salaffi F
        • Manganelli P
        • Carotti M
        A longitudinal study of pulmonary involvement in primary Sjögren's syndrome: relationship between alveolitis and subsequent lung changes on high-resolution computed tomography.
        Br J Rheumatol. 1998; 37: 263-269
        • Papiris SA
        • Saetta M
        • Turato G
        CD4-positive T-lymphocytes infiltrate the bronchial mucosa of patients with Sjögren's syndrome.
        Am J Respir Crit Care Med. 1997; 156: 637-641
        • Wallaert B
        • Hatron PY
        • Grosbois JM
        • Tonnel AB
        • Devulder B
        • Voisin C
        Subclinical pulmonary involvement in collagen-vascular diseases assessed by bronchoalveolar lavage. Relationship between alveolitis and subsequent changes in lung function.
        Am Rev Respir Dis. 1986; 133: 574-580
        • Skopouli FN
        • Li L
        • Boumba D
        Association of mast cells with fibrosis and fatty infiltration in the minor salivary glands of patients with Sjögren's syndrome.
        Clin Exp Rheumatol. 1998; 16: 63-65
        • Bloch KJ
        • Buchanan WW
        • Wohl MJ
        • Bunim JJ
        Sjögren's syndrome. A clinical, pathological, and serological study of sixty-two cases.
        Med Balt. 1992; 71: 386-401
        • Hatron PY
        • Wallaert B
        • Gosset D
        Subclinical lung inflammation in primary Sjögren's syndrome. Relationship between bronchoalveolar lavage cellular analysis findings and characteristics of the disease.
        Arthritis Rheum. 1987; 30: 1226-1231
        • Gudbjörnsson B
        • Hällgren R
        • Nettelbladt O
        Phenotypic and functional activation of alveolar macrophages, T lymphocytes and NK cells in patients with systemic sclerosis and primary Sjögren's syndrome.
        Ann Rheum Dis. 1994; 53: 574-579
        • Coll J
        • Tomás S
        • Vilella R
        • Corominas J
        Interleukin-2 receptor expression in salivary glands of patients with Sjögren's syndrome.
        J Rheumatol. 1995; 22: 1488-1491
        • Konttinen YT
        • Kemppinen P
        • Koski H
        T(H)1 cytokines are produced in labial salivary glands in Sjögren's syndrome, but also in healthy individuals.
        Scand J Rheumatol. 1999; 28: 106-112
        • Wang JH
        • Trigg CJ
        • Devalia JL
        • Jordan S
        • Davies RJ
        Effect of inhaled beclomethasone dipropionate on expression of proinflammatory cytokines and activated eosinophils in the bronchial epithelium of patients with mild asthma.
        J Allergy Clin Immunol. 1994; 94: 1025-1034
        • Suzuki T
        • Yokoi N
        • Takehisa Y
        • Komuro A
        • Kinoshita S
        Evaluation of conjunctival epithelial damage in dry eye.
        Nippon Ganka Gakkai Zasshi. 1997; 101: 52-56
        • McGee ZA
        • Clemens CM
        • Jensen RL
        • Klein JJ
        • Barley LR
        • Gorby GL
        Local induction of tumor necrosis factor as a molecular mechanism of mucosal damage by gonococci.
        Microb Pathol. 1992; 12: 333-341
        • Mendis AH
        • Venaille TJ
        • Robinson BW
        Study of human epithelial cell detachment and damage: effects of proteases and oxidants.
        Immunol Cell Biol. 1990; 68: 95-105
        • Vliagoftis H
        • Metcalfe DD
        Characterization of adhesive interactions between mast cells and laminin isoforms: evidence of a principal role for alpha 6 integrin.
        Immunology. 1997; 92: 553-560
        • Nilsson G
        • Costa JJ
        • Metcalfe DD
        Mast cells and basophils.
        in: Gallin JI Snyderman R Inflammation: Basic Principles And Clinical Correlates. Lippincott Williams & Wilkins, Philadelphia1999: 97-117
        • Björnsson E
        • Janson C
        • Håkansson L
        • Enander I
        • Venge P
        • Boman G
        Serum eosinophil cationic protein in relation to bronchial asthma in a young Swedish population.
        Allergy. 1994; 49: 730-736