Rheumatology (Oxford) 2002 Apr;41(4):416-22
Price EJ, Venables PJ.
Department of Rheumatology, Princess Margaret
Hospital, Okus Road, Swindon SN1 4JU and. Kennedy
Institute of Rheumatology Division, Imperial College,
1 Aspenlea Road, London W6 8LH, UK.
OBJECTIVE: To evaluate the characteristics of patients presenting with symptoms suggestive of Sjogren’s syndrome (SS) but failing to satisfy diagnostic criteria.
METHODS: Clinical, serological and histological data
were collected on 34 patients presenting with dry eyes
and/or mouth who did not satisfy the Vitali criteria
for the diagnosis of SS. They were compared with 136
patients with primary SS, 38 patients with secondary
SS, and 13 patients without SS. Questionnaires on
symptoms from each group were compared with 43 healthy controls.
RESULTS: The 34 patients who did not satisfy the
diagnostic criteria for SS or any other connective
tissue disease were designated dry eyes and mouth
syndrome (DEMS). Their demography including age was
similar to that of a primary SS group and there was no
more atrophy seen on their biopsies compared with SS
and non-SS controls. They scored highly on visual
analogue scales of symptoms but had few objective
signs. All were negative for anti-Ro and anti-La
although the prevalence of antinuclear antibodies
(19%) was increased compared with a normal population.
There was no excess of SS-associated tissue types.
CONCLUSION: There was no evidence that age, salivary
gland atrophy or subclinical SS accounted for the
symptoms in DEMS. Most of the patients fitted into a
spectrum of disease which tended more towards
fibromyalgia and/or chronic fatigue syndrome.