An association of fibromyalgia (FM) with primary Sjogren’s syndrome: a prospective study of 72 patients

OBJECTIVE. Fibromyalgia patients often describe the presence
of dry eyes and dry mouth. Conversely there is an increasing
recognition that many patients with Sjogren's syndrome (SS)
have fibromyalgia (FM). We decided to investigate this

METHODS. Seventy-two patients with FM were
screened with a Schirmer's test. All patients with an abnormal
test had a minor salivary gland biopsy.

RESULTS. Thirty-eight
percent (n = 28) had a Schirmer's test of < 15 mm wetting at 5
minutes, however sicca symptoms were noted in only 19% of
patients. Salivary gland biopsy in these 28 patients showed a
focus score of > or = 1 in 5; a positive antinuclear antibody
test (ANA) was found in 4, a positive rheumatoid factor in 3
and anti-SSA SSB antibodies in 2. Another 8 patients had
abnormal salivary gland lymphocytic foci, but there were < 50
cells or the density was < 1 focus/4 mm2; all 8 of these
patients had a positive ANA. None of these patients have
developed systemic features of SS over a 6 year period of

CONCLUSION. There is a subgroup of patients
presenting with FM who, on further testing, have findings
consistent with primary SS. The prevalence of this association
was 6.9% for probable SS and 11% for possible SS. These
figures are probably an overestimation due to tertiary center
referral bias. The etiologic and management implications of
these observations are unclear.

Bonafede RP, Downey DC, Bennett RM

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