‘Seronegative’ Sjogren’s S manifested as a subset of Chronic Fatigue Syndrome (CFS)

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We determined the extent to which chronic fatigue syndrome (CFS)
patients with sicca symptoms fulfil the diagnostic criteria
for Sjogren's syndrome (SS). Three sets of diagnostic criteria
for SS, formulated by the Japanese, Europeans and Fox, were
used. One-third of the CFS patients with sicca symptoms
fulfilled the diagnostic criteria for SS. However, they were
'seronegative', differing from the ordinary primary SS.

MCM: Rheumatologists study 75 pts w CDC-defined CFS. (Typical
sicca symptoms in eyes include foreign body or sand, burning
sensation, eye discharge, decreased tearing, redness,
photophobia, eye fatigue, itching, blurring, eye discomfort,
ocular pain, smarting sensation, and difficulty in moving the
eyelids.) "Sicca symptoms characteristic of Sjogren's S" were
found in 55 (73%) (3 males, 52 females, mean age 50.5). 32 of
this 55 pt subset underwent detailed testing: of these 32, 10
(31%) had positive Rose Bengal (corneal) testing (3 strongly
positive), the gum test was positive in 24 (75%) (7 strongly
positive), 7 of 20 had decreased accumulation and/or secretion
of 99m-Tc pertechnetate on salivary scintigraphy, lip biopsies
in 20 were Grade 0 in 11, grade 1 in 5, grade 2 in 1, grade 3
in 2, and grade 4 in 1. None of these 32 were positive for
anti-La (SSB) and only one was positive for anti-Ro (SSA). 6
of these 32 were ANA-positive and 8 were positive for RF. 5 of
the 32 pts fulfilled both the "Japanese" and "European"
criteria for Sjogren's Syndrome, 2 fulfilled only the Japanese
criteria, 3 fulfilled only the European criteria, and none of
these 10 pts fulfilled the "Fox" criteria for SS (but 4 were
diagnosed as "Possible SS" by Fox criteria. Thus, "Fox's
criteria may be useful for the differential diagnosis of SS
and CFS".

Nishikai M, Akiya K, Tojo T, Onoda N, Tani M, Shimizu K

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