Is SjöGren’s Syndrome a Cause for Dry Eyes and Dry Mouth in the Elderly?

• Centers for Disease Control and Prevention. Trends in aging: United States and worldwide. MMWR Morb. Mortal. Wkly. Rep.52, 101–104(2003).
   PubMedGoogle Scholar
• Kristine NP , Isenberg, David A: Sjogren‘s syndrome: diagnosis and therapeutic challenges in the elderly. Drugs Aging25(1), 19–33(2008).
   PubMed Web of Science ®Google Scholar
• Ramos-Casals M , García-CarrascoM, BritoP, López-SotoA, FontJ: Autoimmunity and geriatrics: clinical significance of autoimmune manifestations in the elderly.Lupus12(5), 341–355(2003).
   PubMed Web of Science ®Google Scholar
• Lazaro D : Elderly-onset systemic lupus erythematosus: prevalence, clinical course and treatment.Drugs Aging24(9), 701–715(2007).
   PubMedGoogle Scholar
• Närhi TO : Prevalence of subjective feelings of dry mouth in the elderly.J. Dent. Res.73(1), 20–25(1994).
   PubMed Web of Science ®Google Scholar
• Whaley K , WilliamsonJ, WilsonTet al.: Sjögren‘s syndrome and autoimmunity in a geriatric population.Age Aging1, 197–206(1972).
   PubMedGoogle Scholar
• Chisholm DM , WaterhouseJP, MasonDK: Lymphocytic sialadenitis in the major and minor salivary glands: correlation in post-mortem subjectsJ. Clin. Path.23, 690–694(1970).
   PubMed Web of Science ®Google Scholar
• De Rötth A : On the hypofunction of the lacrimal gland.Am. J. Ophthalmol.24, 20–25(1941).
   Google Scholar
• Henderson JW , ProughWA: Influence of age and sex on flow of tears.Arch. Ophthalmol.43(2), 224–231(1950).
   Google Scholar
• Wright C , MegerGE: A review of the Schirmer test for tear production.Arch. Ophthalmol.67, 564–565(1962).
   PubMed Web of Science ®Google Scholar
• Norn MS : Tear secretion in normal eyes.Acta Ophthalmol.43, 567–573(1965).
   PubMed Web of Science ®Google Scholar
• Longman LP , HighamSM, RaiKet al.: Salivary gland hypofunction in elderly patients attending a xerostomia clinic.Gerodontology12, 67–72(1995).
   PubMedGoogle Scholar
• Anaya J -M, Talal N: Sjögren‘s syndrome and connective tissue diseases associated with other immunologic disorders. In: Arthritis and Allied Conditions (13th Edition). Williams and Wilkins, PA, USA 1561–1580(1997).
   Google Scholar
• Diep JT , GorevicPD: Geriatric autoimmune diseases: systemic lupus erythematosus, Sjogren‘s syndrome, and myositis.Geriatrics60, 32–38(2005).
   PubMed Web of Science ®Google Scholar
• Al-Hashimi I , KhuderS, HaghighatN, ZippM: Frequency and predictive value of the clinical manifestations in Sjögren‘s syndrome.J. Oral Pathol. Med.30, 1–6(2001).
   PubMed Web of Science ®Google Scholar
• Sjögren H : Some aspects on the Sicca syndrome.Scand. J. Rheumatol.2, 49–51(1973).
   PubMedGoogle Scholar
• Manthorpe R , AsmussenK, OxholmP: Primary Sjögren‘s syndrome: diagnostic criteria, clinical features, and disease activity.J. Rheumatol.24(Suppl. 50), 8–11(1997).
   Web of Science ®Google Scholar
• Kassan SS , ThomasTL, MoutsopoulosHMet al.: Increased risk of lymphoma in Sicca syndrome.Ann. Intern. Med.89, 888–892(1978).
   PubMed Web of Science ®Google Scholar
• Valensini G , PrioriR, BavoillotDet al.: Differential risk of non-Hodgkin‘s lymphoma in Italian patients with primary Sjögren‘s syndrome.J. Rheumatol.24, 2376–2380(1997).
   PubMed Web of Science ®Google Scholar
• Kassan SS , MoutsopoulosHM: Clinical manifestations and early diagnosis of Sjogren syndrome.Arch. Intern. Med.174(12), 1275–1284(2004).
   Google Scholar
• Al-Hashimi I : Recognition and treatment of Sjögren‘s syndrome, a multisystem disorder.Fam. Pract.25, 35–48(2003).
   Google Scholar
• Nagler RM : Salivary glands and the aging process: mechanistic aspects, health-status and medicinal-efficacy monitoring.Biogerontology5(4), 223–233(2004).
   PubMed Web of Science ®Google Scholar
• Cassolato SF , TurnbullRS: Xerostomia: clinical aspects and treatment.Gerodontology20(2), 64–77(2003).
   PubMedGoogle Scholar
• Sanchez-Guerrero J , Perez-DosalMR, Cardenas-VelazquezFet al.: Prevalence of Sjögren‘s syndrome in ambulatory patients according to the American–European Consensus Group criteria.Rheumatol. (Oxford)44(2), 235–240(2005).
   PubMed Web of Science ®Google Scholar
• Alamanos Y , TsifetakiN, VoulgariPVet al.: Epidemiology of primary Sjogren‘s syndrome in north-west Greece, 1982–2003.Rheumatol (Oxford)45(2), 187–191(2006).
   PubMed Web of Science ®Google Scholar
• Drosos AA , AndonopoulosAP, CostopoulosJSet al.: Prevalence of primary Sjogren‘s syndrome in an elderly population.Br. J. Rheumatol.27(2), 123–127(1988).
   PubMedGoogle Scholar
• Scott J : Qualitative and quantitative observations on the histology of human labial salivary glands obtained post mortem.J. de Biologie Buccale8(3), 187–200(1980).
   PubMedGoogle Scholar
• Scott J : Quantitative age changes in the histological structure of human submandibular salivary glands.Arch. Oral Biol.22, 221–227(1977).
   PubMed Web of Science ®Google Scholar
• Borchers AT , NaguwaSM, KeenCL, GershwinME: Immunopathogenesis of Sjogren‘s syndrome.Clin. Rev. Allergy Immunol.25(1), 89–104(2003).
   PubMed Web of Science ®Google Scholar
• Ittah M , Miceli-RichardC, GottenbergJEet al.: B cell-activating factor of the tumor necrosis factor family (BAFF) is expressed under stimulation by interferon in salivary gland epithelial cells in primary Sjögren‘s syndrome.Arthritis Res. Ther.8(2), R51 (2006).
   PubMed Web of Science ®Google Scholar
• Fauchais AL , BoumedieneA, LalloueFet al.: Brain-derived neurotrophic factor and nerve growth factor correlate with T-cell activation in primary Sjogren‘s syndrome.Scand. J. Rheumatol.38(1), 50–57(2009).
   PubMed Web of Science ®Google Scholar
• Sakata K , SakataA, KongL, DangH, TalalN: Role of Fas/FasL interaction in physiology and pathology: the good and the bad.Clin. Immunol. Immunopathol.87, 1–7(1998).
   PubMedGoogle Scholar
• Tzioufas AG , WassmuthR, DafniUGet al.: Clinical, immunological, and immunogenetic aspects of autoantibody production against Ro/SSA, La/SSB and their linear epitopes in primary Sjögren‘s syndrome (pSS), a European multicentre study.Ann. Rheum. Dis.61, 398–404(2002).
   PubMed Web of Science ®Google Scholar
• Fox RI , MichelsonP: Approaches to the treatment of Sjögren‘s syndrome.J. Rheumatol.27(Suppl. 61), 15–21(2000).
   PubMed Web of Science ®Google Scholar
• Bacman S , PerezLC, Sterin-BoraLet al.: Autoantibodies against lacrimal gland M3 acetylcholine receptors in patients with primary Sjögren‘s syndrome.Invest. Ophthalmol. Vis. Sci.39, 151–156(1998).
   PubMed Web of Science ®Google Scholar
• Robinson CP , BrayerJ, YamachikaSet al.: Transfer of human serum IgG to nonobese diabetic Igµ null mice reveals a role for autoantibodies in the loss of secretory function of exocrine tissues in Sjögren‘s syndrome.Proc. Natl Acad. Sci. USA95, 7538–7543(1998).
   PubMed Web of Science ®Google Scholar
• Waterman SA , GordonTP, RischmuellerM: Inhibitory effects of muscarinic receptor autoantibodies on parasympathetic neurotransmission in Sjögren‘s syndrome.Arth. Rheum.43, 1747–1754(2000).
   Google Scholar
• Fye KH , TerasakiPI, MoutsopoulosHMet al.: Association of Sjögren‘s syndrome with HLA-B8.Arth. Rheum.19, 883–886(1976).
   PubMedGoogle Scholar
• Chused TM , KassanSS, OpelzG, MoutsopoulosHM, TerasakiPI: Sjögren‘s syndrome association with HLA-Dw3.N. Engl. J. Med.296, 895–897(1977).
   PubMed Web of Science ®Google Scholar
• Moutsopoulos HM , MannDL, JohnsonAH, ChusedTM: Genetic differences between primary and secondary sicca syndrome.N. Engl. J. Med.301, 761–763(1979).
   PubMed Web of Science ®Google Scholar
• Wilson RW , ProvostTT, BiasWBet al.: Sjögren‘s syndrome. Influence of multiple HLA-D region alloantigens on clinical and serologic expression:Arth. Rheum.27, 1245–1253(1984).
   PubMed Web of Science ®Google Scholar
• Kawakami A , NakashimaK, TamaiMet al.: Toll-like receptor in salivary glands from patients with Sjögren‘s syndrome: functional analysis by human salivary gland cell line.J. Rheumatol.34(5), 1019–1026(2007).
   PubMed Web of Science ®Google Scholar
• Spachidou MP , BourazopoulouE, MaratheftisCIet al.: Expression of functional Toll-like receptors by salivary gland epithelial cells: increased mRNA expression in cells derived from patients with primary Sjogren‘s syndrome.Clin. Exp. Immunol.147(3), 497–503(2007).
   PubMed Web of Science ®Google Scholar
• Fox RI : Sjögren‘s syndrome.Lancet366, 321–331(2005).
   PubMed Web of Science ®Google Scholar
• Yamazaki M , KitamuraR, KusanoSet al.: Elevated immunoglobulin G antibodies to the proline-rich amino-terminal region of Epstein-Barr virus nuclear antigen-2 in sera from patients with systemic connective tissue diseases and from a subgroup of Sjogren‘s syndrome patients with pulmonary involvements.Clin. Exp. Immunol.139(3), 558–568(2005).
   PubMed Web of Science ®Google Scholar
• Scully C : Sjögren‘s syndrome: clinical and laboratory features immunopathogenesis, and management.Oral Surg. Oral Med. Oral. Pathol.62, 510–23 (1986).
   PubMedGoogle Scholar
• Jorgensen C , LegouffeMC, PerneyPet al.: Sicca syndrome associated with hepatitis C virus infection.Arth. Rheum.39, 1176–1171(1996).
   Google Scholar
• Fox RI , HowellFV, BoneRCet al.: Primary Sjögren syndrome: clinical and immunopathologic features.Semin. Arthritis Rheum.14, 77–105(1984).
   PubMed Web of Science ®Google Scholar
• Itescu S , WinchesterR: Diffuse infiltrative lymphocytosis syndrome: a disorder occurring in human immunodeficiency virus-1 infection that may present as a sicca syndrome.Rheum. Dis. Clin. North Am.18, 683–697(1992).
   PubMed Web of Science ®Google Scholar
• Cainelli F : Hepatitis C virus infection in the elderly epidemiology, natural history and management.Drugs Aging25(1), 9–18(2008).
   PubMed Web of Science ®Google Scholar
• Monteil RA , RaybaudH, Saint-PaulMCet al.: Comparative analysis of inflammation and fibrosis in the liver and salivary glands during chronic hepatitis.Oral Surg. Oral Med. Oral Path. Oral Radiol. Endod.91, 426–467(2001).
   Google Scholar
• Ramos-Casals M , Garcia-CarrascoM, CerveraRet al.: Hepatitis C virus infection mimicking primary Sjögren‘s syndrome: a clinical and immunological description of 35 cases.Medicine80, 1–8(2001).
   PubMed Web of Science ®Google Scholar
• Siagris D , PharmakakisN, ChristofidouMet al.: Keratoconjunctivitis sicca and chronic HCV infection.Infection30(4), 229–233(2002).
   PubMed Web of Science ®Google Scholar
• De Vita S , DamatoR, De Marchi G, Sacco S, Ferraccioli G: True primary Sjögren‘s syndrome in a subset of patients with hepatitis C infection: a model linking chronic infection to chronic sialadenitis. Isr. Med. Assoc. J.4(12), 1101–1105(2002).
   PubMed Web of Science ®Google Scholar
• Nagao Y , HanadaS, ShishidoSet al.: Incidence of Sjogren‘s syndrome in Japanese patients with hepatitis C virus infection.J. Gastroenterol. Hepatol.18(3), 258–266(2003).
   PubMed Web of Science ®Google Scholar
• Toussirot E , Le Huede G, Mougin C et al.: Presence of hepatitis C virus RNA in the salivary glands of patients with Sjogren‘s syndrome and hepatitis C virus infection. J. Rheumatol.29(11), 2382–2385(2002).
   PubMed Web of Science ®Google Scholar
• Sullivan DA : Sex hormones and Sjögren‘s syndrome.J. Rheumatol.24(Suppl. 50), 17–32(1997).
   Web of Science ®Google Scholar
• Sullivan DA , BélangerA, CermakJMet al.: Are women with Sjögren‘s syndrome androgen-deficient?J. Rheumatol.30, 2413–2419(2003).
   PubMed Web of Science ®Google Scholar
• Whitacre CC : Sex differences in autoimmune disease.Nat. Immunol.2, 777–780(2001).
   PubMed Web of Science ®Google Scholar
• Ishimaru N , ArarkakiR, OmoteharaFet al.: Novel role of RbAp48 for tissue specific estrogen deficiency-dependent apoptosis in the exocrine glands.Mol. Cell Biol.26, 2924–2935(2006).
   PubMed Web of Science ®Google Scholar
• Taiym S , HaghighatN, Al-HashimiI: A comparison of the hormone levels in patients with Sjögren‘s syndrome andhealthy controls.Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod.97, 579–583(2004).
   PubMed Web of Science ®Google Scholar
• Deming FP , Al-HashimiI, HaghighatNet al.: Comparison of salivary calmodulin binding proteins in Sjögren‘s syndrome and healthy individuals.J. Oral Path. Med.36, 132–135(2007).
   PubMed Web of Science ®Google Scholar
• Haghighat N , Al-HashimiI: The status of lactoferrin and iron binding capacity of saliva in Sjögren‘s syndrome.Clin. Exp. Rheumatol.21, 485–488(2003).
   PubMed Web of Science ®Google Scholar
• Manthorpe R , Frost-LarsenK, IsagerH, PrauseJU: Sjögren‘s syndrome: a review with emphasis on immunological features.Allergy36, 139–153(1981).
   PubMed Web of Science ®Google Scholar
• Scully C : Sjögren‘s syndrome: clinical and laboratory features, immunopathogenesis, and management.Oral Surg. Oral Med. Oral Pathol.62, 510–523(1986).
   PubMedGoogle Scholar
• Molina R , ProvostT, ArnettFCet al.: Primary Sjögren‘s syndrome in men.Am. J. Med.80, 23–31(1986).
   PubMed Web of Science ®Google Scholar
• Moutsopoulos HM , ChusedTM, MannDLet al.: Sjögren‘s syndrome (sicca syndrome): currentissues.Ann. Int. Med.92, 212–226(1980).
   PubMed Web of Science ®Google Scholar
• Bonafede RP , DowneyDC, BennettRM: An association of fibromyalgia with primary Sjögren‘s syndrome: a prospective study of 72 patients.J. Rheumatol.22, 133–136(1995).
   PubMed Web of Science ®Google Scholar
• Cimaz R , CasadeiA, RoseCet al.: Primary Sjogren syndrome in the paediatric age: a multicentre survey.Eur. J. Paediatr.172(10), 661–665(2003).
   Google Scholar
• Ramos-Casals M , CerveraR, FontJet al.: Young onset of primary Sjögren‘s syndrome: clinical and immunological characteristics.Lupus7, 202–206(1998).
   PubMed Web of Science ®Google Scholar
• Haga HJ , JonssonR: The influence of age on disease manifestations and serological characteristics in primary Sjögren‘s syndrome.Scand. J. Rheumatol.28(4), 227–232(1999).
   PubMed Web of Science ®Google Scholar
• Daniels TE , WhitcherJP: Association of patterns of labial salivary gland inflammation with keratoconjuctivitis sicca. Analysis of 618 patients with suspected Sjögren‘s syndrome.Arth. Rheum.37, 869–877(1994).
   PubMed Web of Science ®Google Scholar
• Rhodus NL , ColbyS, MollerK, BereuterJ: Quantitative assessment of dysphagia in patients with primary and secondary Sjögren‘s syndrome.Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod.79, 305–310(1995).
   PubMed Web of Science ®Google Scholar
• Mandel ID : The functions of saliva.J. Dent. Res.66, 623–627(1987).
   PubMed Web of Science ®Google Scholar
• Dusek M , SimmonsJ, BuschangPH, Al-HashimiI: Masticatory function in patients with xerostomia.Gerodontol.13, 3–6(1996).
   PubMedGoogle Scholar
• Manoussakis MN , MoutsopoulosHM: Sjögren‘s syndrome.Otolaryngol. Clin. North Am.32, 843–860(1999).
   PubMed Web of Science ®Google Scholar
• Bloch KJ , BuchananWW, WohlMJ, BunimJJ: Sjögren‘s syndrome: A clinical, pathological, and serological study of sixty-two cases.Medicine44, 187–231(1965).
   PubMed Web of Science ®Google Scholar
• Abraham CM , Al-HashimiI, HaghighatN: Evaluation of the levels of oral Candida in patients with Sjögren‘s syndrome.Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod.86, 65–68(1998).
   PubMed Web of Science ®Google Scholar
• Hernandez YL , DanielsTE: Oral candidiasis in Sjögren‘s syndrome: prevalence, clinical correlations, and treatment.Oral Surg. Med. Oral Pathol.68, 324–329(1989).
   PubMedGoogle Scholar
• Price EJ , VenablesPJ: Dry eyes and mouth syndrome: a subgroup of patients presenting with sicca symptoms.Rheumatol. (Oxford)41(4), 417–422(2002).
   Web of Science ®Google Scholar
• Ostuni PA , GermanaB, DiMarioFet al.: Gastric involvement in primary Sjögren‘s syndrome.Clin. Exp. Rheumatol.11, 21–25(1993).
   PubMed Web of Science ®Google Scholar
• Mandl T , EkbergO, WollmerP, ManthorpeR, JacobssonLT: Dysphagia and dysmotility of the pharynx and oesophagus in patients with primary Sjogren‘s syndrome.Scand. J. Rheumatol.36(5), 394–401(2007).
   PubMed Web of Science ®Google Scholar
• Trevino H , TsianosEB, SchenkerS: Gastrointestinal and hepatobiliary features in Sjögren‘s syndrome. In: Sjögren‘s Syndrome. Clinical and Immunopathologic Aspects. Talal N, Moutsopoulos HM, Kassan SS (Eds). Springer-Verlag, Berlin, Germany, 89–95 (1987).
   Google Scholar
• Volter F , FainO, MathieuEet al.: Esophageal function and Sjögren‘s syndrome.Dig. Dis. Sci.49, 248–253(2004).
   PubMed Web of Science ®Google Scholar
• Constantopoulos SH , TsianosEV, MoutsopoulosHM: Pulmonary and gastrointestinal manifestations of Sögren‘s syndrome.Rheum. Dis. Clin. North Am.18, 617–635(1992).
   PubMed Web of Science ®Google Scholar
• Schneider A , MerikhiA, FrankBB: Autoimmune disorders: gastrointestinal manifestations and endoscopic findings.Gastrointest. Endoscopy Clin. N. Am.17, 133–151(2006).
   Google Scholar
• Masaki Y , SugaiS: Lymphoproliferative disorders in Sjögren‘s syndrome.Autoimmun. Rev.3, 175–182(2004).
   PubMed Web of Science ®Google Scholar
• Skopouli FN , BarbatisC, MoutsopoulosHM: Liver involvement in primary Sjögren‘s syndrome.Br. J. Rheumatol.33, 745–748(1994).
   PubMedGoogle Scholar
• Kaplan MJ , IkeRW: The liver is a common non-exocrine target in primary Sjogren‘s syndrome: a retrospective review.BMC Gastroenterol.2(1), 21 (2002).
   PubMedGoogle Scholar
• Csepregi A , SzdorayP, ZeherM: Do autoantibodies predict autoimmune liver disease in primary Sjögren‘s syndrome? Data of 180 patients upon a 5-year follow-up.Scand. J. Immunol.56, 623–629(2002).
   PubMed Web of Science ®Google Scholar
• Lindgren S , ManthorpeR, ErikssonS: Autoimmune liver disease in patients with primary Sjögren‘s syndrome.J. Hepatol.20, 354–358(1994).
   PubMed Web of Science ®Google Scholar
• Montefusco PP , GeissAC, BronzoRLet al.: Sclerosing cholangitis, chronic pancreatitis, and Sjögren‘s syndrome: a syndrome complex.Am. J. Surg.147, 822–826(1984).
   PubMed Web of Science ®Google Scholar
• Fenster LF , BuchananWW, LasterL, BunimJJ: Studies of pancreatic function in Sjögren‘s syndrome.Ann. Intern. Med.61, 498–508(1964).
   PubMed Web of Science ®Google Scholar
• Cardell BS , GurlingKJ: Observations on the pathology of Sjögren‘s syndrome.J. Pathol. Bacteriol.68, 137–146(1954).
   PubMedGoogle Scholar
• Bucher UG , ReidL: Sjögren‘s syndrome. Report of a fatal case with pulmonary and renal lesions.Br. J. Dis. Chest53, 237–252(1959).
   PubMedGoogle Scholar
• Matsuda M , HamanoH, YoshidaTet al.: Seronegative Sjögren syndrome with a symptomatic autoimmune sclerosing pancreatitis. Case report.Clin. Rheumatol.26, 117–119(2007).
   PubMed Web of Science ®Google Scholar
• Kino-Ohsaki J , NishimoriI, Morita Met al.: Serum antibodies to carbonic anhydrase I and II in patients with idiopathic chronic pancreatitis and Sjögren‘s syndrome. Gastroenterol.110, 1054–1056(1996).
   Web of Science ®Google Scholar
• Strimlan CV , RosenowEC 3rd, Divertie MB, Harrison EG Jr: Pulmonary manifestations of Sjögren‘s syndrome. Chest70, 354–361(1976).
   PubMed Web of Science ®Google Scholar
• Hunninghake GW , FauciAS: Pulmonary involvement in the collagen vascular diseases.Am. Rev. Resp. Dis.119, 471–503(1979).
   PubMed Web of Science ®Google Scholar
• Fairfax AJ , HaslamPL, PaviaDet al.: Pulmonary disorders associated with Sjögren‘s syndrome.Q. J. Med.50, 279–295(1981).
   PubMedGoogle Scholar
• Constantopoulos SH , PapadimitriouCS, MoutsopoulosHM: Respiratory manifestations in primary Sjögren‘s syndrome. A clinical, functional, and histologic study.Chest88, 226–229(1985).
   PubMed Web of Science ®Google Scholar
• Kelly C , GardinerP, PatB, GriffithsI: Lung function in primary Sjögren‘s syndrome: a cross sectional and longitudinal study.Thorax46, 180–183(1991).
   PubMed Web of Science ®Google Scholar
• Constantopoulos SH , MoutsopoulosHM: The respiratory system in Sjögren‘s syndrome. In: Sjögren‘s syndrome. Clinical and Immunopathologic aspects. Talal N, Moutsopoulos HM, Kassan SS (Eds). Springer-Verlag, Berlin, Germany, 83–88(1987).
   Google Scholar
• Hansen LA , PrakashUB, ColbyTV: Pulmonary lymphoma in Sjögren‘ssyndrome.Mayo Clin. Proc.64, 920–931(1989).
   PubMed Web of Science ®Google Scholar
• Kamholz S , SherA, BarlandPet al.: Sjögren‘s syndrome: severe upper airways obstruction due to primary malignant tracheal lymphoma developing during successful treatment of lymphocytic interstitial pneumonitis.J. Rheumatol.14, 588–594(1987).
   PubMed Web of Science ®Google Scholar
• Kadota J -I, Kusano S, Kawakami K, Morikawa T, Kohno S: Usual interstitial pneumonia associated with primary Sjögren‘s syndrome. Chest108, 1756–1758(1995).
   PubMed Web of Science ®Google Scholar
• Gardiner P , WardC, AllisonAet al.: Pleuropulmonary abnormalities in primary Sjögren‘s syndrome.J. Rheumatol.20, 831–837(1993).
   PubMed Web of Science ®Google Scholar
• Robinson DA , MeyerCF: Primary Sjögren‘s syndrome associated with recurrent sinopulmonary infections and bronchiectasis.J. Allergy Clin. Immunol.945, 263–264(1994).
   Google Scholar
• Hedgpeth MD , BoulwareDW: Pulmonary hypertension in primary Sjögren‘s syndrome.Ann. Rheum. Dis.47, 251–253(1988).
   PubMed Web of Science ®Google Scholar
• McMahon MJ , SwinsonDR, Shettar Set al.: Bronchiectasis and rheumatoid arthritis: a clinical study. Ann. Rheum. Dis.52, 776–779(1993).
   PubMedGoogle Scholar
• Begin R , MasseS, CantinA, MenardHA, BureauMA: Airway disease in a subset of nonsmoking rheumatoid patients. Characterization of the disease and evidence for an autoimmune pathogenesis.Am. J. Med.72, 743–750(1982).
   PubMed Web of Science ®Google Scholar
• Radoux V , MenardHA, BeginR, DecaryF, KoopmanWJ: Airways disease in rheumatoid arthritis patients. One element of a general exocrine dysfunction.Arth. Rheum.30, 249–256(1987).
   PubMedGoogle Scholar
• Kamholz S , SherA, BarlandPet al.: Sjögren‘s syndrome: severe upper airway obstruction due to malignant lymphoma developing during successful treatment of lymphocytic interstitial pneumonia.J. Rheumatol.14, 588–594(1987).
   PubMed Web of Science ®Google Scholar
• Kita T , FujimuraM, HayaseM, MatsudaT, NonomuraA: Pulmonary non-Hodgkin‘s lymphoma that arose in mucosa-associated lymphomoid tissue of the salivary gland and was diagnosed at autopsy.Nippon Kyobu Shikkan Gakkai Zasshi33, 1119–1124(1995).
   PubMedGoogle Scholar
• Tumiati B , CasoliP, ParmeggianiA: Hearing loss in the Sjögren syndrome.Ann. Intern. Med.126, 450–453(1997).
   PubMed Web of Science ®Google Scholar
• Konttinen YT , RamsayH, HietanenJ, SorsaT, NordstromD: Otitis externa sicca/fibrotizing external otitis (FEO) as a complication of Sjögren‘s syndrome.Clin. Exp. Rheumatol.18, 746–748(2000).
   PubMed Web of Science ®Google Scholar
• Haga HJ , GjesdalCG, IrgensLMet al.: Reproduction and gynaecological manifestations in women with primary Sjögren syndrome: a case–control study.Scand. J. Rheumatol.34(1), 45–48(2005).
   PubMed Web of Science ®Google Scholar
• Tishler M , CaspiD, AlmogY, SegalR, YarnoM: Increased incidence of urinary tract infection in patients with rheumatoid arthritis and secondary Sjögren‘s syndrome.Ann. Rheum. Dis.51, 604–606(1992).
   PubMed Web of Science ®Google Scholar
• Soy M , PiskinS: Cutaneous findings in patients with primary Sjögren syndrome.Clin. Rheumatol.26(8), 1350–1352(2006).
   PubMed Web of Science ®Google Scholar
• Bernacchi E , AmatoL, ParodiAet al.: Sjogren‘s syndrome: a retrospective review of the cutaneous features of 93 patients by the Italian Group of Immunodermatology.Clin. Exp. Rheumatol.22(1), 55–62(2004).
   PubMed Web of Science ®Google Scholar
• Anaya J -M, Talal N: Sjögren‘s syndrome. In: Current Therapy in Adult Medicine 4th Edition. Kassirer JP, Greene HL (Eds). Mosby, MO, USA 1291–1298(1997).
   Google Scholar
• Ostuni P , BotsiosC, SfrisoPet al.: Fibromyalgia in Italian patients with primary Sjögren‘s syndrome.Joint Bone Spine69, 51–57(2002).
   PubMed Web of Science ®Google Scholar
• Ramos-Casals M , AnayaJM, Garcia-CarrascoMet al.: Cutaneous vasculitis in primary Sjögren syndrome: classification and clinical significance of 52 patients.Medicine83(2), 96–106(2004).
   PubMed Web of Science ®Google Scholar
• Fox RI , SternM, MichelsonP: Update in Sjögren syndrome.Curr. Opin. Rheumatol.12, 391–398(2000).
   PubMed Web of Science ®Google Scholar
• de Winter S , van Buchem MA, Vermeer MH: Annular erythema of Sjögren‘s syndrome. Lancet367, 1704 (2006).
   Web of Science ®Google Scholar
• Skopouli FN , TalalA, GalanopoulouVet al.: Raynaud‘s phenomenon in primary Sjögren‘s syndrome.J. Rheumatol.17, 618–620(1990).
   PubMed Web of Science ®Google Scholar
• Kassan SS , TalalN: Renal disease with Sjögren‘s syndrome. In: Sjögren‘s Syndrome. Clinical and Immunopathologic Aspects. Talal N, Moutsopoulos HM, Kassan SS(Eds). Springer-Verlag, Berlin, Germany, 96–101(1987).
   Google Scholar
• Moutsopoulos HM , CledesJ, SkopouliFN, ElisafM, YouinouP: Nephrocalcinosis in Sjögren‘s syndrome: a late sequela of renal tubular acidosis.J. Intern. Med.230, 187–191(1991).
   PubMed Web of Science ®Google Scholar
• Moutsopoulos HM , BalowJE, LawleyTJet al.: Immune complex glomerulonephritis in sicca syndrome.Am. J. Med.64, 955–960(1978).
   PubMed Web of Science ®Google Scholar
• Hansen BU , EricssonUB, HenricssonV, LarssonA: Autoimmune thyroiditis and primary Sjögren‘s syndrome: clinical and laboratory evidence of the coexistence of the diseases.Clin. Exp. Rheumatol.9, 137–141(1991).
   PubMed Web of Science ®Google Scholar
• Ichikawa Y , FukudaR: Clinical and pathological features of Sjögren‘s syndrome associated with autoimmune thyroid disease.Nippon Rinsho53, 2545–2550(1995).
   PubMedGoogle Scholar
• Coll J , AngladaJ, ThomasSet al.: High prevalence of subclinical Sjögren‘s syndrome features in patients with autoimmune thyroid disease.J. Rheumatol.24, 1719–1724(1997).
   PubMed Web of Science ®Google Scholar
• Karsh J , PavidisN, WeintraubBD, MoutsopoulosHM: Thyroid disease in Sjögren‘s syndrome.Arth. Rheum.23, 1326–1329(1980).
   PubMed Web of Science ®Google Scholar
• Loviselli A , MathieuA, PalaRet al.: Development of thyroid disease in patients with primary and secondary Sjögren‘s syndrome.J. Endocrinol. Invest.11, 653–656(1988).
   PubMed Web of Science ®Google Scholar
• Scofield RH : Autoimmune thyroid disease in systemic lupus eythematosus and Sjögren‘s syndrome.Clin. Exp. Rheumatol.14, 321–330(1996).
   PubMed Web of Science ®Google Scholar
• Lundstrom IM , LindstromFD: Iron and vitamin deficiencies, endocrine and immune status in patients with primary Sjögren‘s syndrome.Oral. Dis.7, 144–149(2001).
   PubMed Web of Science ®Google Scholar
• Kamilaris TC , DeBoldCR, JohnsonEOet al.: Effects of short and long duration hypothyroidism and hyperthyroidism on the plasma adrenocorticotropin and corticosterone responses to bovine corticotropin-releasing hormone in rats.Endocrinology128, 2567–2576(1991).
   PubMed Web of Science ®Google Scholar
• Johnson EO , VlachoyiannopoulosPG, SkopouliFN, TzioufasAG, MoutsopolousHM: Hypofunction of the stress axis in Sjögren‘s syndrome.J. Rheumatol.25, 1508–1514(1998).
   PubMed Web of Science ®Google Scholar
• Jara LJ , LavalleC, FragaAet al.: Prolactin, immunoregulation, and autoimmune diseases.Semin. Arth. Rheum.20, 273–284(1991).
   PubMed Web of Science ®Google Scholar
• Masi AT , ChattertonRT, AldagJC: Perturbations of hypothalamic-pituitary-gonadal axis and adrenal androgen functions in rheumatoid arthritis: an odyssey of hormonal relationships to the disease.Ann. NY Acad. Sci.876, 53–62(1999).
   PubMed Web of Science ®Google Scholar
• Molina R , ProvostTT, ArnettFCet al.: Primary Sjögren‘s syndrome in men. Clinical, serologic, and immunogenetic features.Am. J. Med.80, 23–31(1988).
   Web of Science ®Google Scholar
• Goransson LG , HerigstadA, TjensvollABet al.: Peripheral neuropathy in primary Sjögren syndrome: a population-based study.Arch. Neurol.63(11), 1712–1715(2006).
   Google Scholar
• Lopate G , PestronkA, Al-LoziMet al.: Peripheral neuropathy in an outpatient cohort of patients with Sjogren‘s syndrome.Muscle Nerve33(5), 672–676(2006).
   PubMed Web of Science ®Google Scholar
• Lafitte C : Neuroradiological manifestations of primary Sjögren‘s syndrome.Rev. Neurol. (Paris)158(10 pt 1), 959–965(2002).
   PubMed Web of Science ®Google Scholar
• Andonopoulos AP , LagosG, DrososAA, MoutsopoulosHM: The spectrum of neurological involvement in Sjögren‘s syndrome.Br. J. Rheumatol.29, 21–23(1990).
   PubMedGoogle Scholar
• Alexander EL , MalinowK, LejewskiJEet al.: Primary Sjögren‘s syndrome with central nervous system disease mimicking multiple sclerosis.Ann. Intern. Med.104, 323–330(1986).
   PubMed Web of Science ®Google Scholar
• Binder A , SnaithML, IsenbergD: Sjogren‘s syndrome: a study of its neurological complications.Br. J. Rheumatol.27(4), 275–280(1988).
   PubMedGoogle Scholar
• Govoni M , PadovanM, RizzoNet al.: Neurological involvement in primary Sjogren‘s syndrome: prevalence, clinical aspects, diagnostic assessment and therapeutic approach.CNS Drugs15(8), 597–607(2001).
   PubMed Web of Science ®Google Scholar
• Lafitte C , AmouraZ, CacoubPet al.: Neurological complications of primary Sjogren‘s syndrome.J. Neurol.248(7), 577–584(2001).
   PubMed Web of Science ®Google Scholar
• Noseworthy JH , BassBH, VandervoortMKet al.: The prevalence of primary Sjögren‘s syndrome in a multiple sclerosis population.Ann. Neurol.25, 95–98(1989).
   PubMed Web of Science ®Google Scholar
• Vincent TL , RichardsonMP, MackworthCG, HawkeSH, VenablesPJW: Sjögren‘s syndrome-associated myelopathy: response to immunosuppressive treatment.Am. J. Med.114, 145–148(2003).
   PubMed Web of Science ®Google Scholar
• Andonopoulos AP , ChristodoulouJ, BallasCet al.: Autonomic cardiovascular neuropathy in Sjögren‘s syndrome: a controlled study.J. Rheumatol.25(12), 2385–2388(1998).
   PubMed Web of Science ®Google Scholar
• Utset TO , GoldenM, SiberryG, KiriN, GrumRM, PetriM: Depressive symptoms in patients with systemic lupus erythematosus: association with central nervous system lupus and Sjögren‘s syndrome.J. Rheumatol.21, 2039–2045(1994).
   PubMed Web of Science ®Google Scholar
• Thomas E , HayEM, HajeerA, SilmanAJ: Sjögren‘s syndrome: a community-based study of prevalence and impact.Br. J. Rheumatol.37, 1069–1076(1998).
   PubMedGoogle Scholar
• Malinow KL , MolinaR, GordonBet al.: Neuropsychiatric dysfunction in primary Sjögren‘s syndrome.Ann. Intern. Med.103, 344–350(1985).
   PubMed Web of Science ®Google Scholar
• Valtysdottir ST , GudbjörnssonB, LindqvistU, HallgrenR, HettaJ: Anxiety and depression in patients with primary Sjögren‘s syndrome.J. Rheumatol.27, 175–179(2000).
   Web of Science ®Google Scholar
• Kauppi M , PukkalaE, IsomäkiH: Elevated incidence of hematologic malignancies in patients with Sjögren‘s syndrome compared with patients with rheumatoid arthritis (Finland).Cancer Causes Control8, 201–204(1997).
   PubMed Web of Science ®Google Scholar
• Ioannidis JP , VassiliouVA, MoutsopoulosHM: Long-term risk of mortality and lymphoproliferative disease and predictive classification of primary Sjögren‘s syndrome.Arth. Rheum.46, 741–747(2002).
   PubMed Web of Science ®Google Scholar
• Kordossis T , PaikosS, Aronika et al.: Prevalence of Sjögren‘s-like syndrome in a cohort of HIV-1-positive patients: descriptive pathology and immunology. Br. J. Rheumatol.37, 691–695(1998).
   PubMedGoogle Scholar
• Lamey P -J, Lundy F, Al-Hashimi I: Primary and secondary Sjögren‘s syndrome: Conditions with features of graft versus host disease and altered duct cell permeability. Medical Hypotheses62, 825–829(2004).
   PubMed Web of Science ®Google Scholar
• Richey TK , BennionSD: Etiologies of the sicca syndrome: primary systemic amyloidosis and others.Int. J. Dermatol.35, 553–557(1996).
   PubMed Web of Science ®Google Scholar
• Al-Hashimi I , DrinnanAA, WrightJR, LevineMJ: Oral amyloidosis: two unusual case presentations.Oral Surg. Oral Med. Oral Pathol.63, 586–591(1987).
   PubMedGoogle Scholar
• Sack KE , WhitcherJP, CartertonNL, GreenspanJS, DanielsTE: Sarcoidosis mimicking Sjögren‘s syndrome: histopathologic observations.J. Clin. Rheumatol.4, 13–17(1998).
   PubMed Web of Science ®Google Scholar
• Drosus AA , ConstantopoulosSH, PsychosDet al.: The forgotten cause of sicca complex: sarcoidosis.J. Rheumatol.17, 1548–1551(1989).
   Google Scholar
• Mansour MJ , Al-HashimiI, WrightJM: Coexistence of sarcoidosis and Sjögren‘s syndrome: a report of 5 cases.J. Oral Path. Med.36, 337–341(2007).
   PubMed Web of Science ®Google Scholar
• Sreebny LM , YuA, GreenA, ValdiniA: Xerostomia in diabetes mellitus.Diabetes Care15, 900–904(1992).
   PubMed Web of Science ®Google Scholar
• Chavez EM , TaylorGW, BorrellLN, ShipJA: Salivary function and glycemic control in older persons with diabetes.Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod.89, 305–311(2000).
   PubMed Web of Science ®Google Scholar
• Simmons DD , Al-HashimiI, HaghighatN: Effect of xerostomic medications on stimulated salivary flow rate in patients with Sjögren‘s syndrome.Quintessence Int.31, 196–200(2000).
   PubMed Web of Science ®Google Scholar
• Vitali C , BombardieriS, JonssonRet al.: Classification criteria for Sjögren‘s syndrome: a revised versions of the European criteria proposed by the American–European Consensus Group.Ann. Rheum. Dis.61, 554–558(2002).
   PubMed Web of Science ®Google Scholar
• Vitali C , BombardieriS, MoutsopoulosMMet al.: Preliminary criteria for the classification of Sjögren‘s syndrome: results of a prospective concerted action supported by the European community.Arth. Rheum.36, 340–347(1993).
   PubMed Web of Science ®Google Scholar
• Manthorpe R : Classification criteria for Sjögren‘s syndrome. Author‘s response.Ann. Rheum. Dis.62, 95 (2003).
   Web of Science ®Google Scholar
• Vitali C : Classification criteria for Sjögren‘s syndrome.Ann. Rheum. Dis.62, 94–95(2003).
   PubMed Web of Science ®Google Scholar
• Bell M , AskariA, FrydrychSet al.: Sjögren‘s syndrome: a critical review of clinical management.J. Rheumatol.26, 2051–2061(1999).
   PubMed Web of Science ®Google Scholar
• de Seze J , DevosD, CastelnovoGet al.: The prevalence of Sjögren syndrome in patients with primary progressive multiple sclerosis.Neurology57, 1359–1363(2001).
   PubMed Web of Science ®Google Scholar
• Thong BY , VenketasubramanianN: A case of Sjögren‘s syndrome or multiple sclerosis? A diagnostic and therapeutic dilemma.Rheumatol. Int.22, 256–258(2002).
   PubMed Web of Science ®Google Scholar
• Ship JA , FoxPC, BaumBJ: How much saliva is enough? ‘Normal’ function defined.J. Am. Dent. Assoc.122, 63–69(1991).
   PubMed Web of Science ®Google Scholar
• Rubin H , HoltM: Secretory sialogram in diseases of the major salivary glands.Am. J. Roentgenol.77, 575–598(1957).
   Web of Science ®Google Scholar
• Dijkstra PF : Classification and differential diagnosis of sialographic characteristics in Sjögren syndrome.Semin. Arth. Rheum.10, 10–17(1980).
   PubMed Web of Science ®Google Scholar
• Umehara I , YamadaI, MurataY, TakehashiY, OkadaN, ShibuyaH: Quantitative evaluation of salivary gland scintigraphy in Sjögren‘s syndrome.J. Nucl. Med.40, 64–69(1999).
   PubMed Web of Science ®Google Scholar
• Aung W , YamadaI, UmeharaI, OhbayashiN, YoshinoN, ShibuyaH: Sjögren‘s syndrome: comparison of assessments with quantitative salivary gland scintigraphy and contrast sialography.J. Nucl. Med.41, 257–262(2000).
   PubMed Web of Science ®Google Scholar
• Schall GL , AndersonLG, WolfROet al.: Xerostomia in Sjögren‘s syndrome: evaluation by sequential salivary scintigraphy.J. Am. Med. Assoc.217, 2109–2117(1971).
   Google Scholar
• Al-Hashimi I , HaghighatN, FoxPC: Salivary electrophoresis in the diagnosis of SS.Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod.85, 542–547(1998).
   PubMed Web of Science ®Google Scholar
• Makula E , PokornyG, KissMet al.: The place of magnetic resonance and ultrasonographic examinations of the parotid gland in the diagnosis and follow-up of primary Sjögren‘s syndrome.Rheumatology (Oxford)39, 97–104(2000).
   PubMed Web of Science ®Google Scholar
• Lamey P -J, Biagioni PA, Al-Hashimi I: The feasibility of infrared thermography in the evaluation of the oral mucosal wetness: a pilot study. J. Oral Path. Med.36, 127–131(2007).
   PubMedGoogle Scholar
• Murube J , NemethJ, HöhHet al.: The triple classification of dry eye for practical clinical use.Eur. J. Ophthal.15, 660–667(2005).
   PubMed Web of Science ®Google Scholar
• Vivino FB , Al-HashimiI, KhanZet al.: Pilocarpine tablets for the treatment of dry mouth and dry eye symptoms in patients with Sjögren syndrome.Arch. Intern. Med.159, 174–181(1999).
   PubMed Web of Science ®Google Scholar
• Petrone D , CondemiJJ, FifeR, GluckO, CohenS, DalginP: A double-blind, randomized, placebo-controlled study of cevimeline in Sjögren‘s syndrome patients with xerostomia and keratoconjunctivitis sicca.Arth. Rheum.46, 748–754(2002).
   PubMed Web of Science ®Google Scholar
• Weber J , KeatingGM: Cevimeline.Drugs68(12), 1791–1798(2008).
   Web of Science ®Google Scholar
• Al-Hashimi I : Xerostomia secondary to Sjögren‘s syndrome in the elderly: recognition and management.Drugs Aging22, 887–899(2005).
   PubMed Web of Science ®Google Scholar
• Ship JA , FoxPC, MichalekJEet al.: Treatment of primary, Sjögren‘s syndrome with low-dose natural human interferon administered, by the oral mucosal route: a Phase II clinical trial.J. Interferon. Cytokine Res.19, 943–951 (1999).
   PubMed Web of Science ®Google Scholar
• Cotrim AP , MineshibaF, SugitoT, SamuniY, BaumBJ: Salivary gland gene therapy.Dent. Clin. N. Am.50, 157–173(2006).
   PubMedGoogle Scholar
• Pflugfelder SC : Anti-inflammatory therapy for dry eye.Am. J. Ophthalmol.137(2), 337–342(2004).
   PubMed Web of Science ®Google Scholar
• Fox RI , ChanE, BentonL, FongS, FriedlanderM, HowellFV: Treatment of primary Sjögren‘s syndrome with hydroxychloroquine.Am. J. Med.85, 62–67(1988).
   PubMed Web of Science ®Google Scholar
• Fox RI : Sjögren‘s syndrome: evolving therapies.Expert Opin. Investig. Drugs12, 247–254(2003).
   PubMed Web of Science ®Google Scholar
• Steinfeld SD , DemolsP, SalmonI, KissR, AppelboomT: Infliximab in patients with primary Sjögren‘s syndrome: a pilot study.Arth. Rheum.44, 2371–2375(2001).
   PubMed Web of Science ®Google Scholar
• Mariette X , RavaudP, SteinfeldSet al.: Inefficacy of infliximab in primary Sjögren‘s syndrome: results of the randomized, controlled trial of Remicade® in primary Sjögren‘s syndrome.Arth. Rheum.50, 4077–4078(2004).
   PubMedGoogle Scholar
• Boillée S , ClevelandDW: Gene therapy for ALS delivers.Trends Neurosciences27, 235–238(2004).
   PubMed Web of Science ®Google Scholar
• Al-Hashimi I : Sjögren‘s syndrome: diagnosis and management.Womens Health (Lond Engl).3(1), 107–122(2007).
   PubMedGoogle Scholar
• Ekström SK , VajdicCM, FalsterMet al.: Autoimmune disorders and risk of non-Hodgkin lymphoma subtypes: a pooled analysis within the Inter Lymph Consortium.Blood111(8), 4029–4038(2008).
   PubMed Web of Science ®Google Scholar
• Ekström S medby K: Risk of non-Hodgkin lymphoma and identification of specific subtypes in NHL in Sjögren‘s syndrome. Sjögren‘s Quarterly3(2), 1 (2008).
   Google Scholar

Websites

• Census offers statistics on older americans http://usgovinfo.about.com/od/censusandstatistics/a/olderstats.htm (Accessed January2009)
   Google Scholar
• Population profile of the United States www.census.gov/population/www/pop-profile/elderpop.html (Accessed January2009)
   Google Scholar
• World Population Ageing 1950–2050, Population Division, DESA, United Nations, IV. demographic profile of the older population, page 23–27 www.un.org/esa/population/publications/worldageing1950–2050/ (Accessed January2009)
   Google Scholar
• Pathogenesis of Sjögren‘s syndrome (v. 17.1) www.uptodate.com/patients/content/topic.do?topicKey=~iPuP_.7KldlVhm (Accessed January2009)
   Google Scholar
• Effect of AdhAQP1 on salivary flow in patients treated with radiation for head and neck cancer http://clinicaltrials.gov/ct2/show/NCT00372320 (Accessed January2009)
   Google Scholar