Precursor B-cells and plasmablasts/plasma cells are spared
Precursor B-cells and plasmablasts/plasma cells are spared. Sj?grens syndrome, as well as different approaches to monitoring the immune system, are discussed. Keywords: immune monitoring, biologics, Sj?grens syndrome, Sj?grens disease 1. Primary Sj?grens Syndrome Primary Sj?grens syndrome (pSS) is a systemic, chronic autoimmune disease mainly affecting the exocrine GNF 5837 glands of the body such as the lacrimal and salivary glands. The symptoms of pSS can vary from sicca symptoms (dryness of the eyes, oral cavity, pharynx, larynx, and/or vagina), more general symptoms (fatigue, chronic pain, depressive disorder, and stress), to systemic or extra-glandular symptoms (e.g., lymphoma, arthritis, interstitial lung disease, and renal failure) [1]. Besides pSS, SS can also occur secondary (sSS) to another autoimmune disease (e.g., systemic lupus erythematosus, rheumatoid arthritis). The estimated incidence of pSS is usually 4 per 1000 patients per year with an estimated overall prevalence between 0.1% and 4.8% in Europe. This is probably an underestimate because some symptoms are not specific to pSS and the disease is very heterogeneous [1]. The diagnosis of pSS is usually most often based upon the 2016 classification criteria of the American College of Rheumatology (ACR)/European League against rheumatism (EULAR) (Table 1) [2]. Systemic disease activity can be evaluated with EULAR Sj?grens syndrome disease activity index (ESSDAI) [3]. The ESSDAI score includes different domains (e.g., organs involved) to determine disease activity and is designed to assess the systemic activity of patients with pSS [4,5]. In addition, the EULAR SS Patient Reported Index (ESSPRI) is designed to assess symptoms with the help of a questionnaire [5,6]. Table 1 The 2016 American College of Rheumatology (ACR)/European League against rheumatism (EULAR) classification criteria for primary Sj?grens syndrome (pSS).
1. Labial salivary gland with focal lymphocytic sialadenitis and focus score of ?1 foci/4 mm23Applies to any individual2. Anti-SSA/Ro-positive3who meets the inclusion criteria (presence of ocular and/or oral dryness) with at least one symptom of ocular or oral dryness or ESSDAI ?13. Ocular Staining Score ?5 GNF 5837 (or van Bijsterveld score ?4) in at least one eye1does not have any of the conditions listed as exclusion criteria a4. Schirmers test ?5 mm/5 min in at least one eye1and has a score of ?4 when the weights from the 5 criteria items are summed5. Unstimulated whole saliva flow rate ?0.1 mL/min1 Open in a individual window a Exclusion criteria include history of head and neck radiation treatment, active hepatitis C infection (with confirmation by PCR), AIDS, sarcoidosis, amyloidosis, graft-versus-host disease, and IgG4-related disease [2]. Lymphocytic (B- as well as T-cell) infiltrations of GNF 5837 exocrine glands and (systemic) hyperactivation of B-cells are characteristics seen in patients with pSS [7,8]. Lymphocytic infiltrations can also occur beyond the exocrine glands. As a result of lymphocyte infiltration, interstitial nephritis, autoimmune primary biliary cholangitis, and obstructive bronchiolitis can occur. Moreover, B-cell hyperactivation can lead to immune depositions (mainly due to cryoglobulinemia), which in turn can lead to palpable purpura, glomerulonephritis, interstitial pneumonitis, interstitial lung disease, and peripheral neuropathy. Finally, patients with pSS have 15C20 times more risk of developing B-cell non-Hodgkin lymphoma (B-cell NHL), mainly lymphoma of mucosa-associated lymphoid tissue (MALT), compared to healthy individuals [9]. Immunological markers can play a role in pSS diagnosis. The main markers are autoantibodies (mainly anti-SSA/Ro antibodies, but also other autoantibodies such as (IgA) rheumatoid factor (RF) and anti-SSB/La are often present), cryoglobulin (associated with lymphoma), and low complement levels [7,10,11]. Besides a critical role for B-cells in the pathogenesis of pSS, other cells also play an important role, such as stromal and epithelial cells, cells of the innate immune system (e.g., dendritic cells, monocytes/macrophages), and T-cells (e.g., Th1, Th2, Th17, and follicular Th cells) (Physique 1) [7,12,13,14,15,16]. Open GNF 5837 in a separate window Figure.