Sjögren's Syndrome in Systemic Lupus Erythematosus

Sicca features of Sjögren's syndrome were investigated in 50 unselected, consecutive patients with systemic lupus erythematosus by questioning, clinical examination, Schirmer's tests, rose bengal staining tests, secretory parotid sialography, scintillation scanning of salivary glands with 99mTc-pertechnetate, radionuclide salivary excretion studies, and histologic study of minor salivary glands of the lip. Twenty-three patients complained of sicca symptoms; of these, 16 had ocular symptoms and xerostomia. Twenty-seven patients had apparently enlarged submandibular or parotid glands. Forty-nine of the 50 patients had abnormalities in at least 2 test results. The other patient had an abnormal sialography. The minor salivary glands of the lip were altered in 47 patients. The 3 patients with normal biopsies had abnormal sialographies or scintiscans, or both. The clinical or subclinical evidence of Sjögren's syndrome in practically all patients with lupus erythematosus may have important theoretical implications regarding the role, whether passive or active, of the lacrimal and salivary glands in autoimmunity.