Labial salivary gland assessment in idiopathic pulmonary fibrosis patients with sicca symptoms

Our plain-English summary of Labial salivary gland assessment in idiopathic pulmonary fibrosis patients with sicca symptoms, by M. Bawazir, S. Cha, N.M. Islam, et al (Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, 2021).

The study

• Authors: M. Bawazir, S. Cha, N.M. Islam, D.M. Cohen, S.G. Fitzpatrick, I. Bhattacharyya
• Journal: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
• Published: 2021;132(4):434-440
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Objective: Patients with idiopathic pulmonary fibrosis (IPF) commonly present with sicca symptoms. This study aimed to assess labial minor salivary glands (LMSGs) in those patients to rule out Sjögren's syndrome (SS), in which sicca symptoms are the clinical hallmark.

Study Design: Cases of patients with IPF with sicca symptoms referred to the oral medicine clinic at the University of Florida within the last 13 years were selected with institutional review board approval. Demographic characteristics, clinical findings, laboratory results, and histomorphologic parameters were retrospectively analyzed.

Results: A total of 12 patients (9 men and 3 women, ages 55-76 years) were identified. History of exposure to asbestos or chemicals, smoking, and medication information was obtained. All patients reported sicca symptoms with 57% of those exhibiting objective or borderline dryness. Anti-SSA/Ro and anti-SSB/La were positive in 25% and 8% of the cases, respectively. Microscopically, 1 out of 12 patients was biopsy positive in the absence of anti-SSA/Ro, fulfilling the 2016 SS criteria with positive sialometry.

Conclusions: A LMSG biopsy is critical to identify SS in patients with diagnosed IPF and present sicca symptoms, especially those with negative serology, as revealed in our study.

Copyright © 2021 Elsevier Inc. All rights reserved.

In plain English

This retrospective study reviewed records and lip salivary gland biopsy slides from 12 patients with idiopathic pulmonary fibrosis (IPF) who had dry mouth or dry eyes. All were referred to the University of Florida oral medicine clinic, with archives searched from January 2005 to September 2018, to check for Sjögren's syndrome. There were 9 men and 3 women, aged 55 to 76. A history of occupational exposure to asbestos or chemicals was found in 25% of patients. The article did not relate this exposure to its findings. All patients reported dry mouth and 75% reported dry eyes. One patient's biopsy was positive, and with a positive saliva flow test this patient met the 2016 Sjögren's syndrome criteria. A second patient met the criteria through a positive anti-SSA/Ro blood test and saliva test despite a negative biopsy. Two others could not be ruled out. Most other biopsies showed degenerative gland changes. The authors concluded that most such patients may not meet the microscopic criteria. They noted a small sample and missing eye tests, which may have undercounted cases.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective case series (review of archived records and biopsy slides) with descriptive statistics
• Who was studied: 12 patients with confirmed idiopathic pulmonary fibrosis and sicca symptoms who were referred to the University of Florida Oral Medicine Clinic for Sjögren's syndrome evaluation including lip biopsy. The archives searched ran from January 2005 to September 2018. The group was 9 men and 3 women, aged 55 to 76.
• Exposure: Not an exposure study. Occupational exposure to asbestos or chemicals was recorded in 25% of patients. Table I lists asbestos for one patient, chemicals for carpet cleaning for one, and construction field for one. Cigarette smoking was reported in 66.7%.
• Main results:
  • All 12 patients reported dry mouth; 75% also reported dry eyes
  • One patient (case #3) had a positive lip biopsy for Sjögren's syndrome. With positive sialometry, this patient fulfilled the 2016 criteria.
  • In the other cases, biopsies showed chronic degenerative changes of the salivary gland
  • 25% of patients were positive for anti-SSA/Ro and 8.3% for anti-SSB/La
  • A second patient (case #4) fulfilled the Sjögren's syndrome criteria through positive anti-SSA/Ro and sialometry, despite a negative lip biopsy
  • Cases #6 and #7 had positive anti-SSA/Ro, but eye test data were missing, so Sjögren's syndrome could not be ruled out for them
  • Unstimulated salivary flow was below the 0.1 mL/min cutoff in 50% of cases
  • There was no significant association between the number of drying (xerogenic) medications and unstimulated salivary flow rate (P > .05, r = 0.431)
• The authors' conclusion: The authors concluded that most patients with IPF and sicca symptoms may not fulfill the microscopic criteria for Sjögren's syndrome, as only 1 of 12 had a positive biopsy. They also concluded that lip biopsy would be essential for timely diagnosis, especially in seronegative patients, and they called for larger studies.
• Limitations the authors state:
  • Small sample size, and no Schirmer's test or ocular surface staining results
  • Because eye evaluation data were unavailable, confirmed Sjögren's syndrome cases may have been underestimated

Topics

Medical terms in this study, explained in our Lexicon: Idiopathic, Pulmonary Fibrosis, Biopsy.

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