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Salivary gland scintigraphy in Sjögren’s syndrome and patients with sicca symptoms but without Sjögren’s syndrome: the psychological profiles and predictors for salivary gland dysfunction

¹ Institute of Biomedicine/Anatomy, Biomedicum Helsinki, University of Helsinki
² Department of Medicine/Invärtes Medicin, Helsinki University Central Hospital, Helsinki
³ Clinical Laboratory Department, Malmi Hospital, Helsinki, Finland
⁴ Orthopaedic Hospital of the Invalid Foundation, Helsinki

Correspondence to:
Correspondence to:
Professor Y T Konttinen, Biomedicum, PO Box 700 (Haartmaninkatu 8), FIN-00029 HUS, Finland;
yrjo.konttinen{at}helsinki.fi

Objective: To characterise the psychological profiles of Sjögren’s syndrome (SS) and patients with sicca symptoms but without SS; to find predictors for salivary gland function; to evaluate salivary scintigraphy as a method to differentiate between SS and patients with sicca symptoms but without SS.

Patients and methods: Psychological tests (Medical Outcomes Study Short Form General Health Survey (SF-36), Jenkins Activity Survey, Toronto Alexithymia Scale, and Maastricht Questionnaire for vital exhaustion) were performed and assessment of the function of the salivary glands made in 26 patients with primary SS, 8 with secondary SS, and 9 with sicca symptoms but without SS. Data were analysed with BMDP new system version 1.0 statistical program.

Results: Psychological profiles were similar in all groups. Hb, RF, ANA, and SSA differentiated between the groups. Results of salivary scintigraphy were predicted to 51% by ANA, SSA, SSB, IgG, IgA, diagnosis, vitality, and role limitations due to emotional problems. No predictors were found for the resting salivary flow. Salivary scintigraphy was pathological in 21/26 (81%) and in 8/8 (100%) patients with secondary SS, but only in 2/9 (22%) patients with sicca symptoms without SS (p=0.002) (sensitivity 85.3%, specificity 77.8%).

Conclusions: Patients with sicca symptoms but without SS have sickness behaviour similar to that of patients with SS. The results of salivary scintigraphy can be predicted by diagnosis and autoimmune findings; psychological characteristics added 20% to this predictive value. Distinction between SS and patients with sicca symptoms but without SS is difficult, but in addition to autoantibodies, salivary scintigraphy can be used for this purpose.

Keywords: Sjögren’s syndrome; salivary gland; scintigraphy; psychological tests

Abbreviations: ACh, acetylcholine; ANA, antinuclear antibodies; CRP, C reactive protein; ESR, erythrocyte sedimentation rate; Hb, haemoglobin; JAS, Jenkins Activity Survey; RF, rheumatoid factor; SF-36, Short Form-36; SS, Sjögren’s syndrome; TAS, Toronto Alexithymia Scale; VE, vital exhaustion