In another study, allergic manifestations were reported frequently by this group of SS patients (65%) and were signiÞcantly higher than that reported in other rheumatic disorders. These allergic manifestations and especially contact dermatitis and drug eruptions were closely related to the existence of anti-ρ(rho) antibodies [5].

In order to try and have better markers of local inßammation that could be of value in the diagnosis of SS, TishlerÕs group examined several markers in the saliva and tears of SS patients. They have found increased concentrations of salivary eicosanoids (thromboxane B2 and prostaglandin E2) in SS patients as compared to a control group of patient with dry mouth [6]. Similar data were found while examining hyaluronic acid concentrations that were elevated in the saliva but not in the sera of SS patient [7].

In order to deÞne the role of several proinßammatory cytokines in the pathophysiology of SS patients, we examined some of them in various ßuids. Elevated levels of IL-6 and soluble IL-2 receptor were found in the saliva of patients suffering from SjšgrenÕs syndrome as well as elevation of IL-6 in their tears.

The fact that no parallel elevation in the concentration of these cytokines was found in the sera of these patients points to the fact that these increases are the result of local inßammation [8Ð10].

An important work in the Þeld of basic research concerning SS was done by the group of Shoenfeld et al. by deÞning experimental and induced animal models in this disease as well in SLE [11].

Yehuda ShoenfeldÕs group concentrated on the speciÞc anti-ρ(rho) and anti-λ(lambda) antibodies and found high incidence of these antibodiesÕ activities in patients with monoclonal gammopathies. They found also that patients with SS had a predominance of IgG1 subclass of anti-ρ(rho) (SSA) antibodies while IgG2 and IgG3 anti-λ(lambda) (SSB) antibodies were more frequent in patients with an extraglandular disease [12].

The important role of IgA in SS was also widely investigated and published by ShoenfeldÕs

group [13]. A mutual work of Shoenfeld and Tishler investigated the whole spectrum of autoantibodies in SS patients. In this work the frequencies of various antibodies were compared between SS patients and patients suffering from primary biliary cirrhosis [14]. The data that yielded similarities in different autoantibodies between the two diseases with different clinical presentations shed more light on the concept of the Òmosaic of autoimmunity,Ó suggested by Yehuda Shoenfeld [15Ð16].

Concerning the treatment issue of SS patients, therapy in Israel is much the same as in other Western countries and mainly involves symptomatic medications aimed at alleviation of mouth and ocular dryness. In an open label study done by Tischler et al., they tried to evaluate treatment with hydroxychloroquine (HCQ) 200 mg/d for 12 months on a group of SS patients. The results of this study showed that HCQ treatment reduced both salivary and serum IL-6 levels with almost no clinical effect on disease symptomatology [17].

Although much progress has been made in Israel in understanding the pathophysiological mechanisms underlying this disease the way to treatment is still obscure.

References

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2.Vitali C, Bombardieri S, Moutsopoulos HM, et al. Preliminary criteria for the classiÞcation of SjšgrenÕs syndrome. Results of a prospective concerted action supported by the European Community. Arthritis Rheum. 1993;36:340Ð7.

3.Tishler M, Alosachie I, Barka N, et al. Primary

SjšgrenÕs syndrome and primary biliary cirrhosis: differences and similarities in the autoantibody proÞle. Clin Exp Rheumatol. 1995;(4): 497Ð500.

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