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Natural History of Salivary Gland Dysfunction and Sjogren's Syndrome

This study is currently recruiting patients

Verified by National Institutes of Health Clinical Center (CC) March 2006

Sponsored by: National Institute of Dental and Craniofacial Research (NIDCR)
Information provided by: National Institutes of Health Clinical Center (CC)
ClinicalTrials.gov Identifier: NCT00001852


Purpose

This study will follow patients with salivary gland dysfunction to identify the long-term course of this disorder and its effects on the mouth, oral function, and overall health. Saliva is important in maintaining oral health and comfort. It moistens the mouth, lubricates food for easier swallowing, provides enzymes needed to begin the digestive process and promotes repair and cleansing of soft tissues of the mouth. Decreased salivary production or changes in salivary composition may affect oral and systemic health and cause an increase in tooth decay.

Patients 4 years of age and older with dry mouth symptoms and a diagnosis of primary, secondary or incomplete Sjogren's syndrome or salivary gland dysfunction due to radiation may be eligible for this study. Candidates will be screened with a complete medical and dental history and blood and saliva tests. Some patients will have a biopsy of the minor salivary glands, usually from the lower lip, to confirm or rule out the diagnosis of Sjogren's syndrome and determine the extent of changes in the salivary glands. (A biopsy is the surgical removal of a small piece of tissue for laboratory examination.) The ability to taste and smell may also be evaluated, and patients may have an ultrasound examination of their swallowing function.

Participants will have a general oral examination of the teeth and soft tissues of the mouth, general physical examination, eye examination and blood tests and will fill out a questionnaire on oral health and function. In addition, they will have the following tests and procedures:

  • Identification of possible fungal infection - Patients rinse their mouth with 2 teaspoons of a salt-water solution and spit it in a sterile container for laboratory examination. If a fungal infection is detected, treatment will be offered.
  • Unstimulated salivary function assessment - Saliva production is measured by collecting saliva samples through small suction cups connected to collection tubes over the salivary gland ducts in the mouth.
  • Stimulated salivary function assessment - A sour-tasting liquid (2% citric acid) is applied to the top and sides of the tongue at 30-second intervals to stimulation saliva production while saliva is collected using the procedure described above.
  • Identification of markers of precancerous lesions - The salivary gland biopsy done at the screening evaluation (or from outside sources) is examined for markers of precancerous lesions, as about 5 percent of patients with Sjogren's syndrome develop a tumor called Non-Hodgkin's lymphoma. In some cases, the minor salivary glands may be re-biopsied a few years after the screening biopsy.

Patients will be followed once a year with a comprehensive history and physical examination, eye examination, full oral examination, salivary function assessment and questionnaires about signs and symptoms of salivary gland dysfunction.





Condition
Lymphoma
Salivary Gland Disease
Sjogren's Syndrome
Xerostomia

Study Type: Observational
Study Design: Natural History

Official Title: Natural History of Salivary Gland Dysfunction and Sjogren's Syndrome

Further study details as provided by National Institutes of Health Clinical Center (CC):

Study start: April 1999

Saliva plays a major role in maintaining oral health and comfort. Saliva is needed to moisten the mouth, to lubricate food for easier swallowing, to protect oral hard and soft tissues, to modulate oral microbial populations, to provide enzymes necessary to begin food breakdown for digestion, and to promote soft tissue repair and oral cleansing. Therefore, salivary dysfunction may result in numerous clinical conditions affecting oral and systemic health, comfort and quality of life. In particular, we will focus on individuals with Sjogren's syndrome, an autoimmune exocrinopathy that primarily affects the salivary and lacrimal glands. A number of unanswered questions remain concerning salivary involvement in this disorder. These include the rate of progression of secretory dysfunction, and related oral and systemic complications associated with xerostomia in autoimmune and non-autoimmune diseases, and B-cell dysregulation. Also, more precise estimates of the incidence of the lymphoma development are needed.

The purpose of this study is: 1) to allow careful follow-up of patients with defined salivary gland alterations so that the long term course and effects of Sjogren's syndrome (SS) on the oral cavity and systemic health in SS may be delineated; 2) to follow the development and progression of B-cell dysregulation in SS; 3) to follow subjects to establish whether those initially manifesting incomplete criteria for SS progress toward fully meeting the criteria; 4) to refine diagnostic tests for SS, and to determine whether those subjects who meet the criteria for SS continue to do so; and, 5) to develop intermediary outcome measures for SS based on long term outcomes (loss of tears and loss of stimulated salivary flow).

Patients will return every two years from the baseline visit for a full oral examination, salivary function assessment, clinical laboratory studies, and questionnaires concerning signs and symptoms of salivary gland dysfunction. These individuals will be patients with Sjogren's syndrome (SS), incomplete SS (patients who have some, but not all of the criteria for SS) or radiation-induced salivary gland hypofunction. We anticipate that many of these patients will also participate in therapeutic trials conducted within the branch.

Eligibility

Ages Eligible for Study:  4 Years and above,  Genders Eligible for Study:  Both
Criteria
  • INCLUSION CRITERIA:

Male and female subjects.

All subjects will have first participated in screening protocol 84-D-0056 to confirm their diagnosis and assess salivary function.

Subjects must have dry mouth symptoms (xerostomia) and a diagnosis of primary or secondary SS, incomplete SS, or radiation-induced salivary gland dysfunction (as determined in protocol 84-D-0056).

Our diagnostic criteria for SS require the presence of:

Positive focus score greater than 1 (aggregation of greater than 50 lymphocytes in 4 mm biopsy of minor salivary gland); and

Schirmer-I test less than 5 mm wetting in 5 minutes, or Lissamine green staining applying the Oxford score, if at least one of the two components score positive: a) a corneal component score of 1 on a 0-5 score, b) a conjunctival component score of 3 (on a 0-10 scale) for any eye. Cases with punctual plug or punctual occlusion performed for dry eyes will be considered to have dry eyes (KCS) if epiphora are not present; and

Positive immunological findings (Igs, RF, anti-SSA, anti-SSB, or ANA).

The incomplete SS are a group of patients who have some objective evidence of an autoimmune exocrinopathy. This group will be followed for possible development of SS.

Objective findings of autoimmune exocrinopathy include positive keratoconjunctivitis sicca (KCS) or low Schirmer-I test, a labial minor salivary gland demonstrating focal infiltrate of lymphocytes replacing normal salivary acini and ducts, or positive immunological laboratory findings.

EXCLUSION CRITERIA:

Failure to complete evaluation procedures as specified in 84-D-0056.

Diagnosis of drug-related xerostomia.

Age less than 4 years.

There are no exclusions based on gender, race, or ethnicity.

HEALTHY VOLUNTEERS

Healthy volunteers will be recruited only for the ultrasound guided core needle biospy of the parotid gland. They will sign the parotid biopsy consent form only.

INCLUSION CRITERIA:

Age 18 years or older.

Ability to give informed consent.

EXCLUSION CRITERIA:

History of bleeding diathesis or the current use of anticoagulants.

Any uncontrolled or severe chronic disease.

Location and Contact Information

Please refer to this study by ClinicalTrials.gov identifier  NCT00001852

Patient Recruitment and Public Liaison Office      (800) 411-1222    prpl@mail.cc.nih.gov
TTY      1-866-411-1010 

Maryland
      National Institutes of Health Clinical Center, 9000 Rockville Pike, Bethesda,  Maryland,  20892,  United States; Recruiting

More Information

NIH Clinical Center Detailed Web Page

Publications

Atkinson JC, Travis WD, Slocum L, Ebbs WL, Fox PC. Serum anti-SS-B/La and IgA rheumatoid factor are markers of salivary gland disease activity in primary Sjogren's syndrome. Arthritis Rheum. 1992 Nov;35(11):1368-72.

Study ID Numbers:  990070; 99-D-0070
Last Updated:  December 12, 2006
Record first received:  November 3, 1999
ClinicalTrials.gov Identifier:  NCT00001852
Health Authority: United States: Federal Government
ClinicalTrials.gov processed this record on 2007-01-26





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