Neurological involvement in primary Sjögren syndrome: a focus on central nervous system

Manuela Morreale; Pasquale Marchione; Patrizia Giacomini; Simona Pontecorvo; Massimo Marianetti; Claudio Vento; Emanuele Tinelli; Ada Francia

doi:10.1371/journal.pone.0084605

Neurological involvement in primary Sjögren syndrome: a focus on central nervous system

PLoS One. 2014 Jan 20;9(1):e84605. doi: 10.1371/journal.pone.0084605. eCollection 2014.

Authors

Manuela Morreale¹, Pasquale Marchione², Patrizia Giacomini³, Simona Pontecorvo⁴, Massimo Marianetti⁵, Claudio Vento⁶, Emanuele Tinelli⁷, Ada Francia⁴

Affiliations

¹ Neuroimmunological Centre, Department of Neurology and Psychiatry, Sapienza - University of Rome, Rome, Italy ; Neurosonological Unit, Department of Medical and Surgical Sciences and Biotechnologies - Section of Neurology, Sapienza - University of Rome, Rome, Italy.
² Neurosonological Unit, Department of Medical and Surgical Sciences and Biotechnologies - Section of Neurology, Sapienza - University of Rome, Rome, Italy ; Department of Clinical Neurosciences, Neurological Centre of Latium - Institute of Neurosciences, Rome, Italy.
³ Neurosonological Unit, Department of Medical and Surgical Sciences and Biotechnologies - Section of Neurology, Sapienza - University of Rome, Rome, Italy ; Neuropsychology Outpatients Service, Department of Medical and Surgical Sciences and Biotechnologies - Section of Neurology, Sapienza - University of Rome, Rome, Italy.
⁴ Neuroimmunological Centre, Department of Neurology and Psychiatry, Sapienza - University of Rome, Rome, Italy.
⁵ Neuropsychology Outpatients Service, Department of Medical and Surgical Sciences and Biotechnologies - Section of Neurology, Sapienza - University of Rome, Rome, Italy.
⁶ Neurosonological Unit, Department of Medical and Surgical Sciences and Biotechnologies - Section of Neurology, Sapienza - University of Rome, Rome, Italy.
⁷ Department of Clinical Neurosciences, Neurological Centre of Latium - Institute of Neurosciences, Rome, Italy ; Neuroradiological Unit, Department of Neurology and Psychiatry, Sapienza - University of Rome, Rome, Italy.

Abstract

Objectives: Sjögren syndrome is an autoimmune disease involving mainly salivary and lacrimal glands. Beyond widely described PNS involvement, high variable prevalence of CNS manifestations ranging from 2.5 and 60% of all pSS patients has been reported, without specific syndrome definition. The aim of this cohort study was to evaluate the prevalence of CNS signs and symptoms in pSS patients and to identify possible biomarkers of CNS damage.

Methods: 120 patients with pSS diagnosis according to the 2002 American-European Consensus Group criteria were enrolled after exclusion of secondary causes. All patients underwent to a wide neurological, neuropsychological, psychiatric, neuroradiological and ultrasonographic evaluation.

Results: Central and peripheral nervous system involvement was observed in 81 patients with a prevalence of 67.5%. The prevalence of CNS involvement was significantly higher than PNS disease (p 0.001). 68 patients (84%) shown non-focal CNS symptoms and 64 (79%) focal CNS deficits with headache as the most common feature (46.9%), followed by cognitive (44.4%) and mood disorders (38.3%). Particularly, we observed a high prevalence of migraine without aura, subcortical frontal executive functions and verbal memory impairment and apathy/alexythimia. MR spectroscopy revealed a reduction of NAA levels or NAA/Cr ratio decrease in subcortical frontal and basal ganglia white matter, while ultrasonography showed an impairment of microvasculature response. At multivariate analysis, headache, cognitive disorders and psychiatric symptoms was significantly associated to serological markers (anti-SSA), MRS and ultrasonographic features.

Conclusions: The higher prevalence of MWO-mimic headache, cognitive dys-executive syndrome and mood disorders observed in this series confirmed previous evidences of a higher diffused CNS compromission rather than focal involvement such as SM-like clinical course or NMO-like syndrome. The association with immunological biomarkers, metabolic cerebral dysfunction and microvascular damage suggests a possible endothelial dysfunction of the cerebral microcirculation or a potential inflammation-mediated shift of the neurovascular coupling.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Central Nervous System / pathology*
Central Nervous System Diseases / etiology
Central Nervous System Diseases / pathology*
Female
Humans
Male
Middle Aged
Sjogren's Syndrome / complications
Sjogren's Syndrome / physiopathology*

Grants and funding

This study has been supported by no profit association SCAN-Onlus. The supporters had no role in study design, data collection and statistical analysis. No funding has been received.