Title Page
Contents
Abstract 9
Ⅰ. INTRODUCTION 11
Ⅱ. PATIENTS AND METHODS 13
Ⅲ. RESULTS 16
Ⅳ. Discussion 47
Conclusion 50
References 51
Table 1. Patient demographics and disease characteristics 17
Table 2. Comparison of patients with dryness due to Sjögren's syndrome and other causes 23
Table 3. Comparison of patients with primary and secondary Sjögren's syndrome 28
Table 4. Comparison of patients with Sjögren's syndrome according to the presence or absence of anti-SS-A/Ro antibodies 31
Table 5. Association between histopathological findings and clinical features in patients with Sjögren's syndrome... 36
(a) Focus score 36
(b) Atrophy 37
(c) Fibrosis 39
(d) Duct dilatation 42
Table 6. The sensitivity and specificity of the classification criteria and histopathology findings for Sjögren's syndrome... 46
(a) Classification criteria 46
(b) Focus score ≥ 1 46
(c) Focal lymphocytic sialadenitis 46
Figure 1. Histopathologic findings in minor salivary gland biopsy 15
Figure 2. Causes of dryness in study participants and systemic connective tissue disease in patients with secondary Sjögren's syndrome 21
Figure 3. Clinical manifestation at the time of salivary gland biopsy and during follow-up 21
Figure 4. The proportion of patients according to the extent of lymphocyte infiltration, atrophy, fibrosis, and duct dilatation 22
Figure 5. Differences between Sjögren's syndrome patients and patients with dryness due to other causes 27
Figure 6. Differences between anti-SS-A/Ro positive and negative SS patients 34
Figure 7. Flowchart displaying a correlation between classification criteria for Sjögren's syndrome and diagnosis by a physician 45