Prevalence of primary Sjögren's syndrome in an elderly population

Sixty-two elderly apparently healthy volunteers, inmates of a public nursing home, were examined for evidence of primary Sjögren's syndrome (pSS). Evaluation included a specific questionnaire for subjective xerophthalmia and xerostomia, slit-lamp eye examination after rose Bengal staining. Schirmer's I test, stimulated parotid flow measurement, testing of sera for autoantibodies and labial minor salivary gland biopsy. A greater than or equal to 2+ lip biopsy score on Tarpley's scale was a sine qua non for the diagnosis of Sjögren's syndrome. Labial salivary gland (LSG) biopsy revealed fibrosis and/or fatty infiltration in the majority of the individuals, related to ageing. However, four people had a lip biopsy score of greater than or equal to 2+, which, supplemented by other objective criteria, classified three of them as having pSS. Another four had an LSG biopsy score of 1+, and although they fulfilled other objective criteria, they could not be characterized as pSS. All these individuals were completely asymptomatic, and none of them had anti-Ro(SSA) or anti-La(SSB) autoantibodies. The present study suggests that pSS in elderly people in elderly people is subclinical, benign and relatively common.