Sjogren's syndromeThe Role of Ectopic Germinal Centers in the Immunopathology of Primary Sjögren's Syndrome: A Systematic Review
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Systematic Review
A systematic search was executed in PubMed (September 2011) for terms and synonyms of “Sjögren's syndrome” and “germinal centers” (Fig. 1). This resulted in 80 articles containing both terms, which were screened on title and abstract for relevance, the availability of a full-text article, and language. Reviews, animal studies, and case reports were not included. Results had to be clarified for pSS. Reference lists of the final 16 studies were screened for missing articles, but this did not lead
Germinal Centers in Primary Sjögren's Syndrome
The literature search resulted in 16 articles reporting on ectopic germinal center formation in patients with pSS (Table 1). One article (15) was later excluded from meta-analysis because patient selection was unclear. It seemed that in this study the patients lacking germinal centers were selected on a high focus score, making the comparison not representative. Results from the recent large study from the Sjögren's International Collaborative Clinical Alliance were not included, because their
Discussion
In this systematic review (using meta-analyses) we show that ectopic GC formation in the exocrine glands, which occurs in one-quarter of patients with pSS, is associated with more severe disease. Although GC assessment was performed in only a limited number of studies and patients, decreasing the generalizability of the outcomes, the results indicate that patients with GCs in salivary gland specimens have a higher lymphocytic focus score, a higher prevalence of autoantibodies, and an increased
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Cited by (0)
The Dutch Arthritis Association supports the work of JAG van Roon, JWJ Bijlsma, and AA Kruize.
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These authors contributed equally to this article.