The Salivary Glands and Their Secretions in Connective Tissue Disease

Chisholm, Derrick MacKenzie (1970) The Salivary Glands and Their Secretions in Connective Tissue Disease. PhD thesis, University of Glasgow.

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Salivary gland function in patients with various connective tissue diseases has been studied by a number of investigative techniques. The normal values for parotid salivary flow have been defined with respect to age and sex distribution. Patients with Sjogren's syndrome have been shown to have remarkably low parotid salivary flow rates. In a proportion of patients with rheumatoid arthritis alone, parotid flow rates are shown to be low, suggesting that a sub-clinical salivary gland lesion exists in such patients. Patients with osteoarthritis, ankylosing spondylitis, psoriatic arthritis, Reiter's disease and various other arthritides and connective tissue disorders had parotid flow rate values within the normal range. The value of hydrostatic sialography as a diagnostic aid was demonstrated though the technique was shown to lack the sensitivity of flow rate studies to detect early changes in salivary gland function. 99m Scintiscanning of the salivary glands using 99m Tc pertechnetate has been quantitatively assessed for the first time. Normal values have been defined and a markedly reduced isotope uptake by the salivary glands in patients with Sjogren's syndrome has been demonstrated. A labial salivary gland biopsy technique together with a grading standard for degrees of lymphocytic infiltration are described. Conceptual support for the method is provided by a post-mortem study in which focal lymphocytic submandibular adenitis correlated with lymphocytic infiltration of the labial salivary glands for each subject in the series. Focal lymphocytic labial sialadenitis was not observed in any of the subjects in the post-mortem series. The majority of patients with Sjogren's syndrome and 20% of patients with rheumatoid arthritis alone were shown to have focal lymphocytic labial adenitis. The use of an indirect immunofluorescent antibody technique to detect a salivary duct autoantibody is described. The autoantibody is shown to be associated not only with patients with Sjogren's syndrome complicated by rheumatoid arthritis but also with 30% of patients with rheumatoid arthritis alone. The presence of the antibody did not correlate with degrees of histopathologic changes as detected by the labial biopsy. The concentration of iodide by the labial salivary glands in normal subjects is reported for the first time, and normal values are defined. Though patients with various connective tissue disorders had slight impairment of the iodide-trapping mechanism, the values reported were within the normal range. In a small group of patients, there was no correlation between labial gland/plasma 131I ratios and labial gland histopathology. The association of Sjogren's syndrome and systemic lupus erythematosus was demonstrated by reduced parotid flow rates, sialectasis and focal lymphocytic labial sialadenitis. The use of the technique of separating parotid salivary proteins using iso-electric focussing on polyacrylamide gels is reported for the first time for saliva from patients with Sjogren's syndrome, rheumatoid arthritis alone, osteoarthritis and other arthritides. Distinct protein band patterns were demonstrated in association with the rheumatoid process. Though the changes were difficult to determine, it is suggested that further work to isolate the protein fractions would yield further valuable information concerning the nature of the salivary gland defect which this test demonstrates. Though a search for mycoplasma in the salivary secretions and labial gland tissue proved fruitless, the possibility of an infective aetiology in the pathogenesis of Sjogren's syndrome could not be discarded. It is suggested that further work utilizing electronmicroscopy and routine serological tests for mycoplasmal antibodies could provide additional useful information. Salivary gland function is studied in patients with symptomatic xerostomia and the allied disorders of Mikulicz's disease and syndrome. Patients with symptomatic xerostomia are. distinguished from those with Sjogren's syndrome by virtue of higher salivary flow rates and the lack of sialographic, serologic or histopathologic change. Patients with Mikulicz's disease are shown to have salivary gland involvement similar to those patients with the sicca syndrome rather than those with Sjogren's syndrome complicated by rheumatoid arthritis. The response to corticosteroid therapy in a patient with Mikulicz's syndrome due to sarcoidosis is shown using parotid flow rate and biochemical methods. It is concluded that in the investigations of salivary gland function in patients with connective tissue disease, stimulated parotid salivary flow rates provide the most sensitive index. In addition where such facilities exist, hydrostatic sialography and quantitative scintiscanning are considered most useful methods of detecting salivary gland abnormalities in Sjogren's syndrome. The labial biopsy not only provides information concerning the degree and nature of the salivary gland defect in Sjogren's syndrome but also provides tissue for a number of laboratory research investigations.

Item Type: Thesis (PhD)
Qualification Level: Doctoral
Keywords: Medicine, Pathology
Date of Award: 1970
Depositing User: Enlighten Team
Unique ID: glathesis:1970-78545
Copyright: Copyright of this thesis is held by the author.
Date Deposited: 30 Jan 2020 15:11
Last Modified: 30 Jan 2020 15:11

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