Clinical and immunological profile of primary Sjogren's syndrome in Kuwait: First report from Middle East

Aim: To describe the clinical and serological findings in primary Sjogren's syndrome (SS) patients seen in a teaching hospital in Kuwait. Methods: Using the European and San Diego criteria for the diagnosis of SS, we studied 10 consecutive (nine female and one male) SS patients seen in our rheumatology clinic. All these patients fulfilled four or more of the diagnostic criteria for SS proposed by the European Community Study Group in 1993 as well as the more stringent San Diego criteria. Results: The mean age of the patients at presentation was 32.9 years (SE 4.4 years), ranging from 15 to 56 years. The mean disease duration was 3.5 years (SE 1.4 years). The most frequently observed clinical manifestations were: xerostomia (80%); xerophthalmia (70%); and parotidomegaly (30%). The main extraglandular manifestation was arthritis (50%). The Schirmer test was positive in 90% and the rose Bengal test in 90%. The immunologic study showed antinuclear antibodies in 80% of patients, rheumatoid factor in 90%, anti-Ro/SS-A in 90% and anti-La/SS-B in 90%. Lip biopsy could be done in only six patients and showed characteristic focal lymphocytic infiltration of minor salivary glands in 67%. There was no statistically significant difference in the occurrence of parotidomegaly or arthritis in patients with disease onset before or after the age of 40 years. Likewise, there was no difference in the positivity of ANA, RF, ant-Ro/SS-A or anti-La/SS-B in the two age groups. Conclusions: Although primary SS is typically said to be a disease of middle-aged women, this does not seem to be the case in Kuwait, where 60% had disease onset below the age of 40 years. We could not find any notable differences in clinical and immunological characteristics between patients with primary SS from Kuwait and those reported from elsewhere, except for higher rates of serological abnormalities (RF, anti-Ro/SS-A, anti-La-SS-B), probably due to genetic differences and the use of the strict San Diego criteria.