[Neuro-psychiatric symptom associated with primary Sjögren's syndrome]

Abstract

Neuro-psychiatric complications of primary Sjögren's syndrome (SjS) were studied on their frequency and characteristics of clinical signs in 150 patients of our clinic. Clinical symptoms and laboratory examinations were compared in the patients group complicated with neuro-psychiatric symptoms and the non-complicated group. Neuro-psychiatric symptoms (neuro SjS) were complicated with 63 patients (42.0%). Central nervous system (CNS) involvement were occurred in 47 patients (31.3%). In this group (CNS SjS), psychiatric complications were observed in 43 patients (28.7%), consisted with 29 cases of neurosis, 7 cases of depression, 6 cases of presenile dementia, and others. Nine patients (6.0%) in this group had neurologic involvement that were 3 cases of aseptic meningitis, 3 cases of neurogenic bladder, and each case of multiple infarction, multiple sclerosis, and others. These 9 patients showed more frequently positive results for rheumatoid factor, anti-SSA antibody, leucopenia, and lymphopenia, so this subgroup might be consisted of a small group which was resemble to systemic lupus erythematosus. Cranial nerve involvement, mainly injured in trigeminal nerve, and peripheral nerve involvement were complicated with 5 patients (3.3%) and 24 patients (16.0%), respectively. In neuro-psychiatric complicated group, mean age was older and dry mouth were more frequent (p less than 0.05) than non-complicated group. In psychiatric complicated group, mean age was older (p less than 0.01) and dry mouth were more frequent (p less than 0.05). In any groups of neuro-psychiatric complications, the frequency of any autoantibodies was not statistically different from non-complicated group. But, in the group of cranial nerve involvement, anti-RNP antibody was 60.0% positive (in non-complicated group, 17.2%: p less than 0.05). In CNS SjS group, magnetic resonance imaging (MRI) abnormalities were occurred in 8 of 13 patients. High intensity lesions in white matter on the T2-weighted examinations was characteristic, which showed lacnar infarctions or demyelinated lesions in MRI abnormalities. In CNS SjS, corticosteroid or immunosuppressant was not always necessary, because this complication was self-limited or enough controlled by minor-tranquilizer or anti-depressant. The character of onset in neuro SjS was chronic and neuro SjS was insidiously developing disease. And more studies including treatment on neuro SjS were needed.