Hematological Involvement in Sjogren's Syndrome and The Relationship of Involvement with Salivary Gland Biopsy

Abstract
Aim: Sjögren's syndrome (SS) is a chronic, multisystem autoimmune disease characterized by inflammation of the glandular tissues. SS can manifest with various extraglandular involvements, including hematologic complications. The aim of our study is to evaluate the relationship between hematologic and pathological data, specifically focusing on the Focus Score (FS) and the Mason Chisholm Score (MS), in SS patients.
Patients and Methods: The study included 101 patients with Sjögren's syndrome (SS) and 91 individuals in the control group. All SS patients were newly diagnosed according to the 2016 ACR/EULAR criteria. Patients with comorbidities that could lead to hematological disorders were excluded from the study.
Results: The neutrophil, monocyte, and platelet values were found to be statistically significantly lower (p=0.000, p=0.002, p=0.016), while lymphocyte and hemoglobin values, although lower in the SS group compared to the control group, did not reach statistical significance (p=0.053, p=0.685). Correlation analysis revealed a negative correlation between both the FS and MS scores and neutrophil (r=-0.329, p<0.01), lymphocyte (r=-0.264, p<0.01), monocyte (r=-0.306, p<0.01), and platelet (r=-0.220, p<0.01) values.
Conclusion: SS can potentially induce cytopenias in the hemogram, with neutropenia, anemia, and thrombocytopenia displaying a negative correlation with FS and MS. Consequently, in patients with elevated FS and MS scores at the time of diagnosis, it is crucial to exercise caution regarding hematological involvement. Even if patients meet the SS diagnostic criteria, a minor salivary gland biopsy should be considered.
Keywords: Sjögren syndrome, minor salivary gland biopsy, focus score, cytopenia