An association of fibromyalgia with primary Sjogren's syndrome: A prospective study of 72 patients

Objective. Fibromyalgia patients often describe the presence of dry-eyes and dry mouth. Conversely there is an increasing recognition that many patients with Sjogren's syndrome (SS) have fibromyalgia (FM). We decided to investigate this association. Methods. Seventy-two patients with FM were screened with a Schirmer's test. All patients with an abnormal test had a minor salivary gland biopsy. Results. Thirty-eight percent (n = 28) had a Schimer's test of < 15 mm wetting at 5 minutes, however sicca symptoms were noted in only 19% of patients. Salivary gland biopsy in these 28 patients showed a focus score of ≥ 1 in 5; a positive antinuclear antibody test (ANA) was found in 4, a positive rheumatoid factor in 3 and anti-SSA SSB antibodies in 2. Another 8 patients had abnormal salivary gland lymphocytic foci, but there were <50 cells or the density was <1 focus/4 mm²; all 8 of these patients had a positive ANA. None of these patients have developed systemic features of SS over a 6 year period of follow up. Conclusion. There is a subgroup of patients presenting with FM who, on further testing, have findings consistent with primary SS. The prevalence of this association was 6.9% for probable SS and 11% for possible SS. These figures are probably an overestimation due to tertiary center referral bias. The etiologic and management implications of these observations are unclear.