Abstract
ObjectivePatients with autoimmune diseases often present with olfactory impairment. The aim of the study was to assess the olfactory functions of patients with primary Sjögren’s syndrome and to correlate these findings with their disease activity.MethodsFifty-two patients with primary SS and 52 sex- and age-matched healthy control subjects were included. All of them underwent clinical and laboratory examination. Olfactory functions were evaluated using olfactory function assessment by computerized testing including the three stages of smell: threshold, identification, and memory of the different odors.ResultsAll the olfactory scores (olfactory threshold, identification, and memory) in patients with pSS were significantly decreased than the control group (all P < 0.01). Patients had higher proportion of anosmia (13.5% vs 0%) and hyposmia (19.2% vs 11.5%) than controls (χ2 = 10.526, P < 0.01). Multivariable regression analysis revealed that ESSDAI and the symptoms of dryness, fatigue, and limb pain had negative influence on olfactory function (adjusted R2 = 0.381, 0.387, 0.513, and 0.614, respectively). ESSPRI showed significantly negative association with olfactory threshold, identification, memory, and total scores. Olfactory identification and memory scores were decreased in pSS patients with thyroid dysfunction or hypocomplementemia (P < 0.05). Smell threshold scores were decreased in pSS patients with anti-SSA antibody or anti-nuclear antibody compared with those without those autoantibodies (P < 0.01).ConclusionOur findings indicate that olfactory functions are impaired in pSS patients. There was a close correlation between olfactory dysfunction and disease severity and immunological abnormalities. Immune and systemic inflammation dysregulation might play a role in the mechanism of this defect.
Highlights
Sjögren’s syndrome (SS) is a chronic autoimmune disorder marked by lymphocytic infiltration of exocrine glands, mainly salivary and lacrimal, causing xerostomia and keratoconjunctivitis sicca [1]
Influence of treatment on olfactory function Comparing the smell test results of the pSS patients treated with different therapies, we found patients under therapy with glucocorticoid showed a tendency for reduced THR scores compared with the patients not taking glucocorticoid (P = 0.063) (Supplementary Fig. 2a)
In this study, we present the first investigation that combined a detailed testing of the olfactory threshold, identification, and memory with a comprehensive rheumatological assessment of disease activity in a cohort of 52 pSS patients
Summary
Sjögren’s syndrome (SS) is a chronic autoimmune disorder marked by lymphocytic infiltration of exocrine glands, mainly salivary and lacrimal, causing xerostomia and keratoconjunctivitis sicca [1]. Recent evidences suggest that autoimmune diseases predispose to an absence of smell function and diminished smell sensitivity. This has been demonstrated in the patients with systemic lupus erythematosus [3], rheumatoid arthritis, and systemic sclerosis [4, 5]. One group reported that smell discrimination test was abnormal in 2 (2.6%) and 1 (1.3%) in pSS patients and controls, but the difference was statistically insignificant [10]. Another group interviewed 36 patients with pSS and demonstrated no differences in smell threshold between patients and controls [11] Some of these studies used the same method to assess olfactory function in patients but have yielded contradictory results. Further complete and precise investigations about olfaction in pSS patients are needed
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