Prevalence and characteristics of Sjogren's syndrome or sicca syndrome in chronic hepatitis C virus infection: A prospective study

Objective. To describe the prevalence and clinical and laboratory character istics of sicca syndrome and Sjogren's syndrome (SS) in chronic hepatitis C virus HCV) infection. Methods. Forty-five consecutive HCV infected patients referred for liver bi opsy were enrolled in a prospective study. Subjective and objective criteri a of xerophthalmia or xerostomia were systematically investigated and the p atients classified according to 3 sets of criteria (European, Manthorpe, an d Fox criteria) for the diagnosis of SS. Results. Sicca syndrome was present in 28 (62%) patients; all had oral dryn ess and 14 had both oral and ocular dryness. Twenty-four (53%) patients had SS by the European criteria, 25 (56%) by Manthorpe criteria, and 4 (8%) by Fox criteria. Salivary gland biopsy was positive for SS (grade M or IV by Chishom classification) in 21 samples (47%); 9 samples (21%) were classifie d grade 0, and 15 (32%) grade I or II. No patient had anti-SSA or anti-SSB antibodies. The presence of SS or sicca syndrome was associated with older age and liver disease activity according to the METAVIR scoring system, but not with the presence of other extrahepatic manifestations or with HCV gen otype. A high METAVIR activity score was only statistically associated with primary SS. Conclusion. HCV infection appears to account for a subgroup of patients wit h sicca syndrome in which half the cases meet the definition for SS accordi ng to European and Manthorpe criteria. This subgroup is characterized by th e constant finding of xerostomia, the absence of classical systemic manifes tations observed in primary SS, and the absence of anti-SSA or anti-SSB ant ibodies. Such characteristics delineate a distinctive, virus associated ent ity that differs from primary SS.