Salivary amylase values in serum (amylase-s) were evaluated before and after sialography in 19 patients with Sjögren's syndrome (SjS) and were compared to those in 10 patients without SjS. Non-SjS patients consisted of systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), ulcerative colitis and chronic pyelonephritis.
Amylase-s in non-SjS patients increased 3 to 6 hours after injection of Conray-400. The amount of that increase was 40±16 SR/dl which was approximately 93% increase from the pre-injection levels of 43±15 SR/dl. In base of maximum elevation of amylase-s after injection of Conray-400, SjS was divided into 3 types: an increase of more than 56 SR/dl (high response type: H type), the same increase of 40±16 SR/dl as in non-SjS patients (control type: C type) and an increase of less than 24 SR/dl (low response type: L type).
Most patients with H type of SjS showed diffusely punctate sialectasis in a sialogram, very mild sialadenitis in histopathology and negative keratoconjunctivitis sicca (KCS). Conversely most with L type of SjS showed verious changes in sialogram from normal feature to diffuse sialectasis and recognized severe sialadenitis histopathologically and positive KCS. These findings suggest that SjS with L type is more advanced and SjS with H type is milder in severity.
Some SjS patients with L type and normal feature or locally punctate sialectasis in sialogram demonstrated histopathologically severe sialadenitis in sublingual glands, so that biopsy of sublingual glands is essential in SjS with L type even if they appeared normal feature on sialogram.
Most patients with SjS alone or both SiS and SLE were severely invaded in their salivary glands, comparing with those of the patients overlapped with SjS and chronic thyroiditis, with or without progressive systemic sclerosis.
