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The Neurological Manifestations of Sjögren’s Syndrome: Diagnosis and Treatment

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Sjögren’s Syndrome
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Abstract

This chapter addresses the following:

  1. (a)

    clinical neurological presentation,

  2. (b)

    laboratory investigation, and

  3. (c)

    treatment of peripheral and central nervous system diseases associated with Sjögren’s syndrome.

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Abbreviations

SS:

Sjögren’s syndrome

PNS:

Peripheral nervous system

CNS:

Central nervous system

ACL:

Anti-cardiolipin

APLS:

Anti-phospholipid antibodies syndrome

FMS:

Fibromyalgia syndrome

MGUS:

Monoclonal gammopathy of unknown significance

CIDP:

Chronic inflammatory demyelinating polyneuropathy

PML:

Progressive multifocal leukoencephalopathy

NMO:

Neuromyelitis optica (Devic’s syndrome)

References

  1. Delalande S, de Seze J, Fauchais AL, Hachulla E, Stojkovic T, Ferriby D, et al. Neurologic manifestations in primary Sjogren syndrome: a study of 82 patients. Medicine (Baltimore) 2004;83(5):280–91.

    Article  Google Scholar 

  2. Goldenberg D. Fibromyalgia, chronic fatigue syndrome, and myofascial pain syndrome. Curr Opin Rheumatol. 1995;7(2):127.

    Article  PubMed  CAS  Google Scholar 

  3. Hanson P, Schumacker P, Clerin M. Evaluation of somatic and autonomic small fibers neuropathy in diabetes. Am J Phys Med Rehabil. 1992;71(1):44.

    Article  PubMed  CAS  Google Scholar 

  4. Rodriquez A, Kanis L, Lane D. Somatosensory evoked potentials from dermatomal stimulation as an indicator of L5 and S1 radiculopathy. Arch Phys Med Rehabil. 1987;68(6):366.

    PubMed  CAS  Google Scholar 

  5. Elert J, Rantapää-Dahlqvist S, Henriksson-Larsen K, Lorentzon R, Gerdle B. Muscle performance, electromyography and fibre type composition in fibromyalgia and work-related myalgia. Scand J Rheumatol. 1992;21(1):28–34.

    Article  PubMed  CAS  Google Scholar 

  6. Bergdahl M, Bergdahl J, Johansson I. Depressive symptoms in individuals with idiopathic subjective dry mouth. J Oral Pathol Med. 1997;26(10):448–50.

    Article  PubMed  CAS  Google Scholar 

  7. Bronge L, Wahlund L, Brauner A, Basun H, Garlind A. White matter lesions and soluble interleukin-1 receptor type II in CSF from demented and non-demented subjects. Neurochem Int. 2002;41(4):217–22.

    Article  PubMed  CAS  Google Scholar 

  8. Coates T, Slavotinek J, Rischmueller M, Schultz D, Anderson C, Dellamelva M, et al. Cerebral white matter lesions in primary Sjögren’s syndrome: a controlled study. J Rheumatol. 1999;26(6):1301.

    PubMed  CAS  Google Scholar 

  9. Pierot L, Sauve C, Leger J, Martin N, Koeger A, Wechsler B, et al. Asymptomatic cerebral involvement in Sjögren’s syndrome: MRI findings of 15 cases. Neuroradiology 1993;35(5):378–80.

    Article  PubMed  CAS  Google Scholar 

  10. Ramos-Casals M, Tzioufas A, Font J. Primary Sjogren’s syndrome: new clinical and therapeutic concepts. Br Med J. 2005;64(3):347.

    CAS  Google Scholar 

  11. Birnbaum J, Kirr D. Frequency of neurologic disease in Sjogren syndrome patients versus controls. Arth Rheum. 2009;60:506.

    Article  Google Scholar 

  12. Birnbaum J, Petri M, Thompson R, Izbudak I, Kerr D. Distinct subtypes of myelitis in systemic lupus erythematosus. Arthritis Care Res. 2009;60(11):3378–87.

    Article  CAS  Google Scholar 

  13. Harboe E, Beyer M, Greve O, G¯ransson L, Tjensvoll A, Kval¯y J, et al. Cerebral white matter hyperintensities are not increased in patients with primary Sjögren’s syndrome. Eur J Neurol. 2009;16(5):576–81.

    Article  PubMed  CAS  Google Scholar 

  14. Harboe E, Tjensvoll A, Maroni S, Goransson L, Greve O, Beyer M, et al. Neuropsychiatric syndromes in patients with systemic lupus erythematosus and primary Sjogren syndrome: a comparative population-based study. Br Med J. 2009;68(10):1541.

    CAS  Google Scholar 

  15. McDonald W, Compston A, Edan G, Goodkin D, Hartung H, Lublin F, et al. Recommended diagnostic criteria for multiple sclerosis: guidelines from the International Panel on the diagnosis of multiple sclerosis. Ann Neurol. 2001;50(1):121–7.

    Article  PubMed  CAS  Google Scholar 

  16. Filippi M, Bozzali M, Rovaris M, Gonen O, Kesavadas C, Ghezzi A, et al. Evidence for widespread axonal damage at the earliest clinical stage of multiple sclerosis. Brain 2003;126(2):433.

    Article  PubMed  CAS  Google Scholar 

  17. Vaudo G, Bocci E, Shoenfeld Y, Schillaci G, Wu R, Del Papa N, et al. Precocious intima–media thickening in patients with primary Sjögren’s syndrome. Arthritis Care Res. 52(12):3890–7.

    Google Scholar 

  18. Shoenfeld Y, Gerli R, Doria A, Matsuura E, Cerinic M, Ronda N, et al. Accelerated atherosclerosis in autoimmune rheumatic diseases. Circulation 2005;112(21):3337.

    Article  PubMed  Google Scholar 

  19. Fox RI. Sjogren’s syndrome. Lancet 2005;366(9482):321–31.

    Article  PubMed  CAS  Google Scholar 

  20. Sanna G, Bertolaccini M, Cuadrado M, Laing H, Khamashta M, Mathieu A, et al. Neuropsychiatric manifestations in systemic lupus erythematosus: prevalence and association with antiphospholipid antibodies. J Rheumatol. 2003;30(5):985–92.

    PubMed  Google Scholar 

  21. Gemignani F, Marbini A, Pavesi G, Di Vittorio S, Manganelli P, Cenacchi G, et al. Peripheral neuropathy associated with primary Sjogren’s syndrome. J Neurol Neurosurg Psychiatry. 1994;57(8):983–6.

    Article  PubMed  CAS  Google Scholar 

  22. Mori K, Iijima M, Koike H, Hattori N, Tanaka F, Watanabe H, et al. The wide spectrum of clinical manifestations in Sjogren’s syndrome-associated neuropathy. Brain 2005;128(11):2518–34.

    Article  PubMed  Google Scholar 

  23. Sghirlanzoni A, Pareyson D, Lauria G. Sensory neuron diseases. Lancet Neurol. 2005;4(6):349–61.

    Article  PubMed  CAS  Google Scholar 

  24. Lafitte C, Amoura Z, Cacoub P, Pradat-Diehl P, Picq C, Salachas F, et al. Neurological complications of primary Sjögren’s syndrome. J Neurol. 2001;248(7):577–84.

    Article  PubMed  CAS  Google Scholar 

  25. Alexander EL, Provost TT, Stevens MB, Alexander GE. Neurologic complications of primary Sjogren’s syndrome. Medicine 1982;61(4):247.

    Article  PubMed  CAS  Google Scholar 

  26. Govoni M, Bajocchi G, Rizzo N, Tola MR, Caniatti L, Tugnoli V, et al. Neurological involvement in primary Sjögren’s syndrome: clinical and instrumental evaluation in a cohort of Italian patients. Clin Rheumatol. 1999;18(4):299–303.

    Article  PubMed  CAS  Google Scholar 

  27. Chai J, Herrmann DN, Stanton M, Barbano RL, Logigian EL. Painful small-fiber neuropathy in Sjogren syndrome. Neurology 2005;65(6):925–7.

    Article  PubMed  CAS  Google Scholar 

  28. Moore PM, Lisak RP. Systemic lupus erythematosus: immunopathogenesis of neurologic dysfunction. In: Springer; 1995. pp. 43–60.

    Google Scholar 

  29. Moore PM. Central nervous system vasculitis. Curr Opin Neurol. 1998;11(3):241.

    PubMed  CAS  Google Scholar 

  30. McCombe PA. Neurological complications of connective tissue diseases and vasculitis. Autoimmune Neurol Dis. 1995:345.

    Google Scholar 

  31. Goransson L, Brun J, Harboe E, Mellgren S, Omdal R. Intraepidermal nerve fiber densities in chronic inflammatory autoimmune diseases. Arch Neurol. 2006;63(10):1410.

    Article  PubMed  Google Scholar 

  32. Goransson L, Herigstad A, Tjensvoll A, Harboe E, Mellgren S, Omdal R. Peripheral neuropathy in primary Sjogren syndrome: a population-based study. Arch Neurol. 2006;63(11):1612.

    Article  PubMed  Google Scholar 

  33. Grant I, Hunder G, Homburger H, Dyck P. Peripheral neuropathy associated with sicca complex. Neurology 1997;48(4):855.

    PubMed  CAS  Google Scholar 

  34. Mori K, Iijima M, Sugiura M, Koike H, Hattori N, Ito H, et al. Sjogren’s syndrome associated painful sensory neuropathy without sensory ataxia. Br Med J. 2003;74(9):1320.

    CAS  Google Scholar 

  35. Griffin J, Cornblath D, Alexander E, Campbell J, Low P, Bird S, et al. Ataxic sensory neuropathy and dorsal root ganglionitis associated with Sjogren’s syndrome. Ann Neurol. 1990;27:304–15.

    Google Scholar 

  36. Malinow K, Yannakakis G, Glusman S, Edlow D, Griffin J, Pestronk A, et al. Subacute sensory neuronopathy secondary to dorsal root ganglionitis in primary Sjögren’s syndrome. Ann Neurol. 1986;20(4):535–7.

    Article  PubMed  CAS  Google Scholar 

  37. Mellgren S, Conn D, Stevens J, Dyck P. Peripheral neuropathy in primary Sjogren’s syndrome. Neurology 1989;39(3):390.

    PubMed  CAS  Google Scholar 

  38. Mellgren S, Göransson L, Omdal R. Primary Sjögren’s syndrome associated neuropathy. Can J Neurol Sci. 2007;34(3):280–7.

    PubMed  Google Scholar 

  39. Terrier B, Lacroix C, Guillevin L, Hatron P, Dhote R, Maillot F, et al. Diagnostic and prognostic relevance of neuromuscular biopsy in primary Sjögren’s syndrome-related neuropathy. Arthritis Rheum. 2007;57(8).

    Google Scholar 

  40. Engel A, Hohlfeld R, Banker B. The polymyositis and dermatomyositis syndromes. Myology 1994;2:1335–83.

    Google Scholar 

  41. Lindvall B, Bengtsson A, Ernerudh J, Eriksson P. Subclinical myositis is common in primary Sjogren’s syndrome and is not related to muscle pain. J Rheumatol. 2002;29(4):717–25.

    PubMed  Google Scholar 

  42. Chahin N, Engel AG. Correlation of muscle biopsy, clinical course, and outcome in PM and sporadic IBM. Neurology 2008;70(6):418–24.

    Article  PubMed  Google Scholar 

  43. Kissel J, Mendell J. Vasculitic neuropathy. Neurol Clin. 1992;10:761–6.

    PubMed  CAS  Google Scholar 

  44. Stevens MJ, Feldman EL, Thomas TP, Greene DA. The pathogenesis of diabetic neuropathy. Clin Manag Diabetic Neuropathy 1998;9:13–21.

    Google Scholar 

  45. Hu S, Wang J, Meijer J, Ieong S, Xie Y, Yu T, et al. Salivary proteomic and genomic biomarkers for primary Sjogren’s syndrome. Arthritis Rheum. 2007;56(11):3588–600.

    Article  PubMed  CAS  Google Scholar 

  46. Taylor PV, Taylor KF, Norman A, Griffiths S, Scott JS. Prevalence of maternal Ro (SS-A) and La (SS-B) autoantibodies in relation to congenital heart block. Rheumatology 1988;27(2):128.

    Article  CAS  Google Scholar 

  47. Buyon JP, Ben-Chetrit E, Karp S, Roubey RA, Pompeo L, Reeves WH, et al. Acquired congenital heart block. Pattern of maternal antibody response to biochemically defined antigens of the SSA/Ro-SSB/La system in neonatal lupus. J Clin Invest. 1989;84(2):627.

    Article  PubMed  CAS  Google Scholar 

  48. Waltuck J, Buyon JP. Autoantibody-associated congenital heart block: outcome in mothers and children. Ann Intern Med. 1994;120(7):544.

    PubMed  CAS  Google Scholar 

  49. Logothetis J, Kennedy WR, Ellington A, Williams RC. Cryoglobulinemic neuropathy: incidence and clinical characteristics. Arch Neurol. 1968;19(4):389–97.

    PubMed  CAS  Google Scholar 

  50. Hughes RAC. Inflammatory and immune mediated sensory neuropathies. Sens Neuropathies. 1995;7:151–9.

    Google Scholar 

  51. Griffin JW, Cornblath DR. Ataxic neuropathies. Sens Neuropathies. 1995:105–25.

    Google Scholar 

  52. Donfrid M, Apostolski S, Suvajdzic N, Jankovic G, Cemerikic-Martinovic V, Atkinson HDE, et al. Monocytoid B cell lymphoma associated with antibodies to myelin-associated glycoprotein and sulphated glucuronyl paragloboside. Acta Haematol. 2000;106(3):130–32.

    Article  Google Scholar 

  53. Voltz R. Paraneoplastic neurological syndromes: an update on diagnosis, pathogenesis, and therapy. Lancet Neurol. 2002;1(5):294–305.

    Article  PubMed  Google Scholar 

  54. Bacman S, Sterin-Borda L, Camusso JJ, Arana R, Hubscher O, Borda E. Circulating antibodies against rat parotid gland M3 muscarinic receptors in primary Sjogren’s syndrome. Clin Exp Immunol. 1996;104(3):454–9.

    Article  PubMed  CAS  Google Scholar 

  55. Watanabe T, Tsuchida T, Kanda N, Mori K, Hayashi Y, Tamaki K. Anti-{alpha}-fodrin antibodies in Sjogren syndrome and lupus erythematosus. Arch Dermatol. 1999;135(5):535.

    Article  PubMed  CAS  Google Scholar 

  56. Kastrup O, Maschke M, Diener H. Pulse cyclophosphamide in the treatment of ataxic sensory and cranial nerve neuropathy associated with Sjogren’s syndrome. Clin Neurol Neurosurg. 2005;107(5):440–1.

    Article  PubMed  CAS  Google Scholar 

  57. Mori K, Iijima M, Koike H, Hattori N, Tanaka F, Watanabe H, et al. The wide spectrum of clinical manifestations in Sjogren’s syndrome-associated neuropathy. Brain 2005;128(11):2518.

    Article  PubMed  Google Scholar 

  58. Delalande S, De Seze J, Fauchais A, Hachulla E, Stojkovic T, Ferriby D, et al. Neurologic manifestations in primary Sjögren syndrome. Medicine 2004;83(5):280–91.

    Article  PubMed  Google Scholar 

  59. Andonopoulos AP, Lagos G, Drosos AA, Moutsopoulos HM. The spectrum of neurological involvement in Sjogren’s syndrome. Rheumatology 1990;29(1):21–4.

    Article  CAS  Google Scholar 

  60. Font J, Valls J, Cervera R, Pou A, Ingelmo M, Graus F. Pure sensory neuropathy in patients with primary Sjogren’s syndrome: clinical, immunological, and electromyographic findings. Br Med J. 1990;49(10):775.

    CAS  Google Scholar 

  61. Mori A, Shimazaki J, Shimmura S, Fujishima H, Oguchi Y, Tsubota K. Disposable eyelid-warming device for the treatment of meibomian gland dysfunction. Jpn J Ophthalmol. 2003;47(6):578–86.

    Article  PubMed  Google Scholar 

  62. Mori K, Koike H, Misu K, Hattori N, Ichimura M, Sobue G. Spinal cord magnetic resonance imaging demonstrates sensory neuronal involvement and clinical severity in neuronopathy associated with Sjogren’s syndrome. Br Med J. 2001;71(4):488.

    CAS  Google Scholar 

  63. Kachi T, Sobue G, Yamamoto M, Igata A. Sensory conduction study in chronic sensory ataxic neuropathy. Br Med J. 1994;57(8):941.

    CAS  Google Scholar 

  64. Sakakibara R, Hirano S, Asahina M, Sawai S, Nemoto Y, Hiraga A, et al. Primary Sjogren’s syndrome presenting with generalized autonomic failure. Eur J Neurol. 2004;11(9):635–8.

    Article  PubMed  CAS  Google Scholar 

  65. Kovacs L, Paprika D, Takacs R, Kardos A, Varkonyi TT, Lengyel C, et al. Cardiovascular autonomic dysfunction in primary Sjogren’s syndrome. Rheumatology 2004;43(1):95–9.

    Article  PubMed  Google Scholar 

  66. Straub R, Baerwald C, Wahle M, Jä nig W. Autonomic dysfunction in rheumatic diseases. Rheum Dis Clin N Am. 2005;31(1):61–75.

    Article  Google Scholar 

  67. Kumazawa K, Sobue G, Yamamoto K, Mitsuma T. Segmental anhidrosis in the spinal dermatomes in Sjögren’s syndrome-associated neuropathy. Neurology 1993;43(9):1820.

    PubMed  CAS  Google Scholar 

  68. Mandl T, Bornmyr S, Castenfors J, Jacobsson L, Manthorpe R, Wollmer P. Sympathetic dysfunction in patients with primary Sjögren’s syndrome. J Rheumatol. 2001;28(2):296–301.

    PubMed  CAS  Google Scholar 

  69. Mandl T, Granberg V, Apelqvist J, Wollmer P, Manthorpe R, Jacobsson L. Autonomic nervous symptoms in primary Sjogren’s syndrome. Rheumatology 2008;47:914.

    Google Scholar 

  70. Wright R, Grant I, Low P. Autonomic neuropathy associated with sicca complex. J Auton Nerv Syst. 1999;75(1):70–6.

    Article  PubMed  CAS  Google Scholar 

  71. Sobue G. Pathophysiology of sensory ataxic neuropathy. Rinsh Shinkeigaku Clin Neurol. 1996;36(12):1356.

    CAS  Google Scholar 

  72. Sobue G, Yasuda T, Kumazawa K, Yamamoto K, Mitsuma T. MRI demonstrates dorsal column involvement of the spinal cord in Sjögren’s syndrome-associated neuropathy. Neurology 1995;45(3):592–3.

    PubMed  CAS  Google Scholar 

  73. Lin C, Chiu M. Teaching neuroimage: cervical cord atrophy with dorsal root ganglionopathy in Sjogren syndrome. Neurology 2008;70(7):e27.

    Article  PubMed  Google Scholar 

  74. Tajima Y, Mito Y, Owada Y, Tsukishima E, Moriwaka F, Tashiro K. Neurological manifestations of primary Sjögren’s syndrome in Japanese patients. Int Med. 1997;36(10):690–3.

    Article  CAS  Google Scholar 

  75. Govoni M, Bajocchi G, Rizzo N, Tola M, Caniatti L, Tugnoli V, et al. Neurological involvement in primary Sjögren’s syndrome: clinical and instrumental evaluation in a cohort of Italian patients. Clin Rheumatol. 1999;18(4):299–303.

    Article  PubMed  CAS  Google Scholar 

  76. Gemignani F, Marbini A, Pavesi G, Di Vittorio S, Manganelli P, Cenacchi G, et al. Peripheral neuropathy associated with primary Sjogren’s syndrome. Br Med J. 1994;57(8):983.

    CAS  Google Scholar 

  77. Servioli L, PÈrez C, Consani S, Surez A, Sehabiaga G, Collazo C, et al. Prevalence and characteristics of immunomediated neuropathies in a group of patients with autoimmune diseases. J Clin Neuromuscular Dis. 2007;9(2):285.

    Article  Google Scholar 

  78. Vetrugno R, Liguori R, Cortelli P, Montagna P. Sympathetic skin response. Clin Auton Res. 2003;13(4):256–70.

    Article  PubMed  Google Scholar 

  79. Kaplan J, Rosenberg R, Reinitz E, Buchbinder S, Schaumburg H. Invited review: peripheral neuropathy in Sjogren’s syndrome. Muscle Nerve 1990;13(7):570–9.

    Article  PubMed  CAS  Google Scholar 

  80. Graus F, Pou A, Kanterewicz E, Anderson N. Sensory neuronopathy and Sjögren’s syndrome: clinical and immunologic study of two patients. Neurology 1988;38(10):1637.

    PubMed  CAS  Google Scholar 

  81. Chai J, Herrmann D, Stanton M, Barbano R, Logigian E. Painful small-fiber neuropathy in Sjogren syndrome. Neurology 2005;65(6):925.

    Article  PubMed  CAS  Google Scholar 

  82. Kaplan J, Schaumburg H. Predominantly unilateral sensory neuronopathy in Sjogren’s syndrome. Neurology 1991;41(6):948–9.

    PubMed  CAS  Google Scholar 

  83. Lacomis D. Small-fiber neuropathy. Muscle Nerve 2002;26(2):173–88.

    Article  PubMed  Google Scholar 

  84. Periquet M, Novak V, Collins M, Nagaraja H, Erdem S, Nash S, et al. Painful sensory neuropathy: prospective evaluation using skin biopsy. Neurology 1999;53(8):1641.

    PubMed  CAS  Google Scholar 

  85. Koike H, Sobue G. Alcoholic neuropathy. Curr Opin Neurol. 2006;19(5):481.

    Article  PubMed  CAS  Google Scholar 

  86. Laaksonen S, Roytta M, Jaaskelainen SK, Kantola I, Penttinen M, Falck B. Neuropathic symptoms and findings in women with Fabry disease. Clin Neurophysiol. 2008;119(6):1365–72.

    Article  PubMed  Google Scholar 

  87. Devigili G, Tugnoli V, Penza P, Camozzi F, Lombardi R, Melli G, et al. The diagnostic criteria for small fibre neuropathy: from symptoms to neuropathology. Brain 2008;131(7):1912.

    Article  PubMed  Google Scholar 

  88. Smith B, Windebank A, Dyck P. Nonmalignant inflammatory sensory polyganglionopathy. Peripheral neuropathy. Philadelphia, PA: WB Saunders; 1993. pp. 1525–31.

    Google Scholar 

  89. Smith A, Bromberg M. A rational diagnostic approach to peripheral neuropathy. J Clin Neuromuscular Dis. 2003;4(4):190.

    Article  Google Scholar 

  90. Collins M. Localized vasculitis and the peripheral nervous system. J Rheumatol. 2005;32:769–71.

    PubMed  Google Scholar 

  91. Ramos-Casals M, Anaya J, GarcÌa-Carrasco M, Rosas J, Bové A, Claver G, et al. Cutaneous vasculitis in primary Sjogren syndrome: classification and clinical significance of 52 patients. Medicine 2004;83(2):96.

    Article  PubMed  Google Scholar 

  92. Ramos-Casals M, Nardi N, Brito-Zeron P, Aguilo S, Gil V, Delgado G, et al. Atypical autoantibodies in patients with primary Sjogren syndrome: clinical characteristics and follow-up of 82 cases. Semin Arthritis Rheum. 2006;35(5):312–21.

    Article  PubMed  CAS  Google Scholar 

  93. Vitali C, Tavoni A, Neri R, Castrogiovanni P, Pasero G, Bombardieri S. Fibromyalgia features in patients with primary Sjögren’s syndrome: evidence of a relationship with psychological depression. Scand J Rheumatol. 1989;18(1):21–7.

    Article  PubMed  CAS  Google Scholar 

  94. Tishler M, Barak Y, Paran D, Yaron M. Sleep disturbances, fibromyalgia and primary Sjögren’s syndrome. Clin Exp Rheumatol. 1997;15(1):71.

    PubMed  CAS  Google Scholar 

  95. Ringel S, Forstot J, Tan E, Wehling C, Griggs R, Butcher D. Sjogren’s syndrome and polymyositis or dermatomyositis. Arch Neurol. 1982;39(3):157.

    PubMed  CAS  Google Scholar 

  96. Cody D, Davidson J. Juvenile dermatomyositis and Sjogren’s syndrome occurring concurrently in an adolescent male. Rheumatology 2002;41(6):698.

    Article  PubMed  CAS  Google Scholar 

  97. Kanellopoulos P, Baltoyiannis C, Tzioufas A. Primary Sjogren’s syndrome associated with inclusion body myositis. Rheumatology 2002;41(4):440.

    Article  PubMed  CAS  Google Scholar 

  98. {Akpek E-B, 1979 #9; French, 2003 #8; Graves, 2003 #10; Jacobs, 1988 #11; Khurrum Baig, 2004 #2; Kiang, 1998 #5; Perry, 1997 #6; Pucci, 2002 #4; Smith, 1981 #12; Tang-Liu, 2005 #1; Temprano, 2005 #7}. The American College of Rheumatology response criteria for proliferative and membranous renal disease in systemic lupus erythematosus clinical trials. Arthritis Rheum. 2006;54(2):421–32.

    Google Scholar 

  99. Hocevar A, Tomsic M, Praprotnik S, Hojnik M, Kveder T, Rozman B. Parasympathetic nervous system dysfunction in primary Sjogren’s syndrome. Br Med J. 2003;62(8):702.

    CAS  Google Scholar 

  100. Bacman S, Perez Leiros C, Sterin-Borda L, Hubscher O, Arana R, Borda E. Autoantibodies against lacrimal gland M3 muscarinic acetylcholine receptors in patients with primary Sjogren’s syndrome. Invest Ophthalmol Vis Sci. 1998;39(1):151–6.

    PubMed  CAS  Google Scholar 

  101. Bacman S, Sterin-Borda L, Camusso JJ, Arana R, Hubscher O, Borda E. Circulating antibodies against rat parotid gland M3 muscarinic receptors in primary Sjogren’s syndrome. Clin Exp Immunol. 1996;104(3):454–9.

    Article  PubMed  CAS  Google Scholar 

  102. Wang F, Jackson M, Maughan V, Cavill D, Smith A, Waterman S, et al. Passive transfer of Sjögren’s syndrome IgG produces the pathophysiology of overactive bladder. Arthritis Rheum. 2004;50(11):3637–45.

    Article  PubMed  CAS  Google Scholar 

  103. Mandl T, Granberg V, Apelqvist J, Wollmer P, Manthorpe R, Jacobsson LTH. Autonomic nervous symptoms in primary Sjogren’s syndrome. Rheumatology 2008;47(6):914.

    Article  PubMed  CAS  Google Scholar 

  104. Low P, Vernino S, Suarez G. Autonomic dysfunction in peripheral nerve disease. Muscle Nerve 2003;27(6):646–61.

    Article  PubMed  Google Scholar 

  105. Alexander E. Neurologic disease in Sjögren’s syndrome: mononuclear inflammatory vasculopathy affecting central/peripheral nervous system and muscle. A clinical review and update of immunopathogenesis. Rheum Dis Clin N Am. 1993;19(4):869–908.

    CAS  Google Scholar 

  106. Urban P, Keilmann A, Teichmann E, Hopf H. Sensory neuropathy of the trigeminal, glossopharyngeal, and vagal nerves in Sjögren’s syndrome. J Neurol Sci. 2001;186(1–2):59–63.

    Article  PubMed  CAS  Google Scholar 

  107. Alexander E. Central nervous system (CNS) manifestations of primary Sjögren’s syndrome: an overview. Scand J Rheumatol Suppl. 1986;61:161.

    PubMed  CAS  Google Scholar 

  108. Garcia-Carrasco M, Ramos-Casals M, Rosas J, Pallares L, Calvo-Alen J, Cervera R, et al. Primary Sjogren syndrome: clinical and immunologic disease patterns in a cohort of 400 patients. Medicine 2002;81(4):270.

    Article  PubMed  Google Scholar 

  109. Anaya J, Villa L, Restrepo L, Molina J, Mantilla R, Vargas S. Central nervous system compromise in primary Sjogren’s syndrome. JCR 2002;8(4):189.

    PubMed  Google Scholar 

  110. Mauch E, Volk C, Kratzsch G, Krapf H, Kornhuber H, Laufen H, et al. Neurological and neuropsychiatric dysfunction in primary Sjogren’s syndrome. Acta Neurol Scand. 1994;89(1):31–5.

    Article  PubMed  CAS  Google Scholar 

  111. Birnbaum J, Petri M, Thompson R, Izbudak I, Kerr D. Distinct subtypes of myelitis in systemic lupus erythematosus. Arthritis Rheum. 2009;60(11):3378–87.

    Article  PubMed  CAS  Google Scholar 

  112. Zeis T, Graumann U, Reynolds R, Schaeren-Wiemers N. Normal-appearing white matter in multiple sclerosis is in a subtle balance between inflammation and neuroprotection. Brain 2007.

    Google Scholar 

  113. Noseworthy J, Bass B, Vandervoort M, Ebers G, Rice G, Weinshenker B, et al. The prevalence of primary Sjögren’s syndrome in a multiple sclerosis population. Ann Neurol. 1989;25(1):95–8.

    Article  PubMed  CAS  Google Scholar 

  114. Sandberg-Wollheim M, Axellm T, Hansen B, Henricsson V, Ingesson E, Jacobsson L, et al. Primary Sjogren’s syndrome in patients with multiple sclerosis. Neurology 1992;42(4):845.

    PubMed  CAS  Google Scholar 

  115. Miro J, Peña-Sagredo J, Berciano J, InsuA S, Leno C, Velarde R. Prevalence of primary Sjögren’s syndrome in patients with multiple sclerosis. Ann Neurol. 1990;27(5):582–4.

    Article  PubMed  CAS  Google Scholar 

  116. Wang Y, Tsai K, Fuh J, Tsai C, Wang S. High frequency of primary Sjögren’s syndrome in Taiwanese patients presenting as relapsing–remitting multiple sclerosis. Eur Neurol. 2004;51(1):21–5.

    Article  PubMed  CAS  Google Scholar 

  117. de Seze J, Delalande S, Fauchais A, Hachulla E, Stojkovic T, Ferriby D, et al. Myelopathies secondary to Sjögren’s syndrome: treatment with monthly intravenous cyclophosphamide associated with corticosteroids. J Rheumatol. 2006;33(4):709–11.

    PubMed  Google Scholar 

  118. Pericot I, Brieva L, Tintore M, Rio J, Sastre-Garriga J, Nos C, et al. Myelopathy in seronegative Sjogren syndrome and/or primary progressive multiple sclerosis. Multiple Sclerosis 2003;9(3):256–9.

    Article  PubMed  CAS  Google Scholar 

  119. Tsai K, Tsai C, Liao N. Sjögren’s syndrome with central nervous system involvement presenting as multiple sclerosis with failure response to beta-interferon. Eur Neurol. 2001;45(1):59–60.

    Article  PubMed  CAS  Google Scholar 

  120. Chang C, Shiau Y, Wang J, Ho S, Kao A. Abnormal regional cerebral blood flow on 99mTc ECD brain SPECT in patients with primary Sjogren’s syndrome and normal findings on brain magnetic resonance imaging. Br Med J. 2002;61(9):774.

    CAS  Google Scholar 

  121. Belin C, Moroni C, Caillat-Vigneron N, Debray M, Baudin M, Dumas JL, Moretti JL, Delaporte P, Guillevin L. Central nervous system involvement in Sjögren’s syndrome: evidence from neuropsychological testing and HMPAO-SPECT. Ann de Méd. 1999;150:598–604.

    CAS  Google Scholar 

  122. Kawashima N, Shindo R, Kohno M. Primary Sjögren’s syndrome with subcortical dementia. Intern Med. 1993;32(7):561–4.

    Article  PubMed  CAS  Google Scholar 

  123. Caselli R, Scheithauer B, Bowles C, Trenerry M, Meyer F, Smigielski J, et al. The treatable dementia of Sjögren’s syndrome. Ann Neurol. 1991;30(1):98–101.

    Article  PubMed  CAS  Google Scholar 

  124. Orman B, Sterin-Borda L, De Couto Pita A, Reina S, Borda E. Anti-brain cholinergic auto antibodies from primary Sjögren syndrome sera modify simultaneously cerebral nitric oxide and prostaglandin biosynthesis. Int Immunopharmacol. 2007;7(12):1535–43.

    Article  PubMed  CAS  Google Scholar 

  125. Liberatore G, Jackson-Lewis V, Vukosavic S, Mandir A, Vila M, McAuliffe W, et al. Inducible nitric oxide synthase stimulates dopaminergic neurodegeneration in the MPTP model of Parkinson disease. Nature Med. 1999;5(12):1403–9.

    Article  PubMed  CAS  Google Scholar 

  126. Kim E, Lee J, Kwon K, Lee S, Moon C, Baik E. Differential roles of cyclooxygenase isoforms after kainic acid-induced prostaglandin E2 production and neurodegeneration in cortical and hippocampal cell cultures. Brain Res. 2001;908(1):1–9.

    Article  PubMed  CAS  Google Scholar 

  127. Hassin-Baer S, Levy Y, Langevitz P, Nakar S, Ehrenfeld M. Anti-2-glycoprotein I in Sjogren’s syndrome is associated with Parkinsonism. Clinical Rheumatol. 2007;26(5):743–7.

    Article  Google Scholar 

  128. Visser L, Koudstaal P, Van de Merwe J. Hemiparkinsonism in a patient with primary Sjögren’s syndrome. A case report and a review of the literature. Clin Neurol Neurosurg. 1993;95(2):141–5.

    Article  PubMed  CAS  Google Scholar 

  129. Hashimoto S, Sawada T, Inoue T, Yamamoto K, Iwata M. Cholinergic-drug induced sicca syndrome in Parkinson’s disease: a case report and a review of the literature. Clin Neurol Neurosurg. 1999;101(4):268–70.

    Article  PubMed  CAS  Google Scholar 

  130. Nishimura H, Tachibana H, Makiura N, Okuda B, Sugita M. Corticosteroid-responsive Parkinsonism associated with primary Sjögren’s syndrome. Clin Neurol Neurosurg. 1994;96(4):327–31.

    Article  PubMed  CAS  Google Scholar 

  131. Creange A, Sedel F, Brugieres P, Voisin M, Degos J. Primary Sjögren’s syndrome presenting as progressive parkinsonian syndrome. Mov Disord. 1997;12(1):121–3.

    Article  PubMed  CAS  Google Scholar 

  132. Walker R, Spiera H, Brin M, Olanow C. Parkinsonism associated with Sjögren’s syndrome: three cases and a review of the literature. Mov Disord. 1999;14(2):262–8.

    Article  PubMed  CAS  Google Scholar 

  133. Venegas Fanchke P, Sinning M, Miranda M. Primary Sjögren’s syndrome presenting as a generalized chorea. Parkinsonism Rel Disord. 2005;11(3):193–4.

    Article  CAS  Google Scholar 

  134. Papageorgiou S, Kontaxis T, Bonakis A, Kalfakis N. Orofacial dystonia related to Sjogren’s syndrome. Clin Rheumatol. 2007;26(10):1779–81.

    Article  PubMed  Google Scholar 

  135. Alexander E, Alexander G. Aseptic meningoencephalitis in primary Sjogren’s syndrome. Neurology 1983;33(5):593.

    PubMed  CAS  Google Scholar 

  136. Hirohata M, Yasukawa Y, Ishida C, Komai K, Yamada M. Reversible cortical lesions in primary Sjögren’s syndrome presenting with meningoencephalitis as an initial manifestation. J Neurol Sci. 2005;232(1–2):111–3.

    Article  PubMed  Google Scholar 

  137. Rossi R, Valeria Saddi M. Subacute aseptic meningitis as neurological manifestation of primary Sjögren’s syndrome. Clin Neurol Neurosurg. 2006;108(7):688–91.

    Article  PubMed  Google Scholar 

  138. Ishida K, Uchihara T, Mizusawa H. Recurrent aseptic meningitis: a new CSF complication of Sjogren’s syndrome. J Neurol. 2007;254(6):806–7.

    Article  PubMed  Google Scholar 

  139. Hoshina T, Yamaguchi Y, Ohga S, Kira R, Ishimura M, Takada H, et al. Sjogren’s syndrome-associated meningoencephalomyelitis: cerebrospinal fluid cytokine levels and therapeutic utility of tacrolimus. J Neurol Sci. 2007.

    Google Scholar 

  140. Caselli R, Scheithauer B, O’Duffy J, Peterson G, Westmoreland B, Davenport P. Chronic inflammatory meningoencephalitis should not be mistaken for Alzheimer’s disease. Mayo Clin Proc. 1993;68:846–53.

    Google Scholar 

  141. Gerraty R, McKelvie P, Byrne E. Aseptic meningoencephalitis in primary Sjögren’s syndrome. Acta Neurol Scand. 1993;88:309–11.

    Article  PubMed  CAS  Google Scholar 

  142. Niemela RK, Hakala M. Primary Sjögren’s syndrome with severe central nervous system disease. Semin Arthritis Rheum. 1999;29:4–13.

    Article  PubMed  CAS  Google Scholar 

  143. Wong S, Pollock A, Burnham J, Sherry D, Dlugos D. Acute cerebellar ataxia due to Sjogren syndrome. Neurology 2004;62(12):2332.

    PubMed  CAS  Google Scholar 

  144. Hayashi Y, Kimura A, Kato S, Koumura A, Sakurai T, Tanaka Y, et al. Progressive multifocal leukoencephalopathy and CD4+ T-lymphocytopenia in a patient with Sjögren syndrome. J Neurol Sci. 2008;268(1–2):195–8.

    Article  PubMed  CAS  Google Scholar 

  145. Li J, Lai P, Lam H, Lu L, Cheng H, Lee J, et al. Hypertrophic cranial pachymeningitis and lymphocytic hypophysitis in Sjogren’s syndrome. Neurology 1999;52(2):420.

    PubMed  CAS  Google Scholar 

  146. Alexander E, Ranzenbach M, Kumar A, Kozachuk W, Rosenbaum A, Patronas N, et al. Anti-Ro (SS-A) autoantibodies in central nervous system disease associated with Sjogren’s syndrome (CNS-SS): clinical, neuroimaging, and angiographic correlates. Neurology 1994;44(5):899.

    PubMed  CAS  Google Scholar 

  147. Spezialetti R, Bluestein H, Peter J, Alexander E. Neuropsychiatric disease in Sjögren’s syndrome: anti-ribosomal P and anti-neuronal antibodies* 1. Am J Med. 1993;95(2):153–60.

    Article  PubMed  CAS  Google Scholar 

  148. Arnett F, Reichlin M. Lupus hepatitis: an under-recognized disease feature associated with autoantibodies to ribosomal P. Am J Med. 1995;99(5):465–72.

    Article  PubMed  CAS  Google Scholar 

  149. Ghirardello A, Doria A, Zampieri S, Gerli R, Rapizzi E, Gambari P. Anti-ribosomal P protein antibodies detected by immunoblotting in patients with connective tissue diseases: their specificity for SLE and association with IgG anticardiolipin antibodies. Br Med J. 2000;59:975–80.

    CAS  Google Scholar 

  150. Moll J, Markusse H, Pijnenburg J, Vecht C, Henzen-Logmans S. Antineuronal antibodies in patients with neurologic complications of primary Sjogren’s syndrome. Neurology 1993;43(12):2574.

    PubMed  CAS  Google Scholar 

  151. Owada K, Uchihara T, Ishida K, Mizusawa H, Watabiki S, Tsuchiya K. Motor weakness and cerebellar ataxia in Sjögren syndrome—identification of antineuronal antibody: a case report. J Neurol Sci. 2002;197(1–2):79–84.

    Article  PubMed  Google Scholar 

  152. Shams’ ili S, Grefkens J, de Leeuw B, van den Bent M, Hooijkaas H, van der Holt B, et al. Paraneoplastic cerebellar degeneration associated with antineuronal antibodies: analysis of 50 patients. Brain 2003;126(6):1409.

    Article  Google Scholar 

  153. Bourahoui A, De Seze J, Guttierez R, Onraed B, Hennache B, Ferriby D, et al. CSF isoelectrofocusing in a large cohort of MS and other neurological diseases. Eur J Neurol. 2004;11(8):525–9.

    Article  PubMed  CAS  Google Scholar 

  154. Vrethem M, Ernerudh J, Lindstrˆm F, Skogh T. Immunoglobulins within the central nervous system in primary Sjögren’s syndrome. J Neurol Sci. 1990;100(1–2):186.

    Article  PubMed  CAS  Google Scholar 

  155. Cauli A, Yanni G, Pitzalis C, Challacombe S, Panayi G. Cytokine and adhesion molecule expression in the minor salivary glands of patients with Sjogren’s syndrome and chronic sialoadenitis. Br Med J. 1995;54(3):209.

    CAS  Google Scholar 

  156. Alexander E, Beall S, Gordon B, Selnes O, Yannakakis G, Patronas N, et al. Magnetic resonance imaging of cerebral lesions in patients with the Sjogren syndrome. Ann Intern Med. 1988;108(6):815.

    PubMed  CAS  Google Scholar 

  157. Morgen K, McFarland H, Pillemer S. Central nervous system disease in primary Sjögren’s syndrome: the role of magnetic resonance imaging. Semin Arthritis Rheum. 2004;34:623–30.

    Google Scholar 

  158. Kao C, Ho Y, Lan J, ChangLai S, Chieng P. Regional cerebral blood flow and glucose metabolism in Sjogren’s syndrome. J Nucl Med. 1998;39(8):1354.

    PubMed  CAS  Google Scholar 

  159. Kao C, Lan J, ChangLai S, Chieng P. Technetium-99m-HMPAO SPECT and MRI of brain in patients with neuro-Behcet’s syndrome. J Nucl Med. 1998;39(10):1707.

    PubMed  CAS  Google Scholar 

  160. Lass P, Krajka-Lauer J, Homziuk M, Iwaszkiewicz-Bilikiewicz B, Koseda M, Hebanowski M, et al. Cerebral blood flow in Sjogren’s syndrome using 99Tcm-HMPAO brain SPET. Nucl Med Commun. 2000;21(1):31.

    Article  PubMed  CAS  Google Scholar 

  161. Tan EM. Antinuclear antibodies. Diagnostic markers for autoimmune diseases and probes for cell biology. Adv Immunol 1989;44:93–151.

    Article  PubMed  CAS  Google Scholar 

  162. Tan EM, Feltkamp TE, Smolen JS, Butcher B, Dawkins R, Fritzler MJ, et al. Range of antinuclear antibodies in “healthy” individuals. Arthritis Rheum. 1997;40(9):1601–11.

    Article  PubMed  CAS  Google Scholar 

  163. Tan EM, Smolen JS, McDougal JS, Butcher BT, Conn D, Dawkins R, et al. A critical evaluation of enzyme immunoassays for detection of antinuclear autoantibodies of defined specificities. I. Precision, sensitivity, and specificity. Arthritis Rheum. 1999;42(3):455–64.

    Article  PubMed  CAS  Google Scholar 

  164. Infirmary E, Stone J, Caruso P, Deshpande V. Case 24—2009: a 26-year-old woman with painful swelling of the neck. N Engl J Med. 2009;361:511–8.

    Article  Google Scholar 

  165. Craig W, Ledue T, Johnson A, Ritchie R. The distribution of antinuclear antibody titers in normal children and adults. J Rheumatol. 1999;26(4):914–9.

    PubMed  CAS  Google Scholar 

  166. Rosler M, Anand R, Cicin-Sain A, Gauthier S, Agid Y, Dal-Bianco P, et al. Efficacy and safety of rivastigmine in patients with Alzheimer’s disease: international randomised controlled trial. Commentary: another piece of the Alzheimer’s jigsaw. Br Med J. 1999;318(7184):633.

    CAS  Google Scholar 

  167. Caroyer J, Manto M, Steinfeld S. Severe sensory neuronopathy responsive to infliximab in primary Sjogren’s syndrome. Neurology 2002;59(7):1113.

    PubMed  Google Scholar 

  168. Kizawa M, Mori K, Iijima M, Koike H, Hattori N, Sobue G. Intravenous immunoglobulin treatment in painful sensory neuropathy without sensory ataxia associated with Sjogren’s syndrome. Br Med J. 2006;77(8):967.

    CAS  Google Scholar 

  169. Takahashi Y, Takata T, Hoshino M, Sakurai M, Kanazawa I. Benefit of IVIG for long-standing ataxic sensory neuronopathy with Sjogren’s syndrome. Neurology 2003;60(3):503.

    PubMed  CAS  Google Scholar 

  170. Rajabally Y, Seow H, Abbott R. Immunoglobulin-responsive dysautonomia in Sjögren’s syndrome. J Neurol. 2007;254(5):674–5.

    Article  PubMed  Google Scholar 

  171. Chen W, Yeh J, Chiu H. Plasmapheresis in the treatment of ataxic sensory neuropathy associated with Sjögren’s syndrome. Eur Neurol. 2000;45(4):270–4.

    Article  Google Scholar 

  172. Gorson K, Natarajan N, Ropper A, Weinstein R. Rituximab treatment in patients with IVIg-dependent immune polyneuropathy: a prospective pilot trial. Muscle Nerve 2007;35(1):66–9.

    Article  PubMed  CAS  Google Scholar 

  173. Asahina M, Kuwabara S, Nakajima M, Hattori T. D-Penicillamine treatment for chronic sensory ataxic neuropathy associated with Sjögren’s syndrome. Neurology 1998;51(5):1451–3.

    PubMed  CAS  Google Scholar 

  174. Wyszynski A, Wyszynski B. Treatment of depression with fluoxetine in corticosteroid-dependent central nervous system Sjogren’s syndrome. Psychosomatics 1993;34(2):173.

    PubMed  CAS  Google Scholar 

  175. Pascual J, Cid C, Berciano J, Grant I, Dyck P. High-dose IV immunoglobulin for peripheral neuropathy associated with Sjogren’s syndrome. Authors’ reply. Neurology 1998;51(2):650–1.

    PubMed  CAS  Google Scholar 

  176. Alexander E, Malinow K, Lejewski J, Jerdan M, Provost T, Alexander G. Primary Sjogren’s syndrome with central nervous system disease mimicking multiple sclerosis. Ann Intern Med. 1986;104(3):323.

    PubMed  CAS  Google Scholar 

  177. Ozgocmen S, Gur A. Treatment of central nervous system involvement associated with primary Sjogrens syndrome. Curr Pharm Des. 2008;14(13):1270–3.

    PubMed  CAS  Google Scholar 

  178. Williams C, Butler E, Roman G. Treatment of myelopathy in Sjogren syndrome with a combination of prednisone and cyclophosphamide. Arch Neurol. 2001;58(5):815.

    Article  PubMed  CAS  Google Scholar 

  179. Rogers S, Williams C, Roman G. Myelopathy in Sjogren’s syndrome: role of nonsteroidal immunosuppressants. Drugs 2004;64(2):123–32.

    Article  PubMed  CAS  Google Scholar 

  180. Wright R, O’Duffy J, Rodriguez M. Improvement of myelopathy in Sjögren’s syndrome with chlorambucil and prednisone therapy. Neurology 1999;52(2):386.

    PubMed  CAS  Google Scholar 

  181. Yamout B, El-Hajj T, Barada W, Uthman I. Successful treatment of refractory neuroSjogren with rituximab. Lupus 2007;16(7):521.

    Article  PubMed  CAS  Google Scholar 

  182. Canhao H, Fonseca J, Rosa A. Intravenous gammaglobulin in the treatment of central nervous system vasculitis associated with Sjögren’s syndrome. J Rheumatol. 2000;27(4):1102.

    PubMed  CAS  Google Scholar 

  183. Konttinen Y, Kinnunen E, Martin Von Bonsdorff M, Lillqvist P, Immonen I, Bergroth V, et al. Acute transverse myelopathy successfully treated with plasmapheresis and prednisone in a patient with primary Sjögren’s syndrome. Arthritis Care Res. 30(3):339–44.

    Google Scholar 

  184. Mavragani C, Moutsopoulos H. Conventional therapy of Sjogren’s syndrome. Clin Rev Allergy Immunol. 2007;32(3):284–91.

    Article  PubMed  CAS  Google Scholar 

  185. Szechtman H, Sakic B, Denburg J. Review: behaviour of MRL mice: an animal model of disturbed behaviour in systemic autoimmune disease. Lupus 1997;6(3):223.

    Article  PubMed  CAS  Google Scholar 

  186. Tomita M, Holman B, Williams L, Pang K, Santoro T. Cerebellar dysfunction is associated with overexpression of proinflammatory cytokine genes in lupus. J Neurosci Res. 2001;64(1):26–33.

    Article  PubMed  CAS  Google Scholar 

  187. Arnsten A. Stress signalling pathways that impair prefrontal cortex structure and function. Nat Rev Neurosci. 2009;10(6):410–22.

    Article  PubMed  CAS  Google Scholar 

  188. Luethi M, Meier B, Sandi C. Stress effects on working memory, explicit memory, and implicit memory for neutral and emotional stimuli in healthy men. Front Behav Neurosci. 2008;2.

    Google Scholar 

  189. Waterman SA, Gordon TP, Rischmueller M. Inhibitory effects of muscarinic receptor autoantibodies on parasympathetic neurotransmission in Sjogren’s syndrome. Arthritis Rheum. 2000;43(7):1647–54.

    Article  PubMed  CAS  Google Scholar 

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Fox, R.I., Birnbaum, J. (2011). The Neurological Manifestations of Sjögren’s Syndrome: Diagnosis and Treatment. In: Fox, R., Fox, C. (eds) Sjögren’s Syndrome. Springer, New York, NY. https://doi.org/10.1007/978-1-60327-957-4_22

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