{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T14:20:39Z","timestamp":1783520439111,"version":"3.55.0"},"reference-count":23,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T00:00:00Z","timestamp":1783468800000},"content-version":"unspecified","delay-in-days":7,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100020595","name":"National Science and Technology Council of Taiwan","doi-asserted-by":"crossref","award":["113-2314-B-002-318"],"award-info":[{"award-number":["113-2314-B-002-318"]}],"id":[{"id":"10.13039\/100020595","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100020595","name":"National Science and Technology Council of Taiwan","doi-asserted-by":"crossref","award":["114-2314-B-002-166-MY3"],"award-info":[{"award-number":["114-2314-B-002-166-MY3"]}],"id":[{"id":"10.13039\/100020595","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100005762","name":"National Taiwan University Hospital","doi-asserted-by":"publisher","award":["113-N0054"],"award-info":[{"award-number":["113-N0054"]}],"id":[{"id":"10.13039\/501100005762","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100005762","name":"National Taiwan University Hospital","doi-asserted-by":"publisher","award":["114-O0033"],"award-info":[{"award-number":["114-O0033"]}],"id":[{"id":"10.13039\/501100005762","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100005762","name":"National Taiwan University Hospital","doi-asserted-by":"publisher","award":["115-N0038"],"award-info":[{"award-number":["115-N0038"]}],"id":[{"id":"10.13039\/501100005762","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["RMD Open"],"accepted":{"date-parts":[[2026,6,22]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Salivary gland dysfunction in Sj\u00f6gren\u2019s disease (SjD) is clinically heterogeneous. Unstimulated whole salivary flow (UWSF) reflects basal secretion, while stimulated tests such as the Saxon test assess secretory reserve. Whether integrating these complementary domains defines clinically meaningful glandular functional states remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study of 193 anti-Sj\u00f6gren\u2019s syndrome antigen A (anti-SSA)-positive patients with SjD. Using established clinical thresholds for UWSF and the Saxon test, we defined three functional phenotypes: preserved basal and reserve (PP), partial impairment (PL\/LP) and combined low function (LL). Clinical features, patient-reported outcomes, submandibular gland (SMG) gland ratio and longitudinal salivary changes were evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Dryness and swallowing difficulty differed significantly across phenotypes. Compared with PP, the LL phenotype exhibited higher European Alliance of Associations for Rheumatology (EULAR) Sj\u00f6gren\u2019s Syndrome Patient-Reported Index dryness (\u03b2=1.67, 95% CI 0.64 to 2.70)\u2009and increased odds of swallowing difficulty (OR 6.19, 95% CI 2.71 to 14.9) after multivariable adjustment. Histological analyses showed markedly reduced SMG preservation in LL. Longitudinally, PP showed measurable declines in UWSF and Saxon test, whereas PL\/LP remained relatively stable. LL had minimal longitudinal change in UWSF and a directionally positive Saxon slope, best interpreted in the context of floor-constrained end point behaviour rather than biological recovery. Baseline-to-last transition analyses showed substantial same-phenotype retention, and most longitudinally evaluable LL patients remained below the impaired Saxon threshold throughout follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Integrated basal-reserve functional phenotyping defines clinically and structurally anchored salivary gland functional states in SjD. This framework may support clinical stratification and state-dependent interpretation of longitudinal salivary end points in studies targeting glandular outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/rmdopen-2026-006843","type":"journal-article","created":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T13:45:27Z","timestamp":1783518327000},"page":"e006843","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Integrating basal and reserve salivary function defines clinically anchored functional phenotypes and contextualises salivary end points in Sj\u00f6gren\u2019s disease"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8618-9945","authenticated-orcid":false,"given":"Chiao-Feng","family":"Cheng","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan"},{"name":"Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ting-Yuan","family":"Lan","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8236-9121","authenticated-orcid":false,"given":"Jui-Hung","family":"Kao","sequence":"additional","affiliation":[{"name":"Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tseng-Cheng","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min-Shu","family":"Hsieh","sequence":"additional","affiliation":[{"name":"Department of Pathology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu-Heng","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi-Min","family":"Huang","sequence":"additional","affiliation":[{"name":"Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan"},{"name":"Department of Internal Medicine, National Taiwan University Cancer Center, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi-Chieh","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, National Taiwan University Hospital, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mei-Fang","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hsiao-Sang","family":"Chu","sequence":"additional","affiliation":[{"name":"Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan"},{"name":"Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4794-9438","authenticated-orcid":false,"given":"Cheng-Hsun","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chieh-Yu","family":"Shen","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4544-4620","authenticated-orcid":false,"given":"Ko-Jen","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8058-7566","authenticated-orcid":false,"given":"Song-Chou","family":"Hsieh","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan"},{"name":"Department of Internal Medicine, National Taiwan University Cancer Center, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,7,8]]},"reference":[{"key":"2026070806452004000_12.3.e006843.1","doi-asserted-by":"crossref","first-page":"1068","DOI":"10.1016\/j.ard.2025.05.004","article-title":"Primary Sj\u00f6gren\u2019s Disease: a review of unmet need, outcome measures, therapeutic advances and health economic impacts. 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