{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T09:23:16Z","timestamp":1783675396843,"version":"3.55.0"},"reference-count":24,"publisher":"The Journal of Rheumatology","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Rheumatol"],"published-print":{"date-parts":[[2018,11]]},"abstract":"<jats:sec><jats:title>Objective.<\/jats:title><jats:p>Primary Sj\u00f6gren syndrome (pSS), an autoimmune epithelitis, bears the risk of evolving to non-Hodgkin lymphoma and most frequently to the mucosa-associated lymphoid tissue (MALT) subtype. Based on the observation that pSS patients with MALT present a more atrophic and more intensely fissured tongue, we aimed to semiquantify severity of tongue atrophy and clinically assess lingual appearance in pSS patients with and without MALT, and investigate whether tongue atrophy and fissured appearance could serve as clinical indicators\/signs of MALT.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods.<\/jats:title><jats:p>A blinded complete oral examination was performed in pSS patients with and without MALT. Tongue atrophy was scored using a semiquantified atrophy score. Clinical and laboratory variables were recorded for all patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results.<\/jats:title><jats:p>After excluding pSS patients with oral candidiasis, iron deficiency, and megaloblastic anemia, 19 pSS patients with salivary MALT were matched 1:3 for age, sex, and disease duration with 57 pSS patients without MALT. The pSS-MALT patients had increased prevalence of salivary gland enlargement, lymphadenopathy, monoclonal gammopathy, rheumatoid factor positivity, higher focus and Tarpley scores in the minor salivary gland biopsy, and hyposalivation, compared to the pSS non-MALT patients. A significantly higher prevalence of tongue atrophy (68% vs 30%, p = 0.006) and fissured tongue (89% vs 33%, p &lt; 0.001) was observed in the former group. Multivariate analysis showed that fissured tongue appearance, hyposalivation, and lymphadenopathy associate independently with salivary MALT in pSS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion.<\/jats:title><jats:p>These results suggest that pSS patients with lymphoid malignancy exhibit a more atrophic and more fissured tongue. This particular clinical tongue appearance can serve as an additional clinical sign for salivary MALT lymphoma in pSS patients.<\/jats:p><\/jats:sec>","DOI":"10.3899\/jrheum.180101","type":"journal-article","created":{"date-parts":[[2018,7,15]],"date-time":"2018-07-15T07:25:11Z","timestamp":1531639511000},"page":"1565-1571","source":"Crossref","is-referenced-by-count":16,"title":["Tongue Atrophy in Sj\u00f6gren Syndrome Patients with Mucosa-associated Lymphoid Tissue Lymphoma: Autoimmune Epithelitis beyond the Epithelial Cells of Salivary Glands?"],"prefix":"10.3899","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3668-4454","authenticated-orcid":false,"given":"Evangelia","family":"Zampeli","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleni-Marina","family":"Kalogirou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evangelia","family":"Piperi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clio P.","family":"Mavragani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haralampos M.","family":"Moutsopoulos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2262","published-online":{"date-parts":[[2018,7,15]]},"reference":[{"key":"2018112909391307000_45.11.1565.1","doi-asserted-by":"publisher","DOI":"10.1006\/clin.1994.1123"},{"key":"2018112909391307000_45.11.1565.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaut.2014.01.001"},{"key":"2018112909391307000_45.11.1565.3","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.122037"},{"key":"2018112909391307000_45.11.1565.4","doi-asserted-by":"publisher","DOI":"10.1002\/1529-0131(199908)42:8<1765::AID-ANR28>3.0.CO;2-V"},{"key":"2018112909391307000_45.11.1565.5","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-89-6-888"},{"key":"2018112909391307000_45.11.1565.6","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.165.20.2337"},{"key":"2018112909391307000_45.11.1565.7","doi-asserted-by":"crossref","first-page":"754825","DOI":"10.1155\/2015\/754825","article-title":"Contribution of genetic factors to Sj\u00f6gren\u2019s syndrome and Sj\u00f6gren\u2019s syndrome related lymphomagenesis","volume":"2015","author":"Nezos","year":"2015","journal-title":"J Immunol Res"},{"key":"2018112909391307000_45.11.1565.8","doi-asserted-by":"publisher","DOI":"10.1016\/S0049-0172(00)80016-5"},{"key":"2018112909391307000_45.11.1565.9","doi-asserted-by":"crossref","first-page":"e3766","DOI":"10.1097\/MD.0000000000003766","article-title":"Predicting the risk for lymphoma development in Sjogren syndrome: an easy tool for clinical use","volume":"95","author":"Fragkioudaki","year":"2016","journal-title":"Medicine"},{"key":"2018112909391307000_45.11.1565.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaut.2009.10.004"},{"key":"2018112909391307000_45.11.1565.11","doi-asserted-by":"publisher","DOI":"10.1111\/odi.12105"},{"key":"2018112909391307000_45.11.1565.12","doi-asserted-by":"publisher","DOI":"10.1016\/S1532-3382(12)70051-9"},{"key":"2018112909391307000_45.11.1565.13","doi-asserted-by":"publisher","DOI":"10.1136\/ard.61.6.554"},{"key":"2018112909391307000_45.11.1565.14","doi-asserted-by":"publisher","DOI":"10.1016\/j.tripleo.2009.02.018"},{"key":"2018112909391307000_45.11.1565.15","doi-asserted-by":"crossref","first-page":"e310","DOI":"10.4317\/medoral.15.e310","article-title":"Oral status and Candida colonization in patients with Sj\u00f6gren\u2019s syndrome","volume":"15","author":"Ergun","year":"2010","journal-title":"Med Oral Patol Oral Cir Bucal"},{"key":"2018112909391307000_45.11.1565.16","first-page":"127","article-title":"Evaluation of unstimulated whole saliva flow rate and stimulated parotid flow as confirmatory tests for xerostomia","volume":"7","author":"Skopouli","year":"1989","journal-title":"Clin Exp Rheumatol"},{"key":"2018112909391307000_45.11.1565.17","doi-asserted-by":"publisher","DOI":"10.1136\/ard.53.10.637"},{"key":"2018112909391307000_45.11.1565.18","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1016\/j.tripleo.2009.08.046","article-title":"Comments on atrophic lingual papillae and candidiasis in Sjogren syndrome","volume":"109","author":"Daniels","year":"2010","journal-title":"Oral Surg Oral Med Oral Pathol Oral Radiol Endod"},{"key":"2018112909391307000_45.11.1565.19","doi-asserted-by":"publisher","DOI":"10.1016\/0030-4220(89)90218-1"},{"key":"2018112909391307000_45.11.1565.20","doi-asserted-by":"crossref","first-page":"619","DOI":"10.2174\/1874210601610010619","article-title":"Diagnosis of lingual atrophic conditions: associations with local and systemic factors. 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