Sialorrhoea as early oral clinical manifestation of primary Sjogren's syndrome?

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Abstract
Sir, Sjögren's syndrome (SS) is a systemic autoimmune exocrinopathy that affects the salivary and lacrimal glands, typically presenting as the ‘sicca complex’ of dry eyes (xerophthalmia) and dry mouth (xerostomia). It is generally accepted that SS diagnosis should be based on several clinical and laboratory findings. At present, even though the high validity and reliability of the classification criteria proposed and recently revised [1] by the European Community Study Group has been reported, there is still a lack of international consensus [2]. This situation, in addition to the observation that the initial clinical manifestation of SS is often non‐specific and vague [3], frequently leads to a delay in diagnosis that, in some cases, can be as long as 11 years [3], with serious consequences in proper management of the diseases and prevention of potential complications. We observed four patients whose histological features and laboratory data suggested that they were suffering from SS, but with initial clinical findings that did not fulfil European diagnostic criteria and did not allow us to make a prompt and early diagnosis. In fact, in each patient we observed the presence of a symptom that is very infrequent in the general population and has never been described in SS but, on the contrary, seems to strongly contrast with traditional clinical features of SS: the occurrence of sialorrhoea.

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