Increased Prevalence of Antibodies to Thyroid Peroxidase in Dry Eyes and Mouth Syndrome or Sicca Asthenia Polyalgia Syndrome

Published: July 23, 2012

Clio P. Mavragani
Fotini N. Skopouli
Haralampos M. Moutsopoulos

Author Affiliations

  1. From the Rheumatology Unit, Athens General Hospital “G. Gennimatas”; Department of Nutrition and Dietetics, Harokopio University; and Department of Pathophysiology, Medical School, University of Athens, Athens, Greece.
  2. C.P. Mavragani, MD, Attending Rheumatologist, Rheumatology Unit, Athens General Hospital “G. Gennimatas”; F.N. Skopouli, MD, Professor in Internal Medicine-Immunology, Department of Nutrition and Dietetics, Harokopio University; H.M. Moutsopoulos, MD, FACP, FRCP, Professor and Chairman, Department of Pathophysiology, Medical School, University of Athens.

* Address reprint requests to Prof. H.M. Moutsopoulos, Department of Pathophysiology, School of Medicine, M. Asias 75, Goudi, 11527, Athens, Greece. E-mail:



A subset of patients presenting with sicca features suggestive of primary Sjögren’s syndrome (pSS) do not fulfill diagnostic or histopathological criteria. This presentation was previously designated as dry eyes and mouth syndrome (DEMS) or sicca asthenia polyalgia syndrome (SAPS). We sought to define the underlying clinical, laboratory, and histological features of these patients.


The study population consisted of 27 consecutive patients with DEMS/SAPS; 54 patients with pSS served as controls. Medical charts were retrospectively evaluated for clinical and serological data and frozen sera were tested for the presence of antibodies against HIV, hepatitis C virus, and thyroid antigens. Immunohistochemical analysis of paraffin embedded tissues was also performed.


Sicca symptoms and nonspecific musculoskeletal pain were the commonest clinical features of patients with DEMS/SAPS; positive titers of antibodies against thyroid peroxidase was the main underlying abnormality found in 16 out of 27 (59.2%) of patients with DEMS/SAPS compared to 11 out of 54 (20.4%) of pSS controls (p = 0.0009). Histological analysis of the minor salivary gland (MSG) biopsies of patients with DEMS/SAPS disclosed a mild inflammatory infiltration of the interstitial tissue with a predominantly perivascular distribution.


Patients with DEMS/SAPS present with sicca features and nonspecific musculoskeletal complaints, have high prevalence of antithyroid antibodies, and their MSG biopsies demonstrate a mild interstitial lymphocytic infiltration with a predominantly perivascular distribution. In the setting of clinical practice, we propose that in the presence of DEMS/SAPS testing for antithyroid antibody should be performed.


Published online before print July 15, 2009, doi: 10.3899/jrheum.081326 The Journal of Rheumatology August 1, 2009 vol. 36 no. 8 1626-1630

See the abstract online at The Journal of Rheumatology.

Jacob Teitelbaum, MD

is one of the world's leading integrative medical authorities on fibromyalgia and chronic fatigue. He is the lead author of eight research studies on their effective treatments, and has published numerous health & wellness books, including the bestseller on fibromyalgia From Fatigued to Fantastic! and The Fatigue and Fibromyalgia Solution. Dr. Teitelbaum is one of the most frequently quoted fibromyalgia experts in the world and appears often as a guest on news and talk shows nationwide including Good Morning America, The Dr. Oz Show, Oprah & Friends, CNN, and Fox News Health.

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