University of Groningen Primary Sjögren’s Syndrome


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University of Groningen

Primary Sjögren’s Syndrome

Delli, Konstantina



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Publication date:

2017


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Citation for published version (APA):

Delli, K. (2017). Primary Sjögren’s Syndrome: towards a new era in diagnosis, treatment and e-patient

education [Groningen]: University of Groningen

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Download date: 22-12-2017



Primary Sjögren’s syndrome: 

Towards a new era

 

in diagnosis,  



treatment and e-patient education

 

 

 



 

Primary Sjögren’s Syndrome: 

Towards a new era 

 

In diagnosis, treatment and e-patient education



 

 

 



PhD thesis  

 

to obtain the degree of PhD at the 



University of Groningen 

on the authority of the 

Rector Magnificus Prof. E. Sterken 

and in accordance with 

the decision by the College of Deans. 

 

This thesis will be defended in public on  



 

Wednesday 31st May at 14:30 hours 

 

 

 



 

by  


 

 

Konstantina Delli  



born on 23 May 1980 

in Chania, Greece

The research presented in this thesis was performed and financed at the Depart-

ment of Oral and Maxillofacial Surgery, University Medical Center Groningen, The 

Netherlands.

© Konstantina Delli

All rights reserved.

No parts of this publication may be transmitted, in any form or by any means

without permission of the author.

Icon made by Freepik from www.flaticon.com

Bookdesign: Sgaar Groningen

Printed by: Drukkerij van der Eems Heerenveen

ISBN: 978-90-367-9789-4 | E-book: 978-90-367-9788-7


Supervisors 

Prof. F.K.L. Spijkervet  

Prof. A. Vissink  

Prof. H. Bootsma  

 

 

 



Assessment Committee 

Prof. R.A.J.O. Dierckx  

Prof. F. van den Hoogen  

Prof. R. Jonsson 

Paranimfen 

Drs E. Mossel 

Drs J.F. van Nimwegen


Contents

Chapter 1

Introduction

9

Chapter 2



Xerostomia

19

Chapter 3



Diagnosis

47

A.



Diagnostic properties of ultrasound of major salivary glands in Sjögren’s 

syndrome: a meta-analysis

49

B.

Comment on: ‘Diagnostic accuracies of sialography and salivary 



ultrasonography in Sjögren’s syndrome patients: a meta-analysis.’  

by Song and Lee (2014)

75

C.

Ultrasound of the major salivary glands is a reliable imaging technique 



in patients with clinically suspected primary Sjögren’s syndrome

81

D.



Ultrasonography of major salivary glands compared to parotid and 

labial gland biopsy and classification criteria in patients with clinically 

suspected primary Sjögren’s syndrome

95

E.



Can ultrasound of the major salivary glands differentiate primary 

Sjögren’s syndrome from other systemic diseases with salivary gland 

involvement?

119


F.

Salivary gland biopsy for Sjögren’s Syndrome

133

Chapter 4



Treatment

151


A.

Towards personalised treatment in primary Sjögren’s syndrome: baseline 

parotid histopathology predicts responsiveness to rituximab treatment

153


B.

In primary Sjögren’s syndrome high absolute numbers and proportions 

of B cells in parotid glands predict responsiveness to rituximab as 

defined by ESSDAI, but not by SSRI

173

C.

Need for consensus guidelines to standardise the assessment of 



germinal centres and other histopathological parameters in salivary 

gland tissue of patients with primary Sjögren’s syndrome

181

Chapter 5



e-Patient education

187


A.

Internet information on xerostomia: what should patients expect?

189

B.

Is YouTube useful as a source of information for Sjögren’s syndrome?



205

Chapter 6

General discussion

219


Chapter 7

Summary


231

Chapter 8

Samenvatting

237


Acknowledgements

245


Curriculum vitae & Publications

251


To all patients with Sjögren’s syndrome


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