Sjogren's Syndrome: Clinical and Immunological Aspects

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I have been a student of Sjogren's syndrome for virtually all of my professional life. My education in this disease began in 1962 when I arrived at the National Institutes of Health to begin a Clinical Asso- ciateship with Dr. Joseph J. Bunim. Bunim introduced me to a pat- ient with Sjogren's syndrome of 8 years duration who had devel- oped malignant lymphoma 6 months previously. He told me that there were other such patients. I obtained serum samples from these patients and studied them by the then new technique of immuno- electrophoresis. We observed that an initial hypergammaglobulin- emia could progressively decline to hypogammaglobulinemia with loss of autoantibodies. One patient in this initial series had macrog- lobulinemia. We published this report and suggested that the auto- immunity predisposed to the malignant transformation. Thus began my love affair with this disease. In those days many rheumatologists considered Sjogren's syn- drome simply a variant of rheumatoid arthritis. It's curious that two decades ago there was little confusion between Sjogren's syndrome and systemic lupus erythematosus, whereas today there is great con- fusion. There is still a great need for internationally agreed upon di- agnostic criteria, which merely illustrates once again the difficulty of accurate diagnosis in our profession. The multidisciplinary aspects of Sjogren's syndrome require au- thorities in several areas of medicine. The various chapter contribu- tors are experts in their field and have often put aside other respon- sibilities to complete their contributions and not delay publication.