Corticosteroid irrigation of parotid gland for treatment of xerostomia in patients with Sjögren's syndrome

Abstract

Objective: To determine the efficacy of corticosteroid irrigation of the parotid gland in relieving salivary flow deficiency in patients with Sjögren's syndrome.

Methods: The parotid glands of 31 patients with primary (24) or secondary (seven) Sjögren's syndrome were irrigated either with saline solution followed by corticosteroid solution, or with saline solution alone. Salivary function was assessed by Saxon test.

Results: Corticosteroid irrigation significantly increased the salivary flow rate in patients with Sjögren's syndrome (p < 0.0001), with clinical improvement detectable 3.7 (2.4) weeks (mean (SD)) after initial corticosteroid irrigation. The extent of improvement in salivary function was reciprocal to the clinical severity of the disease, with patients at the early stages obtaining 1.20 (0.57) g net increase in salivary flow rate, and patients at the most advanced stages obtaining 0.20 (0.47) g net increase. Repeated corticosteroid irrigations did not evoke corticosteroid refractoriness of the salivary gland; similar levels of net increase in salivary flow rate were observed after the second to fourth challenge of the corticosteroid in these patients. The sustained period was 8.4 (3.5) months (mean (SD)).

Conclusion: These findings suggest the clinical usefulness of corticosteroid irrigation therapy in relieving xerostomia in patients with Sjögren's syndrome.

Figures

Figure 1

A catheter used for the saline or corticosteroid irrigation of the parotid gland. It was connected to a 5 ml cylinder and filled with saline or corticosteroid solution. For corticosteroid irrigation, the catheter was inserted 1 to 2 cm into the Stensen's duct, and was held in the duct for two minutes.

Figure 2

A schematic chart showing the procedure for corticosteroid irrigation in a patient with Sjögren's syndrome. The treatment started with irrigation using saline solution, which continued for two to three months, depending on the presence or absence of inflammatory symptoms of the parotid glands. This was followed by corticosteroid irrigation for three weeks and then by the follow up period. A Saxon test was performed at the time of irrigations and also periodically (every two weeks) during the follow up period (arrow heads). The results (salivary flow rates) are expressed as g/2 min. A schematic drawing of the results of the Saxon test is shown below. (A) A time point when the improvement in the salivary flow rate was confirmed; (B) a time point when the loss of the treatment effect was confirmed.

Figure 3

Effects of irrigation using saline solution (A) and the following corticosteroid solution (B) on the salivary flow rate in patients with Sjögren's syndrome. The durations between pretreatment and post-treatment were 2-3 months and three weeks for irrigations with the saline and the corticosteroid, respectively. NS: not significant.

Figure 4

Differences in magnitude of effects of corticosteroid irrigation on the salivary flow rate of patients with Sjögren's syndrome at early, intermediate, and advanced stages of the disease in the parotid gland. The criteria for the classification of patients into the three groups were described previously (references 7 and 8).

Figure 5

A diagram showing effects of repeated corticosteroid irrigation on improvement of the salivary flow rate of patients with Sjögren's syndrome. The left column represents the patient's number (patient no). The second column shows salivary flow rates (SFR (NT) (g/2min)) of 28 patients at the start of corticosteroid irrigation (patients 1 to 28), and of the patients who received long term (up to 35 months) saline irrigations before the start of the saline irrigation (patients 29 to 31). The values in the horizontal tandem bars represent means of the maximum two salivary flow rates (SFR (T)) obtained during the treatment and follow up periods and also sustained periods of improvement in the salivary flow rate (in parentheses) in each of the patients. Each of the tandem bars represents first, second, third, fourth, and fifth series of the corticosteroid irrigation and follow up periods. The three horizontal tandem bars at the bottom demonstrate patients with Sjögren's syndrome treated with the saline solution alone.