key: cord-0867236-389ivmth
authors: Martelli Júnior, Hercílio; Gueiros, Luiz Alcino; de Lucena, Edson Gomes; Coletta, Ricardo D.
title: Increase in the number of Sjögren's syndrome cases in Brazil in the COVID‐19 Era
date: 2021-06-07
journal: Oral Dis
DOI: 10.1111/odi.13925
sha: 2cdd4a8c895f1faac032d98dabb094a2be370a2d
doc_id: 867236
cord_uid: 389ivmth

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Sjögren's syndrome (SS), a chronic autoimmune disorder of the exocrine glands, is multisystemic and heterogeneous in its clinical presentation, course, and outcome. Ocular and oral dryness resulting from the inflammatory impairment of exocrine glands is the common feature of the disease (Fox, 2005) . Systemic therapy includes steroidal and non-steroidal anti-inflammatory agents, disease-modifying agents, and cytotoxic agents to address the extra-glandular manifestations involving skin, lung, heart, kidneys, and nervous system, as well hematological and lymphoproliferative disorders. Diagnosis is not always straightforward and should include an elevated level of clinical suspicion (Fox, 2005) . Besides, several classification criteria have been proposed since 2002, which may include different subsets of patients under the same disease umbrella.

Patients with rheumatic and systemic autoimmune diseases can develop severe forms of COVID-19, considering their underlying abnormal immune response and the use of immunosuppressive drugs.

However, the body of scientific evidence supporting this potential risk is small, especially for individual diseases (Brito-Zerón et al., 2020) . On the other hand, there are reports of patients developing autoimmune diseases after COVID disease (Liu et al., 2021) .

Herein we report the SS's incidence, before and during the pandemic, from January 2017 to December 2020, in the five Brazilian macroregions. The data were extracted from the public database of the Ministry of Health of Brazil (DATASUS, http://tabnet.datas us.gov.br/cgi/tabcgi.exe?sia/cnv/qauf.def).

Over the triennium 2017-2019, the average number of newly diagnosed SS cases was 1,267, while in 2020, the number increased to 1,909 registered individuals, an increment of about 50,7% during the period compared. The increment was consistent across all five Brazilian macroregions, ranged from +27.3% in the South to +105.6% in the Midwest region. The general increase in Brazil was +642 (+50.7%) cases, comparing the period before and during the COVID-19 pandemic (Table 1) Recently, we have shown an increase in the occurrence of systemic lupus erythematosus in Brazil during the pandemic (Martelli et al., 2021) . Xerostomia was reported to be associated with COVID-19, being even common than olfactory symptoms and providing additional difficulties to a proper diagnose of SS (Fantozzi et al., 2020) . This scenario was previously observed in other viral epidemic diseases such as Chikungunya fever, which affects autoimmune diseases' clinical presentation and even contribute to their onset (Tanay, 2017) . During the outbreak, the patients with SS have reported a significant worsening in the symptoms, with articular manifestations, hyposalivation and salivary gland swelling being the most frequent complaints . Ultimately, SARS-CoV-2-related autoimmune disease onset and worsening of symptoms in undiagnosed patients may have collaborated to the increasing numbers of SS.

Patients with SS experience salivary dysfunction, which may significantly affect oral health. Poor oral health has also been shown to influence overall patient quality of life adversely (Stewart et al., 2008) . Thus, our findings have shown an increase in the number of new cases of SS in Brazil during the pandemic period. These results underscore the need for specific close monitoring of comorbidities of patients with primary SS during the pandemic. TA B L E 1 Sjögren's syndrome diagnosis reported by the Brazilian public health system in all geographic regions, from 2017 to 2020.

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