Primary Sjögren’s syndrome (pSS) exhibits considerable clinical and immunological heterogeneity, complicating personalized management. We aimed to delineate the demographic, functional, serological, histopathological, and therapeutic features of a Romanian pSS cohort and to identify biomarker–treatment correlations that could inform patient-oriented strategies. Thirty-two patients meeting the 2016 ACR/EULAR classification criteria for pSS were retrospectively analyzed. Data collected included demographics, autoantibody profiles (Anti-Ro/SSA, Anti-La/SSB, ANA, RF, Anti-CCP), immunoglobulin levels, complement consumption (C3/C4), minor salivary gland biopsy (focus score), salivary flow tests, and systemic inflammation markers (CRP). Pearson correlation matrices were constructed to explore the associations between serological markers and prescribed therapies. The cohort was predominantly female (87.5%) with a mean age of 52.8 ± 9.9 years. Seropositivity rates were 50% for Anti-Ro/SSA, 77% for Anti-La/SSB, and 40% for ANA. Clinically significant glandular dysfunction was evident in 65% of patients (unstimulated flow ≤ 0.1 mL/min), and all biopsies demonstrated focus scores > 1. Methotrexate use correlated strongly with Anti-Ro/SSA and Anti-La/SSB positivity (p ≤ 0.05), indicating its targeted application in seropositive sub-phenotypes. Conclusion: These findings underscore the immunologic and clinical diversity of pSS and support a biomarker-driven, multidisciplinary framework for personalized treatment. Larger prospective and multicenter studies are warranted to validate these correlations and to refine precision medicine approaches in pSS.

Background: This study investigates the clinical characteristics and differences between primary Sjögren’s Syndrome (pSS) and secondary Sjögren’s Syndrome (sSS) in a cohort of 50 patients. Methods: Conducted across two academic facilities in North-East Romania, the study emphasizes the importance of glandular and extraglandular manifestations, focusing on salivary flow rates, pH levels, and buffer capacity. Patients were diagnosed using the 2016 ACR-EULAR classification criteria, with a detailed examination including salivary tests, biopsies, and antibody presence. Results: The findings highlight significant differences between pSS and sSS, particularly in salivary function, with pSS patients exhibiting more severe glandular dysfunction. The study also notes a higher prevalence of inflammatory joint involvement in sSS patients, often associated with rheumatoid arthritis. Statistical analysis revealed correlations between salivary parameters and disease progression, underscoring the necessity of tailored treatment strategies. The research suggests that lower salivary flow rates and altered pH levels in pSS patients contribute to compromised oral health, including increased dental cavities and periodontal disease. Conclusions: The study’s results contribute to a deeper understanding of Sjögren’s Syndrome and reinforce the need for multidisciplinary management to address both systemic and oral health complications in these patients.

Background/Objectives: Matrix metalloproteinases (MMP-8 and MMP-9) are key mediators of periodontal tissue degradation and have been proposed as salivary biomarkers of disease activity. However, their comparative responsiveness to non-surgical periodontal therapy remains insufficiently clarified. This study aimed to assess short-term changes in salivary MMP-8 and MMP-9 following full-mouth disinfection (FMD), to evaluate their association with clinical periodontal parameters, and to explore potential differences according to depressive comorbidity. Methods: Eighty patients were included and divided into two groups: 40 patients without depressive disorder (PAR group) and 40 patients with depressive disorder (DEP group). Clinical periodontal parameters (probing depth and clinical attachment loss) and salivary levels of MMP-8 and MMP-9 were assessed at baseline and 12 weeks following FMD. Salivary MMP-8 and MMP-9 levels were determined using the enzyme-linked immunosorbent assay (ELISA). Results: Significant reductions in probing depth and clinical attachment loss were observed following therapy (p < 0.01). Salivary MMP-9 levels decreased significantly in both groups (PAR: 2.4 to 1.1 ng/mL, p = 0.002; DEP: 2.6 to 1.5 ng/mL, p = 0.004), whereas MMP-8 did not show statistically significant changes (p > 0.05). Moderate positive correlations were identified between MMP-9 and clinical parameters (r = 0.46–0.51), while MMP-8 showed no significant associations. No significant differences in treatment response or biomarker dynamics were observed between groups. Conclusions: The findings indicate a differential salivary biomarker response to periodontal therapy, with MMP-9 showing greater responsiveness than MMP-8 under the conditions of this study. These results suggest a potential role for salivary MMP-9 in reflecting short-term periodontal changes; however, further longitudinal and controlled studies are required to establish its clinical applicability. Depressive comorbidity did not appear to influence short-term outcomes, although this finding should be interpreted cautiously due to the lack of a standardized severity assessment.

Background: Salivary gland dysfunction is a central manifestation of Sjögren’s syndrome, but the relationship between quantitative salivary impairment and salivary microcrystallization remains insufficiently defined. This study aimed to assess unstimulated and stimulated whole salivary flow and salivary pH in patients with primary and secondary Sjögren’s syndrome and to explore salivary microcrystallization indices as complementary descriptive markers of salivary physicochemical patterns. Materials and Methods: This cross-sectional observational study included 126 patients diagnosed with primary or secondary Sjögren’s syndrome. Unstimulated whole salivary flow, stimulated whole salivary flow, and salivary pH were assessed under standardized conditions. Salivary dysfunction severity was classified according to predefined functional salivary parameters. Salivary microcrystallization was evaluated microscopically on dried saliva samples and expressed using the IMK-RFR and IMK-RFS indices. Differences between disease subtypes and associations between salivary parameters, microcrystallization indices, and dysfunction severity were analyzed. Results: The mean unstimulated salivary flow rate was 0.272 ± 0.246 mL/min, while the mean stimulated salivary flow rate was 1.04 ± 0.50 mL/min. In unadjusted analyses, patients with primary Sjögren’s syndrome showed lower unstimulated and stimulated salivary flow rates than patients with secondary Sjögren’s syndrome. Both salivary flow parameters were inversely associated with salivary dysfunction severity. In an exploratory internal consistency ROC analysis, unstimulated salivary flow showed good internal agreement with grade ≥ 3 salivary dysfunction, while stimulated salivary flow showed very high internal agreement. Salivary pH showed limited internal consistency with dysfunction severity. Firth penalized logistic regression indicated that stimulated whole salivary flow remained associated with grade ≥ 3 salivary dysfunction after adjustment for unstimulated salivary flow. IMK values described salivary microcrystallization patterns within the Sjögren’s syndrome cohort; however, they were not robustly correlated with salivary flow, pH, or dysfunction severity. Conclusions: Salivary flow assessment remains a simple, non-invasive, and clinically relevant method for evaluating glandular dysfunction in Sjögren’s syndrome. In this cohort, primary Sjögren’s syndrome was associated with lower salivary flow rates, but these unadjusted findings should be interpreted as descriptive. Salivary microcrystallization provided exploratory information on qualitative salivary patterns, but its clinical value remains limited and requires methodological standardization and validation in larger prospective studies.