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Steven P. Ringel, MD; Joseph Z. Forstot, MD; Eng M. Tan, MD; Carol Wehling; Robert C. Griggs, MD; Dennis Butcher, MD

Arch Neurol. 1982;39(3):157-163.

Abstract
• Of four patients with Sjögren's syndrome, three had polymyositis and one had dermatomyositis. In all, deposition of IgG, IgA, IgM, and C3 was observed in muscle by immunofluorescent techniques. Serologic studies revealed elevated levels of serum IgG and IgM, rheumatoid factor, and antinuclear antibody with specificity for SS-A and SS-B antigens. In muscle there was a mononuclear cell infiltrate with plasma cell predominance around small vessels and capillaries. Ultrastructural changes in the vessels included reduplication of the basement membrane, endothelial thickening, and numerous tubuloreticular and dense inclusions. In two patients, electrondense deposits were noted in the microvasculature. This combination of immunoglobulin deposition in muscle, prominent microvascular changes, and characteristic serology suggests that the myositis in Sjögren's syndrome may result from small-vessel injury by autoantibodies or circulating immune complexes.

Author Affiliations
From the Department of Neurology (Dr Ringel and Ms Wehling) and the Division of Rheumatology, Department of Internal Medicine (Drs Forstot, Tan, and Butcher), University of Colorado Health Sciences Center, Denver; and the Department of Neurology (Dr Griggs), University of Rochester, NY.

Footnotes
Accepted for publication May 28, 1981.

Reprint requests to Department of Neurology, University of Colorado Health Sciences Center, 4200 E Ninth Ave, Denver, CO 80262 (Dr Ringel).

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