Abdominal symptoms during Sjogren's syndrome: a pilot study

Abstract Background: Abdominal symptoms in patients with primary Sjögren syndrome (pSS) are poorly documented. The objective of the study was to describe the abdominal symptoms of patients with pSS and to assess their association with characteristics of the disease. Methods: One hundred and fifty patients with pSS were evaluated using a composite global symptom score for abdominal symptoms and their severity. Data concerning the clinical and biological characteristics of pSS and abdominal disorders were also collected. Results: Of the patients with pSS, 95% suffered from abdominal symptoms (median global symptom score 7.5 ±5.5 points out of 30). More than half of the patients experienced abdominal tension (68%), upper abdominal pain (54%), abdominal discomfort (58%) and/or constipation (54%). Regarding the pSS activity, in relation to European League Against Rheumatism (EULAR) Sjogren syndrome disease activity index score items, general and central nervous system involvement wereassociated with a high global symptom score. The EULAR Sjogren Syndrome Patient Reported Index (ESSPRI) symptom score was positively correlated with the global symptom score (p < 0.01). Multivariate analysis showed a significant association between a high global symptom score and SSA seronegativity, gastroparesis, and ESSPRI score (p < 0.01 for each). Conclusions: The majority of patients with pSS suffered abdominal symptoms. There is currently no therapeutic recommendation because of the lack of information on the underlying pathophysiological mechanisms. Trial registration: NCT03157011. Date of registration: July 17, 2017.(AU)

Disfunción temporomandibular en pacientes con síndrome de Sjögren / Temporomandibular dysfunction in patients with Sjögren's syndrome

Introducción: El síndrome de Sjögren es una enfermedad reumática, inflamatoria y crónica caracterizada por dolor articular y resequedad de las mucosas. La articulación temporomandibular (ATM) y las glándulas parótidas y salivales suelen estar afectadas. Objetivo: Determinar la prevalencia de la afectación de la articulación temporomandibular en pacientes con síndrome de Sjögren. Métodos: Estudio básico, no experimental, descriptivo y de corte transversal que incluyó a 78 pacientes con diagnóstico de síndrome de Sjögren atendidos en la Unidad Móvil número 2 de Alausi entre 2017 y 2019. Para identificar la afectación de la ATM se realizaron ecosonografías. Se usó la prueba de correlación de Pearson para establecer la relación entre las características de la enfermedad y la presencia de afectación articular. Resultados: El promedio de edad fue de 46,18 años. Predominaron los pacientes entre 40 y 60 años (62,82 por ciento), el sexo femenino (85,90 por ciento), y el tiempo de evolución de la enfermedad entre 3 y 5 años (50,00 por ciento). El 79,49 por ciento presentó síndrome de Sjögren secundario, y la artritis reumatoide fue la causa más frecuente (54,84 por ciento). El 65,38 por ciento tenía algún tipo de afectación de la ATM, y el hallazgo más común fue la disminución del espacio articular (56,86 por ciento). Conclusiones: Existió una elevada prevalencia de afectación de la ATM en los pacientes con síndrome de Sjögren, y el hallazgo principal fue la disminución del espacio articular. Se encontró una correlación positiva media entre el tiempo de evolución de la enfermedad y la presencia de afectación de la ATM(AU)

Introduction: Sjögren's syndrome is a rheumatic, inflammatory and chronic disease characterized by the presence of joint pain and dryness of the mucous membranes. The temporomandibular joint and the parotid and salivary glands usually have a high frequency of involvement. Objective: To determine the prevalence of temporomandibular involvement in patients with Sjögren's syndrome. Methods: Descriptive, correlational and explanatory study that included 78 patients diagnosed with Sjögren's syndrome treated in the mobile unit number 2 of Alausi. Echocardiography of the temporomandibular joints was performed to identify the involvement of the joint. Pearson's correlation test was used to establish a relationship between the characteristics of the disease and the presence of joint involvement. Results: Average age of 46.18 years with a predominance of patients between 40 and 60 years of age (62.82 percent), of the female sex (85.90 percent) and with time of evolution of the disease between 3 and 5 years (50.00 percent). 79.49 percent of the cases presented secondary Sjögren's syndrome, rheumatoid arthritis being the most frequent disease (54.84 percent). 65.38 percent of the patients presented some type of involvement of the temporomandibular joint, with the decrease in joint space being the most frequent finding (56.86 percent). Conclusions: There was a high prevalence of temporomandibular joint involvement in patients with Sjögren's syndrome, with the decrease in joint space being the finding that was most frequently identified. A positive average correlation was found between the time of evolution of the disease and the presence of temporomandibular joint involvement(AU)

Manifestaciones bucales del síndrome de Sjögren. Presentación de un caso / Oral manifestations of the Sjögren's syndrome. Presentation of a case

El síndrome de Sjögren es una enfermedad autoinmunitaria, caracterizada por la infiltración linfoplasmocitaria de las glándulas exocrinas con destrucción epitelial, provocando un síndrome seco. El objetivo de esta presentación de caso fue profundizar en el conocimiento de la enfermedad, ya que constituye la clave para su diagnóstico oportuno. Se presentó a una paciente femenina de 54 años, con antecedentes de lupus eritematoso sistémico. El interrogatorio, el examen clínico general y bucal, los estudios de laboratorio e histológico, así como la sospecha clínica de la enfermedad, permitieron realizar el diagnóstico del síndrome de Sjögren asociado a lupus eritematoso sistémico. En esta paciente concurrieron las siguientes manifestaciones bucales: xerostomía, halitosis, sensación de sed constante, dificultades para la deglución y para hablar, labios secos y pálidos, lengua depapilada, ardor bucal, intolerancia al uso de la prótesis, queilitis angular y candidiasis bucal. El manejo de la enfermedad tiene un enfoque multidisciplinario; el estomatólogo cumple un papel esencial en su diagnóstico y tratamiento, lo cual permite mejorar la calidad de vida de estos pacientes.

The Sjögren’s syndrome is an auto-immune disease, characterized by the limpho-plasmocytic infiltration of the exocrine glands with epithelial destruction, provoking a dry syndrome. The objective of this case presentation was deepening in this disease knowledge, because it is the key for its opportune diagnosis. We presented a female patient, aged 54 years, with antecedents of systemic lupus erythematosus. The anamnesis, oral and general examination, histological and laboratory studies, and also the clinical suspicion, allowed arriving to the diagnosis of Sjögren’s syndrome associated to systemic lupus erythematosus. This patient showed the following oral manifestations: xerostomia, halitosis, sensation of constant thirst, difficulties for deglutition and speaking, dry and pale lips, depapillated tongue, oral burning, intolerance to prosthesis usage, angular cheilitis and oral candidiasis. The disease management has a multidiscipline approach; the dentist plays an essential role in the disease’s diagnosis and treatment, allowing improving the life quality of these patients.

Secondary Sjögren's syndrome and disease activity of rheumatoid arthritis / Síndrome de Sjögren secundária e atividade da artrite reumatoide

OBJECTIVE: To study the relationship of the presence of secondary SS with disease activity, duration in RA. METHODS: Eighty two patients with RA were submitted to Schirmer test, minor salivary gland biopsy, questionnaire on sicca symptoms, DAS-28 4v determination. RESULTS: In this population, 20 (24.3 percent) patients fulfilled the American-European classification criteria for secondary SS. No relation could be found between the presence of secondary SS and disease activity (p = 0.31) and RA duration (p = 0.95). CONCLUSION: Appearance of Secondary SS in RA patients is independent of RA duration or activity.

OBJETIVO: Estudar a associação entre presença de SS secundária e atividade e duração da artrite reumatoide. MÉTODOS: Oitenta e dois pacientes com artrite reumatoide foram submetidos ao teste de Schirmer, biópsia de glândula salivar menor, questionários acerca de sintomas de secura e determinação do DAS28 4v. RESULTADOS: Nesta população, 20 (24,3 por cento) dos pacientes preenchiam os Critérios Americanos Europeus para classificação de SS Secundário. Nenhuma associação foi encontrada entre presençade SS secundário e atividade da doença (p = 0.31) e duração da doença (p = 0.95). CONCLUSÃO: O aparecimento de SS secundário em AR é independente da duração e atividade da AR.

Suppurative dacroadenitis causing ocular sicca syndrome in classic Wegener’s granulomatosis.

Wegener’s granulomatosis (WG) is a multisystem vasculitic disorder which can commonly afflict various components of the eye. Here we describe some unusual ocular manifestations of the disease in one patient. A young male with history of upper respiratory tract symptoms including epistaxis, nasal stuffiness and maxillary sinus pain presented with bilateral lacrimal gland abscess and ptosis. Lacrimal gland biopsy revealed granulomatous vasculitis. Lung cavities, positive cytoplasmic-antineutrophil cytoplasmic antibodies and high titers of serine proteinase-3 antibodies confirmed the diagnosis of WG. The patient developed dry eyes after a month of first presentation. There was no dryness of mouth, suggesting the absence of salivary gland involvement, and antinuclear antibodies as well as antibodies against Ro and La antigens classical of primary Sjogren’s syndrome were absent. Granulomatous vasculitis of lacrimal gland leading to abscess formation and dryness of eyes has not been described in WG and reflects the aggressive nature of inflammatory process in this disease.

Síndrome de Sjögren / Sjögren syndrome

Se realiza una revisión de las bases de datos a las que se puede acceder a través de Internet sobre temas de medicina, así como de las principales revistas y sitios que tratan sobre afecciones reumatológicas buscando los conceptos más actuales que se presentan sobre el síndrome de Sjögren (SS), elementos de su cuadro clínico y complicaciones que pudieran ser útiles para el personal médico que labora en todos los niveles de salud donde se puedan presentar pacientes con esta entidad, logrando recuperar 71 citas de los últimos años útiles para nuestros fines, de las que exponemos los elementos más actuales encontrados en cuanto a los mecanismos etiopatogénicos presentes en su evolución, cuadro clínico, terapéutica y complicaciones más frecuentes

Authors made a review of databases to which it is possible to enter in Internet on medicine subjects, as well as of leading journals and sites related to Rheumatology affections to search the more updated concepts on Sj÷gren syndrome, elements of its clinical picture and complications that could be useful for medical staff working at all health levels where may be patients presenting with this entity, achieving to recover 71 quotations of past years essential for our aims showing the more updated elements found as regards the etiopathogeny mechanism present in its course, clinical picture, therapeutics and more frequent complications

Curso de Reumatologia: aula 4: manifestações gastrointestinais nas colagenoses / Course of Rheumatology: class 4: gastrointestinal manifestations in collagenosis

O termo colagenose, surgido em 1942, é hoje substituído por doenças difusas do tecido conjuntivo, que se constituem em um grupo de moléstias que afetam o tecido conjuntivo, rico em colágeno. São enfermidades que podem comprometer vários sistemas e múltiplos órgãos, sendo, portanto, de caráter sistêmico. O objetivo desta aula é discutir as manifestações gastrointestinais e sua abordagem terapêutica. Serão focadas algumas doenças difusas do tecido conjuntivo, a saber: esclerose sistêmica, lúpis eritematoso sistêmico, dermatopolimiosite e Sjõgren.

The term "collagen diseases" was first introduced by Klemperer in 1942, and is currently been called connective tissue diseases. All the organ and systems are both affected by them, so that's why it can be called systemic diseases. The aim of this lesson is to discuss gastrointestinal manifestations and its therapeutic approach, while it will be detailed the connective tissue diseases like systemic sclerosis, systemic lupus erythematosus, polymyositis/dermatomyositis and Sjõgren's syndrome.

Prevalência de manifestações oculares em 198 pacientes com artrite reumatóide: um estudo retrospectivo / Prevalence of ocular manifestation in 198 patients with rheumatoid arthritis: a restrospective study

OBJETIVO: Estimar a prevalência de manifestações oculares na população local de artrite reumatóide (AR). Estimar se a presença de auto-anticorpos como fator reumatóide (FR) e fator antinuclear (FAN) influi no aparecimento destas manifestações e se existe associação entre o aparecimento de manifestações oculares e índice funcional do paciente, idade ao diagnóstico e tempo de doença. MÉTODOS: Foram estudados retrospectivamente 198 prontuários de pacientes com AR, acompanhados durante o período de 2003 a 2006. Avaliou-se a prevalência das manifestações oftalmológicas, perfil de auto-anticorpos, dados demográficos e índice funcional de Steinbrock destes pacientes. RESULTADOS: Síndrome de Sjõgren secundária apareceu em 12,1 por cento dos pacientes sendo mais comum em mulheres (p=0,049) e em pacientes com maior dano articular (p=0,016). Ceratite ulcerativa e esclerite incidiram em torno de 2 por cento dos pacientes. Fator reumatóide (FR) e fator antinuclear (FAN) assim como tempo de doença e idade do paciente ao diagnóstico não influíram no aparecimento das manifestações estudadas. CONCLUSÃO: A síndrome de Sjõgren secundária é a manifestação ocular mais prevalente em pacientes com AR, sendo mais comum em mulheres e em pacientes com mais disfunção articular.

PURPOSE: To study the prevalence of eye manifestations in the local rheumatoid arthritis (RA) population, as well as to know if the presence of rheumatoid factor (RF) and antinuclear antibodies (ANA) affect this profile. To study if there is association between eye manifestations and patient's articular functional index, age at diagnosis and illness duration. METHODS: We reviewed 198 charts of rheumatoid arthritis patients followed-up from 2003 to 2006. They were studied for: prevalence of ophthalmologic manifestations, autoantibody profile, demographic data and Steinbrock's functional index. RESULTS: Secondary Sjõgren's syndrome was seen in 12.1 percent of the patients being more common in women (p=0.049) and in patients with greater articular damage (p=0.016). Ulcerative keratitis and scleritis appeared in 2 percent of patients each. Antinuclear antibodies (ANA) and rheumatoid factor (RF) as well as illness duration and age at diagnosis had no influence in the appearance of eye manifestations. CONCLUSION: Secondary Sjõgren syndrome was the most common ocular manifestation in patients with RA, mainly in women and patients with greater joint damage.

La xerostomía en el síndrome de Sjögren: tratamientos paliativos: revisión bibliográfica actualizada / Xerostomia in Sjögren syndrome: coadjuvant treatment: an updated review of the literature

El objetivo de este trabajo fue la revisión bibliográfica actualizada del Síndrome de Sjõgren (SS), la Xerostomía como síntoma inducido por SS y los diferentes productos que existen para el tratamiento coadyuvante de estos síntomas. El Síndrome de Sjõgren (SS) es un trastorno autosómico recesivo, que se caracteriza por la tríada de ojos y boca seca (xeroftalmia y xerostomía) Síndrome Primario SSP y cuando tiene asociación con alguna enfermedad del tejido conectivo, es el Síndrome Secundario SSS. La sequedad en los ojos va a ocasionar sensación de quemadura y dolor alrededor de estos, fotosensibilidad, déficit y fatiga visual. La sequedad en la boca va a ocasionar dificultad en la masticación, deglución y fonación. Es posible la hipertrofia de glándulas lacrimales, parótidas y submaxilares así como linfoadenopatías en ganglios parotídeos y submaxilares. Abarca también aparato respiratorio, piel y, en mujeres, la vagina. En el mercado hay una cantidad limitada de productos que tratan de proporcionarle al paciente con SS una relativa mejoría en sus funciones de masticación, ingesta, digestión, fonación y secreción salival.

The main objective of this article was updated literature review of Sjögren Syndrome (SS), the Xerostomia as a symptom induced by the SS and the different medications used for the treatment of these symptoms. The Sjögren Syndrome (SS) is a recessive autosomic disease, which is characterized by the triad of dry eyes mouth (xerophthalmia and xerostomia) Primary Syndrome PSS and when it has association with some illness connective tissue, is the Secondary Syndrome SSS. The dryness in the eyes causes burning sensation and pain around of these, photosensibility, deficit and visual fatigue. The dryness in the mouth is going to produce difficulty in the chewing, deglution and phonation. The hypertrophy is possible in lachrymals, parotids and submaxillary glands as well as lymphadenopaty in parotid and submaxillary ganglions. It also embraces respiratory system, skin and, in women, the vagina. On the market there is a limited quantity of products that try to provide the patient with SS a relative improvement in the chewing, intake, digestion, phonation and salivary secretion functions.

Avaliação da sialometria e biópsia de glândula salivar menor na classificação de pacientes com Síndrome de Sjõgren

A Síndrome de Sjõgren é afecção auto-imune das glândulas exócrinas, que envolve particularmente as glândulas salivares e lacrimais. Não existe exame de certeza para diagnóstico. OBJETIVO: Avaliação da importância do papel da biópsia de glândula salivar menor e da sialometria, isoladamente ou associadas, como métodos utilizados para a classificação da Síndrome de Sjõgren. FORMA DE ESTUDO: Coorte transversal. CASUíSTICA E MÉTODO: Todos os 72 pacientes com queixa de boca seca, de janeiro de 1997 a setembro de 2003, foram submetidos à investigação diagnóstica e classificação com base nos critérios estabelecidos. A sialometria não-estimulada foi realizada com a técnica do swab. Os exames histopatológicos foram avaliados quanto à presença de focos inflamatórios. RESULTADOS: A sialometria não-estimulada e a biópsia de glândula salivar menor apresentaram sensibilidades diferentes para Síndrome de Sjõgren primária e Síndrome de Sjõgren secundária. A sialadenite focal com maior número de focos foi característica da Síndrome de Sjõgren primária. Compararam-se biópsia e sialometria e observou-se que a especificidade e o valor preditivo positivo da biópsia foram maiores. Entre biópsia e biópsia associada à sialometria, a biópsia teve maior sensibilidade e maior valor preditivo negativo. A especificidade da biópsia associada à sialometria foi maior. Entre sialometria e biópsia associada à sialometria, a biópsia associada à sialometria apresentou maior valor preditivo positivo e maior especificidade. A sensibilidade da sialometria foi maior. CONCLUSÕES: Os testes sialometria e biópsia apresentaram desempenhos diferentes nos pacientes com Síndrome de Sjõgren primária e secundária; a positividade dos dois critérios em conjunto aumenta muito a especificidade para Síndrome de Sjõgren (95 por cento).

Compromiso de las glándulas salivales en la enfermedad HIV/Sida / Salivary glands involvement in HIV/AIDS disease

La enfermedad de las glándulas salivales asociada al HIV es definida como la presencia de aumento del tamaño de la glándula asociado o no a xerostomía. Esta patología es más habitual en niños que en adultos. La enfermedad de las glándulas salivales asociada al HIV incluye lesiones linfoepiteliales y quistes que comprometen el tejido glandulas y/o los ganglios linfáticos, síndrome símil-Sjogren, síndrome de linfocitosis T CD8 difuso y neoplasias. Este artículo incluye una revisión de la epidemiología, la fisiopatología, las manifestaciones clínicas, la metodololgía diagnóstica y los diagnósticos diferenciales de la enfermedad de las glándulas salivales asociada al HIV

Sindrome de Sjogren y linfoma. A proposito de dos casos / Sjogren Syndrome and lymphoma

El conocimiento de las enfermedades hematologicas malignas asociadas a enfermedades reumaticas es fragmentario e incompleto. Se presentan dos casos de linfoma coexistiendo con Sindrome de Sjogren. El primer caso se trata de un linfoma de celulas grandes de alto grado de malignidad asociado a un sindrome de Sjogren secundario a enfermedad mixta del tejido conectivo. El segundo caso es el de un linfoma nodal de pequeñas celulas y bajo grado de malignidad, que plantea diagnostico diferencial entre asociacion de patologia autoinmune y linfoma, o bien de un cuadro Sjogren like producido por enfermedad hematologica primaria

Paucity of anti-hepatitis C virus antibodies in the serum of Indian patients with Sjogren's syndrome and inflammatory myositis.

Several extrahepatic manifestations have been associated with infection with Hepatitis C virus (HCV) infection. It has been associated with Sjogren's syndrome (SS) and inflammatory myositis (IM). The objective was to look at the prevalence of anti-HCV antibodies in the serum of SS and IM patients of Indian origin. Individuals satisfying the European Economic Community criteria for the diagnosis of SS and those satisfying the criteria of Bohan and Peter for the diagnosis of IM were recruited in the study. Routine evaluation for liver functions was made. Anti-HCV antibodies were tested by a third generation ELISA, using microplate HCV3.0 ELISA. Of the 23 patients with SS studied, 14 had extraglandular features. The commonest were anaemia and arthritis in six each, followed by in lymphopenia in two. One patient each had interstitial lung disease, hypothyroidism and chronic active hepatitis. Twenty-two patients with IM were studied alongside. None of the patients had abnormal liver functions. One patient with primary SS tested positive for anti-HCV antibodies. None of the patients with inflammatory myositis tested positive for anti-HCV antibodies. The presence of anti-HCV antibodies in our cohort of patients with SS and IM is low and more in keeping with the generally low prevalence of the infection in the Indian population.

Actualización diagnóstica y terapéutica: síndrome de sjogren / Diagnostic and therapeutic updating: sjogren syndrome

Se presenta el caso de una parotiditis recurrente secundaría al síndrome Sicca. Se revisan los criterios clínicos y paraclínicos del síndrome de Sjögren con los aspectos más importantes que debe conocer el otorrinolaringólogo en el diagnóstico y tratamiento de esta comun patología

Síndrome de sjögren primario: caracteristicas clínicas e inmunogenéticas

Objetivo: Examinar las características clínicas del síndrome de Sjögren (SS) primario en pacientes colombianos, y analizar la asociación de los genes HLA-DRB1 y DQB1 con la presencia y severidad de la enfermedad. Métodos: Este es un estudio transversal y comparativo. Todos los pacientes cumplieron con los criterios europeos para la clasificación de SS primario, incluyendo una biopsia positiva de las glándulas salivales menores (GSM); y fueron evaluados utilizando un registro que incluyó el compromiso exocrino y no exocrino de la enfermedad. Los anticuerpos antinucleares se determinaron por IFI en células Hep-2, los anticuerpos anti-Ro (IgG) y anti-La (IgG) se determinaron por ELISA. El polimorfismo de los genes HLA-DRB1 y DQB1 fue examinado mediante reacción en cadena de la polimerasa con iniciadores de secuencia específica. La severidad de la enfermedad fue determinada por la relación entre el puntaje por focos inflamatorios en GSM (método de Daniels) y la duración de la enfermedad (en años). Resultados: Se estudiaron 74 pacientes (97 por ciento mujeres) de Medellín y Santafé de Bogotá, y 76 individuos sanos apareados por edad, sexo y geografía. La enfermedad tuvo una presentación clínica similar a la del resto del mundo, y se asoció con el haplotipo HLA-DRB1*0301-DQB1*0201 (OR: 4.3, IC 95 por ciento: 1.6-12, p=0.002). Este a su vez se asoció con una severidad > 1 (OR: 15.5, IC 95 por ciento: 1.8-129, p=0.001), a la presencia de anticuerpos anti-Ro (OR:4.3, IC 95 por ciento:1.3-14, p=0.01). La frecuencia alélica del HLA-DQB1*0602 fue mayor en los controles (0.303) que en los pacientes (0.121) (OR:0.3, IC 95 por ciento: 0.2-0.8, p=0.01). Conclusión: El presente estudio describe las caracteráisticas clínicas del SS primario, confirmando la similitud de éstas en diferntes razas, y muestra, por primera vez en la población colombiana, la asociación del HLA-DRB1*0301-DQB1*0201 a la enfermedad y a su gravedad, así como el papel protector del HLA-DQB1*0602. La presencia de una carga negativa en la posición B71 del HLA-DRB1*0301 y DQB1*0201 así como una carga negativa en la posición b74 del hla-DQB1*0602 permite una explicación funcional del papel de estos alelos en la predisposición y protección de la enfermedad.

El gen tax del virus linfotrópico humano tipo I en la identificación etiológica de la paraparesia espástica tropical: estudio clínico, serológico y de polimerasa en cadena en 72 pacientes / HTLV-I tax gene on the etiological identification of tropical spastic paraparesis: a clinical, serological and polymerase chain reaction study in 72 patients

Background: Tropical spastic paraparesis (TSP) is an endemic disease in Chile. In most countries, only 50 percent of patients are seropositive to HTLV-I. However, new studies suggest that seronegative TSP is also associated with HTLV-I. Aim: To describe clinical and virological features of seronegative patients with TSP. Patients and methods: seventy two chilean patients with TSP, studied by clinical, radiological and laboratory methods during 1998, are reported. The determination of antibodies to HTLV-I was accomplished by ELISA, immunofluorescence and western-blot analysis. Polymerase chain reaction for tax and 5'Ltr genes was made using primers SK 43-44, LTR1 and LTR6. Results: Thirty one patients were HTLV-I positive and 41 were negative. No clinical, radiological or laboratory differences were observed between both groups. In seropositive patients, tax and 5'ltr viral gene sequences of the HTLV-I provirus were detected in DNA of peripheral blood mononuclear cells. In seronegative cases, sequences of tax gene were detected, exclusively, in 18 of 41 patients. Conclusions: These results confirm an association with HTLV-I infection in 43,9 percent of the TSP seronegative patients. These findings support the hypothesis that a defective provirus infects peripheral blood mononuclear cells in seronegative cases of TSP. The importance tax gene in the diagnosis of the TSP is also emphasized