Insights from the ganglionic acetylcholine receptor autoantibodies in patients with Sjögren's syndrome
Objective: It is not known whether autonomic neuropathy is a feature of Sjögren's syndrome (SS) or whether it is related to circulating antiganglionic acetylcholine receptor (gAChR) antibodies. The goal of the present study was to investigate the autonomic dysfunction in patients with SS and th...
Gespeichert in:
| Veröffentlicht in: | Modern rheumatology 2016-09, Vol.26 (5), p.708-715 |
|---|---|
| Hauptverfasser: | , , , , , , , , , , , , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 715 |
|---|---|
| container_issue | 5 |
| container_start_page | 708 |
| container_title | Modern rheumatology |
| container_volume | 26 |
| creator | Mukaino, Akihiro Nakane, Shunya Higuchi, Osamu Nakamura, Hideki Miyagi, Tomo Shiroma, Kanako Tokashiki, Takashi Fuseya, Yasuhiro Ochi, Kazuhide Umeda, Masataka Nakazato, Tetsuya Akioka, Shinji Maruoka, Hiroyuki Hayashi, Masatoshi Igarashi, Shu-ichi Yokoi, Katsunori Maeda, Yasuhiro Sakai, Waka Matsuo, Hidenori Kawakami, Atsushi |
| description | Objective: It is not known whether autonomic neuropathy is a feature of Sjögren's syndrome (SS) or whether it is related to circulating antiganglionic acetylcholine receptor (gAChR) antibodies. The goal of the present study was to investigate the autonomic dysfunction in patients with SS and the associations between autonomic dysfunction, anti-gAChR antibodies, and clinical features of SS.
Methods: (1) The first observational study tested for the presence of gAChR antibodies in the serum samples from 39 patients with SS (absent information regarding autonomic symptoms) and healthy volunteers. (2) In the second study, serological and clinical data from 10 Japanese patients diagnosed with SS were reviewed. These patients showed autonomic dysfunction, and luciferase immunoprecipitation systems (LIPS) test was conducted to detect anti-α3 and anti-β4 gAChR antibodies. (3) In the final analysis, we combined the data of seropositive SS patients with autonomic symptom from the first study with all of the patients from the second study, and analyzed the clinical features.
Results: (1) The LIPS assay revealed that anti-gAChRα3 and anti-gAChRβ4 antibodies were detected in the sera from patients with SS (23.1%, 9/39). Five of nine SS patients had autonomic symptoms. (2) Anti-α3 and anti-β4 gAChR antibodies were also detected in 80.0% (8/10) of patients with SS with autonomic symptoms. Six of the ten patients were diagnosed as having SS after neurological symptoms developed. These seropositive patients had predominant and severe autonomic symptoms and were diagnosed with autonomic neuropathy. (3) Thirteen of fifteen SS patients with autonomic symptoms (86.7%) were seropositive for anti-gAChR antibodies, and we confirmed sicca complex, orthostatic hypotension, upper and lower gastrointestinal (GI) symptoms, and bladder dysfunction at high rates.
Conclusion: The present results suggest the possibility of anti-gAChR antibodies aiding the diagnostics of SS with autonomic dysfunction. |
| doi_str_mv | 10.3109/14397595.2016.1147404 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_journals_1823392886</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>4195182101</sourcerecordid><originalsourceid>FETCH-LOGICAL-c549t-2e034fdd6d6c746f725abb62db050263e89808d2606344aff331c4be31e912a73</originalsourceid><addsrcrecordid>eNp9kctuEzEUhi0EoqXwCCBLLGCT4Nt47B2o4lKpEgtgPfLYxxNHM3awParyYrxAX6wTJWHRRVfHOvr-z5Z_hN5SsuaU6E9UcN02ulkzQuWaUtEKIp6hy8N-1Uqin5_PC3SBXpWyJYQ3WumX6IJJ1XKmm0s03MQShk0t2Oc04boBPJg4jCHFYLGxUPej3aQxRMAZLOxqytjMNZlYQ59cgIJDxDtTA8TFchfqBv_a3v8bMsQPBZd9dIsYXqMX3owF3pzmFfrz7evv6x-r25_fb66_3K5sI3RdMSBceOekk7YV0resMX0vmetJQ5jkoLQiyjFJJBfCeM85taIHTkFTZlp-hT4evbuc_s5QajeFYmEcTYQ0l44qKqRigvIFff8I3aY5x-V1C8U410wpuVDNkbI5lZLBd7scJpP3HSXdoYnu3ER3aKI7NbHk3p3scz-B-586f_0CfD4CIfqUJ3OX8ui6avZjyj6baEM5-J-64wEKnplO</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1823392886</pqid></control><display><type>article</type><title>Insights from the ganglionic acetylcholine receptor autoantibodies in patients with Sjögren's syndrome</title><source>MEDLINE</source><source>Oxford University Press Journals All Titles (1996-Current)</source><creator>Mukaino, Akihiro ; Nakane, Shunya ; Higuchi, Osamu ; Nakamura, Hideki ; Miyagi, Tomo ; Shiroma, Kanako ; Tokashiki, Takashi ; Fuseya, Yasuhiro ; Ochi, Kazuhide ; Umeda, Masataka ; Nakazato, Tetsuya ; Akioka, Shinji ; Maruoka, Hiroyuki ; Hayashi, Masatoshi ; Igarashi, Shu-ichi ; Yokoi, Katsunori ; Maeda, Yasuhiro ; Sakai, Waka ; Matsuo, Hidenori ; Kawakami, Atsushi</creator><creatorcontrib>Mukaino, Akihiro ; Nakane, Shunya ; Higuchi, Osamu ; Nakamura, Hideki ; Miyagi, Tomo ; Shiroma, Kanako ; Tokashiki, Takashi ; Fuseya, Yasuhiro ; Ochi, Kazuhide ; Umeda, Masataka ; Nakazato, Tetsuya ; Akioka, Shinji ; Maruoka, Hiroyuki ; Hayashi, Masatoshi ; Igarashi, Shu-ichi ; Yokoi, Katsunori ; Maeda, Yasuhiro ; Sakai, Waka ; Matsuo, Hidenori ; Kawakami, Atsushi</creatorcontrib><description>Objective: It is not known whether autonomic neuropathy is a feature of Sjögren's syndrome (SS) or whether it is related to circulating antiganglionic acetylcholine receptor (gAChR) antibodies. The goal of the present study was to investigate the autonomic dysfunction in patients with SS and the associations between autonomic dysfunction, anti-gAChR antibodies, and clinical features of SS.
Methods: (1) The first observational study tested for the presence of gAChR antibodies in the serum samples from 39 patients with SS (absent information regarding autonomic symptoms) and healthy volunteers. (2) In the second study, serological and clinical data from 10 Japanese patients diagnosed with SS were reviewed. These patients showed autonomic dysfunction, and luciferase immunoprecipitation systems (LIPS) test was conducted to detect anti-α3 and anti-β4 gAChR antibodies. (3) In the final analysis, we combined the data of seropositive SS patients with autonomic symptom from the first study with all of the patients from the second study, and analyzed the clinical features.
Results: (1) The LIPS assay revealed that anti-gAChRα3 and anti-gAChRβ4 antibodies were detected in the sera from patients with SS (23.1%, 9/39). Five of nine SS patients had autonomic symptoms. (2) Anti-α3 and anti-β4 gAChR antibodies were also detected in 80.0% (8/10) of patients with SS with autonomic symptoms. Six of the ten patients were diagnosed as having SS after neurological symptoms developed. These seropositive patients had predominant and severe autonomic symptoms and were diagnosed with autonomic neuropathy. (3) Thirteen of fifteen SS patients with autonomic symptoms (86.7%) were seropositive for anti-gAChR antibodies, and we confirmed sicca complex, orthostatic hypotension, upper and lower gastrointestinal (GI) symptoms, and bladder dysfunction at high rates.
Conclusion: The present results suggest the possibility of anti-gAChR antibodies aiding the diagnostics of SS with autonomic dysfunction.</description><identifier>ISSN: 1439-7595</identifier><identifier>EISSN: 1439-7609</identifier><identifier>DOI: 10.3109/14397595.2016.1147404</identifier><identifier>PMID: 26873295</identifier><language>eng</language><publisher>United States: Taylor & Francis</publisher><subject>Adult ; Aged ; Antiganglionic acetylcholine receptor antibodies ; Autoantibodies - blood ; Autoimmune diseases ; Autonomic dysfunction ; Female ; Humans ; Luciferase immunoprecipitation systems ; Male ; Medical tests ; Middle Aged ; Patients ; Receptors, Cholinergic - immunology ; Sjogren's Syndrome - blood ; Sjogren's Syndrome - immunology ; Sjögren's syndrome</subject><ispartof>Modern rheumatology, 2016-09, Vol.26 (5), p.708-715</ispartof><rights>2016 Japan College of Rheumatology 2016</rights><rights>Copyright Informa Healthcare 2016</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c549t-2e034fdd6d6c746f725abb62db050263e89808d2606344aff331c4be31e912a73</citedby><cites>FETCH-LOGICAL-c549t-2e034fdd6d6c746f725abb62db050263e89808d2606344aff331c4be31e912a73</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,782,786,27931,27932</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26873295$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mukaino, Akihiro</creatorcontrib><creatorcontrib>Nakane, Shunya</creatorcontrib><creatorcontrib>Higuchi, Osamu</creatorcontrib><creatorcontrib>Nakamura, Hideki</creatorcontrib><creatorcontrib>Miyagi, Tomo</creatorcontrib><creatorcontrib>Shiroma, Kanako</creatorcontrib><creatorcontrib>Tokashiki, Takashi</creatorcontrib><creatorcontrib>Fuseya, Yasuhiro</creatorcontrib><creatorcontrib>Ochi, Kazuhide</creatorcontrib><creatorcontrib>Umeda, Masataka</creatorcontrib><creatorcontrib>Nakazato, Tetsuya</creatorcontrib><creatorcontrib>Akioka, Shinji</creatorcontrib><creatorcontrib>Maruoka, Hiroyuki</creatorcontrib><creatorcontrib>Hayashi, Masatoshi</creatorcontrib><creatorcontrib>Igarashi, Shu-ichi</creatorcontrib><creatorcontrib>Yokoi, Katsunori</creatorcontrib><creatorcontrib>Maeda, Yasuhiro</creatorcontrib><creatorcontrib>Sakai, Waka</creatorcontrib><creatorcontrib>Matsuo, Hidenori</creatorcontrib><creatorcontrib>Kawakami, Atsushi</creatorcontrib><title>Insights from the ganglionic acetylcholine receptor autoantibodies in patients with Sjögren's syndrome</title><title>Modern rheumatology</title><addtitle>Mod Rheumatol</addtitle><description>Objective: It is not known whether autonomic neuropathy is a feature of Sjögren's syndrome (SS) or whether it is related to circulating antiganglionic acetylcholine receptor (gAChR) antibodies. The goal of the present study was to investigate the autonomic dysfunction in patients with SS and the associations between autonomic dysfunction, anti-gAChR antibodies, and clinical features of SS.
Methods: (1) The first observational study tested for the presence of gAChR antibodies in the serum samples from 39 patients with SS (absent information regarding autonomic symptoms) and healthy volunteers. (2) In the second study, serological and clinical data from 10 Japanese patients diagnosed with SS were reviewed. These patients showed autonomic dysfunction, and luciferase immunoprecipitation systems (LIPS) test was conducted to detect anti-α3 and anti-β4 gAChR antibodies. (3) In the final analysis, we combined the data of seropositive SS patients with autonomic symptom from the first study with all of the patients from the second study, and analyzed the clinical features.
Results: (1) The LIPS assay revealed that anti-gAChRα3 and anti-gAChRβ4 antibodies were detected in the sera from patients with SS (23.1%, 9/39). Five of nine SS patients had autonomic symptoms. (2) Anti-α3 and anti-β4 gAChR antibodies were also detected in 80.0% (8/10) of patients with SS with autonomic symptoms. Six of the ten patients were diagnosed as having SS after neurological symptoms developed. These seropositive patients had predominant and severe autonomic symptoms and were diagnosed with autonomic neuropathy. (3) Thirteen of fifteen SS patients with autonomic symptoms (86.7%) were seropositive for anti-gAChR antibodies, and we confirmed sicca complex, orthostatic hypotension, upper and lower gastrointestinal (GI) symptoms, and bladder dysfunction at high rates.
Conclusion: The present results suggest the possibility of anti-gAChR antibodies aiding the diagnostics of SS with autonomic dysfunction.</description><subject>Adult</subject><subject>Aged</subject><subject>Antiganglionic acetylcholine receptor antibodies</subject><subject>Autoantibodies - blood</subject><subject>Autoimmune diseases</subject><subject>Autonomic dysfunction</subject><subject>Female</subject><subject>Humans</subject><subject>Luciferase immunoprecipitation systems</subject><subject>Male</subject><subject>Medical tests</subject><subject>Middle Aged</subject><subject>Patients</subject><subject>Receptors, Cholinergic - immunology</subject><subject>Sjogren's Syndrome - blood</subject><subject>Sjogren's Syndrome - immunology</subject><subject>Sjögren's syndrome</subject><issn>1439-7595</issn><issn>1439-7609</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kctuEzEUhi0EoqXwCCBLLGCT4Nt47B2o4lKpEgtgPfLYxxNHM3awParyYrxAX6wTJWHRRVfHOvr-z5Z_hN5SsuaU6E9UcN02ulkzQuWaUtEKIp6hy8N-1Uqin5_PC3SBXpWyJYQ3WumX6IJJ1XKmm0s03MQShk0t2Oc04boBPJg4jCHFYLGxUPej3aQxRMAZLOxqytjMNZlYQ59cgIJDxDtTA8TFchfqBv_a3v8bMsQPBZd9dIsYXqMX3owF3pzmFfrz7evv6x-r25_fb66_3K5sI3RdMSBceOekk7YV0resMX0vmetJQ5jkoLQiyjFJJBfCeM85taIHTkFTZlp-hT4evbuc_s5QajeFYmEcTYQ0l44qKqRigvIFff8I3aY5x-V1C8U410wpuVDNkbI5lZLBd7scJpP3HSXdoYnu3ER3aKI7NbHk3p3scz-B-586f_0CfD4CIfqUJ3OX8ui6avZjyj6baEM5-J-64wEKnplO</recordid><startdate>20160902</startdate><enddate>20160902</enddate><creator>Mukaino, Akihiro</creator><creator>Nakane, Shunya</creator><creator>Higuchi, Osamu</creator><creator>Nakamura, Hideki</creator><creator>Miyagi, Tomo</creator><creator>Shiroma, Kanako</creator><creator>Tokashiki, Takashi</creator><creator>Fuseya, Yasuhiro</creator><creator>Ochi, Kazuhide</creator><creator>Umeda, Masataka</creator><creator>Nakazato, Tetsuya</creator><creator>Akioka, Shinji</creator><creator>Maruoka, Hiroyuki</creator><creator>Hayashi, Masatoshi</creator><creator>Igarashi, Shu-ichi</creator><creator>Yokoi, Katsunori</creator><creator>Maeda, Yasuhiro</creator><creator>Sakai, Waka</creator><creator>Matsuo, Hidenori</creator><creator>Kawakami, Atsushi</creator><general>Taylor & Francis</general><general>Informa Healthcare</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>7X8</scope></search><sort><creationdate>20160902</creationdate><title>Insights from the ganglionic acetylcholine receptor autoantibodies in patients with Sjögren's syndrome</title><author>Mukaino, Akihiro ; Nakane, Shunya ; Higuchi, Osamu ; Nakamura, Hideki ; Miyagi, Tomo ; Shiroma, Kanako ; Tokashiki, Takashi ; Fuseya, Yasuhiro ; Ochi, Kazuhide ; Umeda, Masataka ; Nakazato, Tetsuya ; Akioka, Shinji ; Maruoka, Hiroyuki ; Hayashi, Masatoshi ; Igarashi, Shu-ichi ; Yokoi, Katsunori ; Maeda, Yasuhiro ; Sakai, Waka ; Matsuo, Hidenori ; Kawakami, Atsushi</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c549t-2e034fdd6d6c746f725abb62db050263e89808d2606344aff331c4be31e912a73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Antiganglionic acetylcholine receptor antibodies</topic><topic>Autoantibodies - blood</topic><topic>Autoimmune diseases</topic><topic>Autonomic dysfunction</topic><topic>Female</topic><topic>Humans</topic><topic>Luciferase immunoprecipitation systems</topic><topic>Male</topic><topic>Medical tests</topic><topic>Middle Aged</topic><topic>Patients</topic><topic>Receptors, Cholinergic - immunology</topic><topic>Sjogren's Syndrome - blood</topic><topic>Sjogren's Syndrome - immunology</topic><topic>Sjögren's syndrome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mukaino, Akihiro</creatorcontrib><creatorcontrib>Nakane, Shunya</creatorcontrib><creatorcontrib>Higuchi, Osamu</creatorcontrib><creatorcontrib>Nakamura, Hideki</creatorcontrib><creatorcontrib>Miyagi, Tomo</creatorcontrib><creatorcontrib>Shiroma, Kanako</creatorcontrib><creatorcontrib>Tokashiki, Takashi</creatorcontrib><creatorcontrib>Fuseya, Yasuhiro</creatorcontrib><creatorcontrib>Ochi, Kazuhide</creatorcontrib><creatorcontrib>Umeda, Masataka</creatorcontrib><creatorcontrib>Nakazato, Tetsuya</creatorcontrib><creatorcontrib>Akioka, Shinji</creatorcontrib><creatorcontrib>Maruoka, Hiroyuki</creatorcontrib><creatorcontrib>Hayashi, Masatoshi</creatorcontrib><creatorcontrib>Igarashi, Shu-ichi</creatorcontrib><creatorcontrib>Yokoi, Katsunori</creatorcontrib><creatorcontrib>Maeda, Yasuhiro</creatorcontrib><creatorcontrib>Sakai, Waka</creatorcontrib><creatorcontrib>Matsuo, Hidenori</creatorcontrib><creatorcontrib>Kawakami, Atsushi</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Modern rheumatology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mukaino, Akihiro</au><au>Nakane, Shunya</au><au>Higuchi, Osamu</au><au>Nakamura, Hideki</au><au>Miyagi, Tomo</au><au>Shiroma, Kanako</au><au>Tokashiki, Takashi</au><au>Fuseya, Yasuhiro</au><au>Ochi, Kazuhide</au><au>Umeda, Masataka</au><au>Nakazato, Tetsuya</au><au>Akioka, Shinji</au><au>Maruoka, Hiroyuki</au><au>Hayashi, Masatoshi</au><au>Igarashi, Shu-ichi</au><au>Yokoi, Katsunori</au><au>Maeda, Yasuhiro</au><au>Sakai, Waka</au><au>Matsuo, Hidenori</au><au>Kawakami, Atsushi</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Insights from the ganglionic acetylcholine receptor autoantibodies in patients with Sjögren's syndrome</atitle><jtitle>Modern rheumatology</jtitle><addtitle>Mod Rheumatol</addtitle><date>2016-09-02</date><risdate>2016</risdate><volume>26</volume><issue>5</issue><spage>708</spage><epage>715</epage><pages>708-715</pages><issn>1439-7595</issn><eissn>1439-7609</eissn><abstract>Objective: It is not known whether autonomic neuropathy is a feature of Sjögren's syndrome (SS) or whether it is related to circulating antiganglionic acetylcholine receptor (gAChR) antibodies. The goal of the present study was to investigate the autonomic dysfunction in patients with SS and the associations between autonomic dysfunction, anti-gAChR antibodies, and clinical features of SS.
Methods: (1) The first observational study tested for the presence of gAChR antibodies in the serum samples from 39 patients with SS (absent information regarding autonomic symptoms) and healthy volunteers. (2) In the second study, serological and clinical data from 10 Japanese patients diagnosed with SS were reviewed. These patients showed autonomic dysfunction, and luciferase immunoprecipitation systems (LIPS) test was conducted to detect anti-α3 and anti-β4 gAChR antibodies. (3) In the final analysis, we combined the data of seropositive SS patients with autonomic symptom from the first study with all of the patients from the second study, and analyzed the clinical features.
Results: (1) The LIPS assay revealed that anti-gAChRα3 and anti-gAChRβ4 antibodies were detected in the sera from patients with SS (23.1%, 9/39). Five of nine SS patients had autonomic symptoms. (2) Anti-α3 and anti-β4 gAChR antibodies were also detected in 80.0% (8/10) of patients with SS with autonomic symptoms. Six of the ten patients were diagnosed as having SS after neurological symptoms developed. These seropositive patients had predominant and severe autonomic symptoms and were diagnosed with autonomic neuropathy. (3) Thirteen of fifteen SS patients with autonomic symptoms (86.7%) were seropositive for anti-gAChR antibodies, and we confirmed sicca complex, orthostatic hypotension, upper and lower gastrointestinal (GI) symptoms, and bladder dysfunction at high rates.
Conclusion: The present results suggest the possibility of anti-gAChR antibodies aiding the diagnostics of SS with autonomic dysfunction.</abstract><cop>United States</cop><pub>Taylor & Francis</pub><pmid>26873295</pmid><doi>10.3109/14397595.2016.1147404</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1439-7595 |
| ispartof | Modern rheumatology, 2016-09, Vol.26 (5), p.708-715 |
| issn | 1439-7595 1439-7609 |
| language | eng |
| recordid | cdi_proquest_journals_1823392886 |
| source | MEDLINE; Oxford University Press Journals All Titles (1996-Current) |
| subjects | Adult Aged Antiganglionic acetylcholine receptor antibodies Autoantibodies - blood Autoimmune diseases Autonomic dysfunction Female Humans Luciferase immunoprecipitation systems Male Medical tests Middle Aged Patients Receptors, Cholinergic - immunology Sjogren's Syndrome - blood Sjogren's Syndrome - immunology Sjögren's syndrome |
| title | Insights from the ganglionic acetylcholine receptor autoantibodies in patients with Sjögren's syndrome |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-04T21%3A49%3A35IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Insights%20from%20the%20ganglionic%20acetylcholine%20receptor%20autoantibodies%20in%20patients%20with%20Sj%C3%B6gren's%20syndrome&rft.jtitle=Modern%20rheumatology&rft.au=Mukaino,%20Akihiro&rft.date=2016-09-02&rft.volume=26&rft.issue=5&rft.spage=708&rft.epage=715&rft.pages=708-715&rft.issn=1439-7595&rft.eissn=1439-7609&rft_id=info:doi/10.3109/14397595.2016.1147404&rft_dat=%3Cproquest_cross%3E4195182101%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1823392886&rft_id=info:pmid/26873295&rfr_iscdi=true |