## 4 Discussion  
Current SS diagnostic criteria are based on selected clinical, laboratory, and histopathological features. The co-existence of all symptoms attributed to SS is rare, causing the exclusion of some patients with sica symptoms who do not meet the criteria for SS. This discrepancy between clinical and either laboratory or microscopic symptoms makes it difficult to introduce an effective treatment policy. Furthermore, there are no strict guidelines indicating when to refer patients for labial salivary gland biopsy. Therefore, finding possible correlations between phenotypic features specific to SS is crucial. \begin{table}
\begin{tabular}{c c c c} \hline \hline
**Parameter** & **SS Patients with Kerostomia** & **SS Patients without** & **\(p\) Value** \\  & **(\(n\) = 31)** & **Xerostomia (\(n\) = 19)** & **\(p\) Value** \\ \hline Age, mean & 54.48 & 49.10 & \(p\) = 0.08 a \\ Gender, \(n\) & & & \\ Female/Male & _28/3_ & _15/4_ & \(p\) = 0.40 b \\ BMI & & & \\ median (IQR) & 23.74 (8.59) & 27.34 (7.88) & **\(p\) = 0.03 c** \\ CRP (mg/dL) & 0.76 & 0.48 & \(p\) = 0.37 c \\ ESR (mm/h) & 0.80 & 0.90 & \(p\) = 0.05 c \\ RF positive, \(n\) & \(9\) & 4 & \(p\) = 0.74 b \\ USWSF & & & \\ median (IQR) & 1 (2.5) & 3 (3) & **\(p\) = 0.00 c** \\ FS: & & & \\ median (IQR) & 2 (2) & 2 (2) & \(p\) = 0.87 c \\ FS \(\leq\) 1, \(n\) & 22 & 11 & \\ FS \(<\) 2, \(n\) & \(9\) & 8 & \(p\) = 0.34 d \\ Xerophthalmia, \(n\) & _24_ & 7 & **\(p\) = 0.00 d** \\ [PERSON]’s test positive, \(n\) & 22 & 13 & \(p\) = 0.84 d \\ Arthritis, \(n\) & _25_ & 17 & \(p\) = 0.69 b \\ Arthritis, \(n\) & \(8\) & 5 & \(p\) = 1.00 b \\ Fatigue, \(n\) & \(4\) & 5 & \(p\) = 0.27 b \\ Skin involvement, \(n\) & \(9\) & 5 & \(p\) = 1.00 b \\ Leukopenia, \(n\) & \(3\) & 1 & \(p\) = 1.00 b \\ ANA positive, \(n\): & & & \\ + (\(<\)1:160), \(n\) & \(6\) & 4 & \\ ++ (\(<\)1:320), \(n\) & \(3\) & 1 & \\ ++ (\(<\)1:320), \(n\) & _13_ & 9 & \(p\) = 0.83 d \\ ANA negative, \(n\): & & & \\ \(-(<\)1:160) & \(9\) & 5 & \\ ANA profile, \(n\): & & & \\ anti-Ro/SSA antibodies, \(n\) & _17_ & _10_ & \(p\) = 1.00 b \\ anti-Ro52 antibodies, \(n\) & \(5\) & \(3\) & \(p\) = 1.00 b \\ anti-La/SSB antibodies, \(n\) & \(6\) & \(3\) & \(p\) = 1.00 b \\ \hline \hline \end{tabular}  
* Data presented as the median (interquartile range) (IQR), mean \(\pm\) standard deviation (SD) or as number, \(n\); BMI, body mass index; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; RF, rheumatoid factor; USWSF; unstimulated whole salivary flow rate; FS, focus score; ANA, antinuclear antibodies; *, Student’s *-test; *, [PERSON]’s exact test; *, Mann–Whitney U test; *, Chi2 [PERSON]’s test.  
\end{table} 
Table 3: Comparison between SS patients with xerostomia and without xerostomia. One of the most common clinical manifestations of SS is dry mouth and dry eyes. Some patients with sicca symptoms are seronegative with simultaneously positive results of labial salivary gland biopsy. In the study, xerostomia corresponded with positive USWSF results and xerophthalmia. This finding proves that USWSF is a reliable test for confirming hyposvaluation and correctly identifying patients with symptoms of sicca syndrome. Patients with xerostomia reported xerophthalmia. The co-occurrence of dry mouth and dry eye is an SS-specific manifestation and a feature of sicca syndrome. On the other hand, contrary to USWSF, there were no differences in [PERSON]'s test between patients with and without xerostomia. Therefore, it appears that [PERSON]'s test cannot confirm xerophthalmia properly. In the study, there was no difference in FLS and FS occurrence between SS patients with and without xerostomia. In previous studies, dry mouth was treated as a predictor of FLS on labial salivary gland biopsy. However, these studies revealed divergent results depending on disease suspicion. The results of salivary gland biopsy were significantly higher in patients for whom a biopsy was requested by internists or rheumatologists compared to other departments due to a stronger suspicion of SS [31].