I have been a student of Sjogren's syndrome for virtually all of my
professional life. My education in this disease began in 1962 when
I arrived at the National Institutes of Health to begin a Clinical
Asso- ciateship with Dr. Joseph J. Bunim. Bunim introduced me to a
pat- ient with Sjogren's syndrome of 8 years duration who had
devel- oped malignant lymphoma 6 months previously. He told me that
there were other such patients. I obtained serum samples from these
patients and studied them by the then new technique of immuno-
electrophoresis. We observed that an initial hypergammaglobulin-
emia could progressively decline to hypogammaglobulinemia with loss
of autoantibodies. One patient in this initial series had macrog-
lobulinemia. We published this report and suggested that the auto-
immunity predisposed to the malignant transformation. Thus began my
love affair with this disease. In those days many rheumatologists
considered Sjogren's syn- drome simply a variant of rheumatoid
arthritis. It's curious that two decades ago there was little
confusion between Sjogren's syndrome and systemic lupus
erythematosus, whereas today there is great con- fusion. There is
still a great need for internationally agreed upon di- agnostic
criteria, which merely illustrates once again the difficulty of
accurate diagnosis in our profession. The multidisciplinary aspects
of Sjogren's syndrome require au- thorities in several areas of
medicine. The various chapter contribu- tors are experts in their
field and have often put aside other respon- sibilities to complete
their contributions and not delay publication.
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