pSS can occur in patients of all ages, but it affects primarily females during the fourth and fifth decade of life. The female/male ratio is about 9:1 (Rehman, 2003), thus, making pSS in men an uncommon condition with clinical and serological characteristics similar to those observed in women (Anaya et al., 1995; Cervera et al., 2000). Studies evaluating clinical or serological differences between male and female patients with pSS reveal that women may have more positive serological findings than men and a higher prevalence of fatigue, fibromyalgia, thyroidal manifestations and carpal tunnel syndrome. No sex differences could be established with other extraglandular manifestations of pSS, such as the presence of Raynaud's phenomenon, arthritis, erosive osteoarthritis, liver disease or other visceral manifestations (Brennan and Fox, 1999; Diaz-Lopez et al., 2004).
Paediatric presentation of pSS is very rare even though sporadic cases of the disease are reported in children from the age of 3 to the mid-teens (Siamopoulou-Mavridou et al., 1989). Data on 40 cases of pSS with onset before the 16th birthday have been recently published. Almost all patients (35/40) were females, age at onset varied from 9.3 to 12.4 years (mean 10.7 years), signs and symptoms at disease onset were mainly recurrent parotid swelling followed by sicca symptoms and abnormal laboratory tests were found in the majority of cases (Cimaz et al., 2003).
Finally, elderly onset pSS disease seems to have milder clinical symptoms with fewer immunolog-ical manifestations than younger onset disease and the elevation of salivary interleukin (IL)-6 in the younger group of SS patients supports in part the differences in the inflammatory process between the two groups (Tishler et al., 2001).
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