mikulicz's syndrome. many conditions, such as tuberculosis, infections, sarcoidosis and lymphoma present with similar conditions to those ascribed to mikulicz's syndrome. nevertheless, the term "mikulicz's syndrome" is still used occasionally to describe the appearance of lymphocytic infiltrates on salivary-gland biopsies. in 1930, henrik sjögren (1899–1986), an ophthalmologist in jönköping, sweden, observed a patient with low secretions from the lacrimal and salivary glands. sjögren introduced the term keratoconjunctivitis sicca for the symptom of dry eyes (keratoconjunctivitis). in 1933, he published his doctoral thesis describing 19 females, most of whom were postmenopausal and had arthritis, showing clinical and pathological manifestations of the syndrome. sjögren clarified that keratoconjunctivitis sicca, resulting from water deficiency, had no relation to xerophthalmia, resulting from vitamin a deficiency. sjögren's thesis was not well received as the board of examiners criticized some clinical aspects. after extensive research and data collection, sjögren published an essential paper in 1951, describing 80 patients with keratoconjunctivitis sicca, 50 of whom also had arthritis. his subsequent follow-up conference trips pertaining to his paper led to an international interest in sjögren's syndrome. the term "keratoconjunctivitis sicca" was coined by sjögren himself and began to be identified as sjögren's syndrome in literature, although it can now have more general usage. research singer-actress carrie ann inaba is the national awareness ambassador and spokesperson for the sjögren's syndrome foundation. research into multifactorial autoimmune diseases such as ss focuses on expanding the knowledge surrounding the disorder, improving diagnostic tools and finding ways to prevent, manage and cure the disorder. the united kingdom primary sjögren's syndrome registry, a tissue biobank of samples taken for research, supported by the medical research council, uk, was established in 2010. it supports clinical trials and genetic studies of sjögren's syndrome and is open to those wishing to participate in research studies and to researchers studying the disease. as with other autoimmune diseases, susceptibility to sjögren's syndrome is greatly influenced by the human leukocyte antigen. dqa1*05:01, dqb1*02:01, and drb1*03:01 alleles were identified as risk factors, while dqa1*02:01, dqa1*03:01 and dqb1*05:01 alleles were found to be protective factors for the disease. the relationship between alleles and specific race was also established. hla-dq2 and hla-b8 are generally found in caucasian patients, while hla-dr5 is related to greek and israeli patients. multiple genome-wide association scans may be conducted in the future to identify key risk variants. viruses that have been associated with sjögren's syndrome include human t-lymphotropic virus type 1 (htlv-1), epstein-barr virus (ebv), human immunodeficiency virus (hiv), hepatitis delta virus (hdv) and hepatitis c virus (hcv). some research has showed that the lack of vitamin a and vitamin d are associated with the disease. vitamin d deficiency was found to be related to neurological manifestations and the presence of lymphoma among patients, but vitamin a levels were inversely associated with extraglandular manifestations of the disease. saliva is a potential diagnostic tool for sjögren's syndrome because the salivary component is changed after onset of the disease. with the new miniaturization technology, called lab on a chip, the diagnosis can be more convenient. with regard to therapeutics, multiple monoclonal antibodies were under investigation in 2007. the most promising seemed to be the anti-cd20 rituximab and the anti-cd22 epratuzumab, while the anti-tnf-α and ifn-α seemed less effective. in 2014, the sjögren's syndrome foundation announced a five-year goal to halve the disease's average time to diagnosis. notable cases shannon boxx (u.s. olympic soccer player) has both sjögren's syndrome and lupus. carrie ann inaba (singer-actress) is the national awareness ambassador and spokesperson for the sjögren's syndrome foundation. venus williams (world-champion tennis player) has been diagnosed with sjögren's syndrome and said she had struggled with fatigue for years. stephen mcphail (professional soccer player for ireland, leeds and cardiff city) was diagnosed with lymphoma and sjögren's syndrome at age 29. halsey (singer) diagnosed with sjogren's, ehlers-danlos syndrome, mast cell activation syndrome, and postural orthostatic tachycardia syndrome