TNF and systemic sclerosis: Although a little knowledge about salivary gland involvement in SSc has been reported in the literature, it was demonstrated, in a previous study, that salivary gland changes (increased expression of E-selectin and TNF-α and infiltration by mast cells) are detectable in the early stages of the disease, before the onset of skin changes and when the criteria for a diagnosis of SSc are absent [11].