Summary
Definition
History and exam
Key diagnostic factors
- fatigue
- dry eyes
- dry mouth
Other diagnostic factors
- vasculitis
- dental caries
- increased oral fungal and bacterial infections
- musculoskeletal pain
- thyroid disease
- urogenital disease
- pulmonary disease
- gastrointestinal disease
- peripheral neuropathy
- corneal ulceration
- no saliva pool
- enlarged salivary glands
- facial pain
- burning mouth syndrome
Risk factors
- female
- systemic lupus erythematosus (SLE)
- rheumatoid arthritis
- systemic sclerosis (scleroderma)
- HLA class II markers
- age 40 to 70
- genetic inheritance
Diagnostic investigations
1st investigations to order
- Schirmer test
- anti-60 kD (SS-A) Ro and anti-La (SS-B)
Investigations to consider
- sialometry
- minor salivary gland biopsy
- lissamine green test
- fluorescein corneal staining test
- parotid sialography
- salivary gland technetium-99m pertechnetate scintigraphy
- skin biopsy
- angiography
- urinalysis
- serum electrolytes
Emerging tests
- MRI salivary glands
- ultrasound salivary glands
Treatment algorithm
dry eyes
dry mouth
with fatigue
with musculoskeletal manifestations
with vasculitis
with renal tubular acidosis
with neuropathy
Contributors
Authors
Biji T. Kurien, PhD
Staff Scientist
Arthritis and Clinical Immunology Research Program
Oklahoma Medical Research Foundation
Research Associate
Department of Veterans Affairs
Oklahoma City
OK
Disclosures
BTK is an author of several articles cited in this topic.
R. Hal Scofield, MD
Professor
Section of Endocrinology and Diabetes
Department of Medicine
University of Oklahoma Health Sciences Center
Member
Arthritis and Clinical Immunology Research Program
Oklahoma Medical Research Foundation
Associate Chief of Staff for Research and Staff Physician
Department of Veterans Affairs Medical Center
Oklahoma City
OK
Disclosures
RHS received honorarium and travel expenses from Eisai Korea for speaking at the Korean Rheumatology Association meeting. RHS has been a paid consultant for UCB in regards to Sjogren's and he has received honorarium for speaking on Sjogren's at Lily. Both instances included travel expenses. RHS is an author of several articles cited in this topic.
Peer reviewers
Nora Sandorfi, MD
Associate Professor of Medicine
University of Pennsylvania
Philadelphia
PA
Disclosures
NS declares she has no competing interests.
Differentials
- Systemic lupus erythematosus (SLE)
- Rheumatoid arthritis
- Hepatitis C
More DifferentialsGuidelines
- Guideline for vaccinations in patients with rheumatic and musculoskeletal disease
- Consensus guidelines for the evaluation and management of pulmonary disease in Sjorgren's
More Guidelines
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