Sjogren syndrome is a chronic inflammatory and autoimmune disorder characterized by diminished lacrimal and salivary gland secretion (sicca complex).
May present with fatigue and dry eyes (keratoconjunctivitis sicca) and dry mouth (xerostomia).
Diagnosed by positive antinuclear antibodies, anti-60 kD (SS-A) Ro and anti-La autoantibodies, decreased saliva and tear production, lymphocytic infiltration in labial salivary gland biopsy.
Treatment is mainly symptomatic.
Sjogren syndrome is a systemic autoimmune disorder, characterized by the presence of dry eyes (keratoconjunctivitis sicca) and dry mouth (xerostomia) as a consequence of lymphocytic infiltration into the lacrimal and salivary glands.
Additional symptoms can include dryness of skin, nose, throat, vagina; arthralgias and myalgias; peripheral neuropathies; pulmonary, thyroid, and renal disorders; and lymphoma.
Sjogren syndrome can occur alone (primary Sjogren syndrome) or be associated with another autoimmune disease (secondary Sjogren syndrome) such as lupus, rheumatoid arthritis, and systemic sclerosis.
History and exam
Key diagnostic factors
- dry eyes
- dry mouth
Other diagnostic factors
- 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
- systemic lupus erythematosus (SLE)
- rheumatoid arthritis
- systemic sclerosis (scleroderma)
- HLA class II markers
- age 40 to 70
- genetic inheritance
1st investigations to order
- Schirmer test
- anti-60 kD (SS-A) Ro and anti-La (SS-B)
Investigations to consider
- minor salivary gland biopsy
- lissamine green test
- fluorescein corneal staining test
- parotid sialography
- salivary gland technetium-99m pertechnetate scintigraphy
- skin biopsy
- serum electrolytes
- MRI salivary glands
- ultrasound salivary glands
with musculoskeletal manifestations
with renal tubular acidosis
- Systemic lupus erythematosus (SLE)
- Rheumatoid arthritis
- Hepatitis C
- Guideline for vaccinations in patients with rheumatic and musculoskeletal disease
- Consensus guidelines for the evaluation and management of pulmonary disease in Sjorgren's
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