Sjogren syndrome
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
- arthralgia
- myalgia
- arthritis
- kidney disease
- peripheral neuropathy
- corneal ulceration
- no saliva pool
- enlarged salivary glands
- facial pain
- burning mouth syndrome
- history of venous thromboembolism
- history of aortic aneurysm or dissection
Risk factors
- female
- systemic lupus erythematosus (SLE)
- rheumatoid arthritis
- systemic sclerosis (scleroderma)
- HLA class II markers
- genetic inheritance
- age peaks in 20s to 30s and after menopause
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 symptoms
with vasculitis
with renal tubular acidosis
with neuropathy
Contributors
Authors
Biji T. Kurien, PhD
Professor of Research
Section of Endocrinology and Diabetes
Department of Medicine
University of Oklahoma Health Sciences Center
Affiliate
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 and Director of Fellowship Program
Section of Endocrinology and Diabetes
Department of Medicine
University of Oklahoma Health Sciences Center
Member of Arthritis and Clinical Immunology Research Program
Oklahoma Medical Research Foundation
Associate Chief of Staff for Research
Department of Veterans Affairs
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
Maureen Rischmueller, MD
Head of Unit
Queen Elizabeth Hospital
Woodville South
South Australia
Australia
Disclosures
MR declares that she has no competing interests.
Alan Baer, MD
Associate Professor of Medicine
Johns Hopkins University
Baltimore
MD
Disclosures
AB declares that he has no competing interests.
Differentials
- Systemic lupus erythematosus (SLE)
- Rheumatoid arthritis
- Hepatitis C
More DifferentialsGuidelines
- Oral management: caries prevention in Sjogren’s patients
- Systemic manifestations in Sjogren’s patients
More Guidelines
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