Sjögren's syndrome

Question 1

what is sjogren’s syndrome?

Answer 1

inflammatory autoimmune disorder characterised by decreased lacrimal and salivary gland secretion, which manifests as dry eyes and dry mouth

Question 2

what is the cause of sjogren’s syndrome?

Answer 2

lymphocyte-mediated autoimmune destruction (type IV hypersensitivity) of minor salivary and lacrimal glands that can lead to atrophy and fibrosis

Question 3

what are the different types of sjogren’s?

Answer 3

• primary = developing in isolation
• secondary = on the background of other autoimmune diseases

Question 4

what are the ocular symptoms of sjogren’s syndrome?

Answer 4

• keratoconjunctivitis sicca (reduced tear secretion)
• dry, gritty feeling eyes

Question 5

what are the oral symptoms of sjogren’s syndrome?

Answer 5

• dryness of the mouth (xerostomia) - difficulties with swallowing food or talking
• dental caries
• oral candidiasis
• intermittent parotid gland swelling

Question 6

what are the other exocrine gland dysfunction symptoms in sjogren’s?

Answer 6

• vaginal dryness
• reduced GI mucus scretions - dysphagia/oesophagitis/gastritis
• Mucosa-Associated Lymphoid Tissue lymphoma (increased risk) - painless parotid swelling and lymphadenopathy

Question 7

what blood tests are undertaken in sjogren’s?

Answer 7

• markers of inflammation are usually riased
• +ve ANA
• +ve anti-Ro
• +ve anti-La

Question 8

what special tests are undertaken in sjogren’s syndrome?

Answer 8

• schirmer’s test
• rose bengal staining
• salivary flow rate monitoring
• salivary gland biopsy

Question 9

what is schirmer’s test?

Answer 9

demonstrates reduced tear production using a strip of filter paper on the lower eyelid

wetting of >5mm = positive

Question 10

what is the management of sjogren’ syndrome?

Answer 10

• artifical tears = hypromellose
• artifical saliva + good dental hygiene
• topical lubrication for vaginal dryness
• hydroxychloroquine +/- NSAIDs for arthritis