Sjogren's Syndrome (3)

Question 1

What is this?

What is its pathophysiology?

What are the types?

Answer 1

➊ Autoimmune condition characterised by decreased lacrimal and salivary gland secretion, leading to dry eyes and mouth

➋ Lymphocyte-mediated autoimmune destruction (type IV hypersensitivity) of minor salivary and lacrimal glands that leads to atrophy and fibrosis

➌ • Primary – Occurs alone
• Secondary – Occurs related to SLE or RA

Question 2

What are the main complications?

What is there a much higher risk of here?
→ Which pts should therefore be investigated promptly?

Answer 2

➊ • Eye – Reduced tear secretion (causing dry, gritty eyes that may appear red)
‣ Superimposed bacterial conjunctivitis often occurs
• Mouth – Dry mouth (causing difficulty talking or swallowing), Swollen parotids
‣ Cavities and candida infection often occurs
• Vagina – Dryness, Candida infection, Sexual dysfunction

➋ Lymphoma
→ Pts with new/changing lymphadenopathy

Question 3

Which bloods should be done?

Which special test could be done?
→ Which result is significant?

How is it managed?

Answer 3

➊ CRP/ESR, Anti-Ro, Anti-La

➋ Schirmer’s Test - Demonstrates reduced tear secretion - Paper put under lower eyelid. After 5 minutes, the distance that becomes moist is measured
→ < 10mm (NR >15mm)

➌ Symptomatic relief:
• Dry eyes - Artificial tears and saliva
• Dry mouth - Artificial saliva, hydration, and good dental hygiene
• Vaginal dryness - Topical lubricants