Sjogrens syndrome

Question 1

What is sjogrens

Answer 1

An autoimmune disease affecting the salivary glands

Question 2

What are the classifications of Sjogrens

Answer 2

Sicca syndrome (partial sjogrens findings)

Primary Sjogrens

Secondary sjogrens

Question 3

What is sicca syndrome and what does it mainly affect

Answer 3

Where there is only partial sjogrens findings of dry eyes and mouth

Question 4

What does primary and secondary sjogrens involve

Answer 4

Primary
-no connective tissue disease

Secondary
-connective tissue disease
-SLE, Rheumatoid Arthritis, Scleroderma

Question 5

What doe Sjogrens cause

Answer 5

Gradual loss of salivary/lacrimal gland tissue through inflammatory destruction

Enlargement of major salivary glands – usually symmetrical

Increased risk of
-Any lymphoma (5% quoted)
-Salivary marginal B-cell (MALT) Lymphoma

Oral and Ocular effects of loss of saliva and tears

Question 6

How do you diagnose

Answer 6

American-European Consensus Group

ACR-EULAR joint criteria

Question 7

How many symptoms on the AECG is needed for a diagnosis of sjogrens

Answer 7

4 or more as long as one of tem is histopathology or positive auto antibody findings

Question 8

The AECG signs for sjogrens is what?

Answer 8

Dry eyes/mouth
-Subjective or objective

Needs to have Autoantibody findings

Needs to have Imaging findings

Needs to have Histopathology findings

Question 9

What does the ACR-EULAR look for in diagnosis

Answer 9

Histopathology findings
-focus score >1

Autoantibody findings
-anti-Ro only

Dry eyes/mouth
-objective salivary flow
-Schirmer test

Ultrasound now accepted as well

Question 10

What are the oral and occlar symptoms of sjogrens

Answer 10

Oral
-Daily feeling of a dry mouth for >3 months
-Recurrent swelling of salivary glands as an adult
-Frequently drink liquid to aid swallowing dry foods

Ocular
-Persistent troublesome dry eyes for >3 months
-Recurrent sensation of sand/gravel in the eyes
-Tear substitutes used >3 times day

Question 11

What oral test can be done for sjogrens

Answer 11

Abnormal UNSTIMULATED whole salivary flow (UWS)

<1.5ml in 15 mins means not good

Question 12

What antibodies are commonly found in Sjogrens

Answer 12

Anti-Ro and Anti-La

Question 13

What is meant by positive antibodies

Answer 13

They are not causitive of the disease process they are just ASSOCIATED with it

Question 14

What is the most predictive test for sjogrens

Answer 14

Positive Labial Gland BiopsyW

Question 15

hat is meant by lympocytic focus

Answer 15

Collection of >50 lymphocytes around a duct

Question 16

What focus score is consistent with sjogrens

Answer 16

> 1 Focus Score (FS)

Question 17

When checkinf sjogrens what tests do you do first

Answer 17

The least harmful

-UWS in 15 mins - <1.5ml
-Anti-Ro antibody
-Salivary ultrasound scan
-Baseline MRI of major salivary glands

After all that and still equivocal do labial gland biopsy

Question 18

How to manage sjogrens

Answer 18

If dry mouth,
-Oral Health needs paramount – diet, OHI, 5000ppm toothpaste
-Symptomatic treatment of oral dryness
-Salivary stimulants - pilocarpine

If patient presenting early but NO dry mouth yet with active gland disease
-Liaise with rheumatologist – multisystem disease
-Consider Immune modulating treatment – hydroxychloroquine, methotrex