183. Sjögren's syndrome

Question 1

Definition of Sjogren’s syndrome

Answer 1

Autoimmune condition with lymphocytic infiltration of exocrine glands [salivary and lacrimal]

Question 2

Aetiology of Sjogren’s syndrome

Answer 2

Primary- autoimmune

or secondary to SLE, RA, systemic sclerosis

Question 3

Symptoms of Sjogren’s syndrome

Answer 3

Dry eye
Dry mouth
Dyspareunia- dry vagina
Dry skin
Fatigue
Arthralgia
Glandular enlargement- submandibular, parotid
Lymphadenopathy
Raynaulds

Question 4

Investigations of Sjogren’s syndrome?

Answer 4

Schirmer’s test- eye, filter paper
Drool test

FBC
U+E
LFT
ESR
Imunoglobulins- high

Autoantibodies
RhF
Anti Ro
Anti La
ANA

USS + biopsy of salivary glands

Question 5

What condition are you at increased risk of with Sjogren’s syndrome?

Answer 5

Non hodgkin’s lymphoma

Question 6

Management of Sjogren’s syndrome?

Answer 6

Symptomatic
Dry mouth- artificial saliva, good dental hygieene, high fluoride [risk of dental caries+decay]
Eyes- artificial tears- if resistant sx- opthal review
- Punctal plug, cyclosporin eye drops
Other symptoms - analgesia for arthralgia, emollient for dry skin, raynaulds- warm hands
Systemic therapy- hydroxychloroquine

Question 7

Epidemiology of Sjogren’s syndrome?

Answer 7

Female

After menarche [twenty to thirty years] and after menopause [fifty years]

Question 8

BONUS: What conditions are RhF elevated in? [rheumatoid factor]

Answer 8

Rheumatoid arthritis/
SLE/
Sjogren's syndrome/
Infectious mononucleosis/
Sarcoidosis/
Infective endocarditis