sjogren's

Question 1

definition of sjogren’s

Answer 1

systemic autoimmune disorder
lymphocytic infiltration in lacrimal and salivary glands

Question 2

sx of sjogrens

Answer 2

• fatigue
• dry eyes >3mo
• red eyes and light sensitivity
• dry mouth -> difficulty chewing and swallowing, speaking

Question 3

signs of sjogrens

Answer 3

dry skin (xeroderma)
palpable and non-palpable purpura / urticaria
dental caries - destruction of neck of teeth

Question 4

RF for sjogrens

Answer 4

• female
• SLE
• Systemic sclerosis
• RA
• HLA type 2 -A1, -B8, or -DR3/DQ2
• DR2 is also strongly associated with anti-Ro/La-positive Sjogren syndrome
• 20-30yrs
• post-menopause

Question 5

pathophysiology of sjogren’s

Answer 5

infiltration and damage of the salivary glands
lymphocytes infiltrate the gland
multifactorial:
* immunological - lymphocytes produce anti-Ro La
* genetic
* hormonal
* viral

Question 6

Ix for Sjogren’s

Answer 6

Anti-Ro and Anti-La
Schirmer’s test - quantitively measure tears by putting filter paper in lower conjunctival sac -** positive if less than 5mm of paper is wet after 5min**

Question 7

mx of sjogrens - dry eyes

Answer 7

1. artificial tears
2. opthalmic ciclosporin drops
3. cholinergic drug to stimulate secretion form exocrine gland (pilocarpine)

Question 8

rx sjogrens with dry mouth

Answer 8

1. salivary substitues alone
2. cholinergic drug

Question 9

rx of sjogrens with musculoskeletal manifestations

Answer 9

analgesia
DMARD - hydroxychloroquine (2nd line = methotrexate)

Question 10

rx of sjogrens with vasculitis

Answer 10

1. steroid
2. IVOG
3. rituximab

Question 11

r of sjogrens with renal tubular acidosis

Answer 11

K repletioon and alkali

Question 12

rx of sjogrens with neuropathy

Answer 12

IVIG

Question 13

complications of sjogrens

Answer 13

lymphoma - marginal B cell lymphoma
steroid SE
blepharitis - inflammation of sebaceous glands in eylid
exacerbation of dry eyes and blurring vision
oral candidiasis
autonomic dysfunction inc bladder irritability
anaemia of chronic disease
corneal ulceration/secondary infection
depression
cholinergic meds SE

Question 14

SE of cholinergic meds

Answer 14

• sweating,
• mild abdominal pain,
• headache,
• nausea and gastrointestinal upset,
• urinary frequency,
• chills and influenza-like symptoms,
• rhinitis,
• flushing,
• increased lacrimation,
• palpitations

Question 15

ix into candida in sjogrens

Answer 15

if hyperplastic - need biopsy to rule out malignant transformation

Question 16

px of sjogrens

Answer 16

normal life expectency