Sjogren's Flashcards
A 46 yo female presents complaining of dry mouth, dry, gritty feeling eyes, and Raynaud’s. On exam you note parotid glad swelling. What do you suspect? What is the pathology behind this condition?
Primary Sjogren’s Syndrome
Idiopathic chronic, systemic, autoimmune inflammatory d/o
Destruction of exocrine glands d/t infiltration by B lymphocytes
A 48 yo female presents complaining of dry mouth, dry eyes, and warm, slightly red, “squishy” MCP joints. She has a history of SLE and scleroderma. What do you suspect? What complications are you worried about this pt developing?
Secondary Sjogren's Syndrome Lymphoma Glomerulonephritis Purpura Low C4 component (hypocomplementemia (premature death))
A 36 yo female presents complaining of xerostomia and keratoconjunctivitis sicca. She also has parotid gland swelling, non-erosive arthralgia, Raynaud’s, and lymphadenopathy. What do you suspect? What labs should you perform?
Primary Sjogren’s Syndrome
C3 & C4 (low indicates hypocomplementemia)
A 37 yo female presents complaining of xerostomia and keratoconjunctivitis sicca. She has renal and hepatic problems, and on exam you note increased dental decay. What OTC treatment could you reocmmend for this pt?
Primary Sjogren's Syndrome Biotene products Sugar-free chewing gum Sugar-free lozenges (Xylitol) OTC eye drops (Systane, Refresh)
A 39 yo female presents complaining of dry mouth and dry eyes that often feel gritty, like there’s sand in her eyes. C3 & C4 are normal. After recommending several OTC products, she comes back a week later saying nothing has worked well for her. What could you recommend?
Primary Sjogren’s Syndrome
Muscarinic cholinergic agnoists: Cevimeline, Pilocarpine
Eye drops: Restasis - ophthamologist Rx
What would CI muscarinic agonist use in a pt with primary sjogren’s syndrome?
Arrhythmias, angina, BB use, glaucoma, severe asthma
A pt presents complaining of dryness and FB sensation in her eyes. It has been slowly getting worse over the past couple years, and she describes it as a “gritty, sandy feeling”. On exam you note irritation and photophobia as well as thick, rope-like strands at the inner canthus. She denies xerostomia. What do you suspect? How can you diagnose?
Keratoconjunctivitis Sicca
Rose-Bengal Test (Fluorescein stain)
Schirmer’s Test - measure tear production
Salivary gland biopsy
A pt presents complaining of dry eyes, FB sensation, and photophobia. You note diliated vessels of the conjunctiva and that the conjunctiva and cornea appear dull. Salivary gland biopsy reveals lymphoid germinal centers and interstitial plasma cells. What Tx should you recommend?
Keratoconjunctivitis Sicca
OTC eye drops (Systane, Refresh)
Rx eye drops (Restasis) - from ophthalmologist
A pt presents with xerostomia and keratoconjunctivitis sicca. The pt has a history of diabetes. Labs show auto-Abs SSA & SSB and HLA-DR 4 halplotype. What is your diagnosis?
Sicca Syndrome
