Sjogren's Syndrome

Question 1

What kind of people are most commonly affected with Sjogrens?

Answer 1

postmenopausal women. (90%)

Question 2

patients with sjogrens have a 44 times greater chance of developing…

Answer 2

non hodgkins lymphoma

Question 3

Secondary SS

Answer 3

patients with a preexisting connective disease (lupus, scleroderma, RA) that get sjogrens

Question 4

what is the most common and second most common autoimmune rheumatic disease?

Answer 4

RA, then sjogrens

Question 5

etiology of sjogrens

Answer 5

genetic, hormonal, and environmental (trigger- virus) component

Question 6

what oral PE findings might you see in sjogrens

Answer 6

many dental caries, don’t have glistening of tongue and mucous membranes, diminished salivary pool under tongue, salivary gland swelling, candidiasis, erythema, fissuring of the tongue, angular cheilitis

Question 7

Patient oral complaints in sjogrens

Answer 7

sore or burning mouth, drinking lots of liquids constantly, intolerance to hot, spicy foods, abnormalities of taste, difficulty chewing and swallowing dry foods, difficulty with speaking, and wearing dentures

Question 8

consequences of severe dry eye or if goes untreated

Answer 8

bacterial conjunctivitis, corneal ulcer or performation, and loss of vision

Question 9

name some extraglanduar manifestations in sjogrens

Answer 9

general- fatigue, malaise. skin- xeroderma. ENT- epistaxis, congestion, pulm- xerotrachea, bronchitis. GI- gerd, decreased esophageal motility. Gyn- dyspareunia, vulvovaginitis. Peripheral neuropathy, arthralgias, myalgias, raynaud’s, anemia, leukopenia

Question 10

avg time from onset of symptoms to diagnosis

Answer 10

6.5-7 years

Question 11

r/o other causes of dryness for sjogrens:

Answer 11

medications, hepatitis C, HIV, mouth breathing, previous radiation to head and neck, other systemic diseases

Question 12

criteria for sjogrens diagnosis

Answer 12

1. positive serum anti-SSA or anti-SSB (positive RF and antinuclear antibody titer), 2. ocular staining score greater than 3. 3) presence of focal lymhocytic sialadenitis with a focus score greater than 1/4 mm square in labial salivary gland biopsy samples

Question 13

you are suspicious of patient with sjogrens. What test can you do to determine tear production?

Answer 13

shirmer’s test

Question 14

positive shirmer’s test=

Answer 14

producing 5 or less ml of tears over 5 minutes

Question 15

ocular diagnostic tests

Answer 15

Shirmer’s test, vital dye- determines presence of dry spots on ocular surface, and fluorescein tear break up time

Question 16

what does fluorescin tear break up time measure and what is it

Answer 16

measures tear film stability. how long does it take for dry spots to develop on cornea during non-blinking. less than 5 sec- abnormal

Question 17

oral diagnostic tests

Answer 17

minor salivary gland biopsy- positive if lymphocytic infiltration of glands, salivary flow rate- determines if salivary glands are hypofunctioning, salivary scintigraphy- nuclear medicine test of salivary gland function

Question 18

positive focal lymphocytic sialadenitis=

Answer 18

focus score of equal to or greater than 1/4 mm square

Question 19

labs to order if suspect sjogrens

Answer 19

anti-SSA/ and/or anti-SSB (marker autoantibodies- confirm diagnosis), positive ANA greater than 1:320, positive RF, elevated ESR, and elevated CRP

Question 20

focus of tx in sjogrens

Answer 20

no cure. focus on relieving symptoms, improving complications, and preventing complications