Sjögren's syndrome

Question 1

What is Sjögren’s syndrome?

Answer 1

This is an autoimmune condition that affects the exocrine glands, characterised by lymphocytic infiltrates

Question 2

Who is most likely to get Sjögren’s syndrome?

Answer 2

Females (9:1)
Middle aged women

Question 3

What are some causes of secondary Sjögren’s syndrome?

Answer 3

Rheumatoid arthritis
SLE

Question 4

What are the 2 main antibodies associated with Sjögren’s syndrome?

Answer 4

Anti-SS-A => Anti-Rho antibodies
Anti-SS-B => Anti-La antibodies

Question 5

Describe the pathophysiology of Sjögren’s syndrome?

Answer 5

This condition occurs when lymphocytes infiltrate the exocrine glands, mostly the lacrimal or salivary glands, therefore causing dry eye and mouth

Question 6

What are some common presentations in Sjögrens syndrome?

Answer 6

Dry (Gritty) eyes
Dry mouth (-> Fissured tongue)
Dry throat
Vaginal dryness
Joint pains
Fatigue

Question 7

What are some clinical signs of Sjögren’s syndrome?

Answer 7

Bilateral parotid gland enlargement
Unexplained increase in dental visits

Question 8

What are some possible complications of Sjögren’s syndrome ?

Answer 8

Lymphoma development
Peripheral neuropathy
Interstitial lung disease

Question 9

What tests are required in diagnosis of Sjögren’s disease?

Answer 9

Clinical examination and testing
Blood tests
Gland biopsy (Uncommon)

Question 10

What is the main clinical test available for Sjögrens syndrome?

Answer 10

Schirmers test

Question 11

What is Schimers test?

Answer 11

This is a test in which is piece of filter paper is placed under the bottom eyelid for 5 minutes, after which the distance travelled by the liquid is measured

Question 12

What is a normal Schirmer’s test result?

Answer 12

15mm is normal for a young, healthy adult

Question 13

What Schemer’s test value is significant for Sjögren’s syndrome?

Answer 13

<10mm

Question 14

What will blood tests usually show in Sjögren’s disease?

Answer 14

Anti-rho antibody positive
Anti-La antibody positive
Possible raised PV
Possible raised IgG

Question 15

How are dry eyes managed in Sjögren’s syndrome?

Answer 15

Polyvinyl eye drops during the day
Carbomer eye gel during the night

Question 16

How can dry mouth be treated in Sjögren’s syndrome?

Answer 16

Artificial saliva

Question 17

What new treatment option is available for treatment of dry eyes and mouth in Sjögrens syndrome?

Answer 17

Pilocarpine can also be used for dry eyes and mouth as they stimulate muscarinic receptors, stimulating the parasympathetic nerves and promoting salivary and lacrimal gland secretion

Question 18

What treatment option is available for arthralgia and fatigue in Sjögren’s syndrome?

Answer 18

Hydroxychloroquine

Question 19

What may be used in cases of further organ involvement in Sjögren’s syndrome?

Answer 19

Other immunosuppresents, e.g. methotrexate