Sjogren’s Syndrome

Question 1

What is sjogern’s syndrome?

Answer 1

Chronic autoimmune inflammatory disorder affecting the lacrimal + salivary glands

Question 2

What are the salivary glands?

Answer 2

Parotid
Sublingual
Submandibular

Question 3

Primary + secondary sjogern’s syndrome

Answer 3

• primary: not associated with other disease
• secondary: associated with another underlying rheumatic disease e.g. SLE, RA

Question 4

What are the most common diseases associated with Sjögren’s syndrome?

Answer 4

SLE
RA

Question 5

Common signs + symptoms of sjogern’s syndrome

Answer 5

MADFRED
- Mayalgia
- Arthralgia
- Dry mouth
- Fatigue
- Raynaud’s phenomenon
- Enlarged parotids
- Dry eyes
.
Sicca symptoms

Question 6

What are sicca symptoms?

Answer 6

• fatigue
• xerophthalmia - dry eyes
• xerostomia - dry mouth

Question 7

What antibodies are associated with sjogern’s dynrome?

Answer 7

anti-Ro / anti SS-A
anti-La / anti SS-B

Question 8

Investigations of Sjogern’s syndrome

Answer 8

• schirmer’s test
• anti-Ro + anti-La
• salivary gland biopsy

Question 9

What is characteristic of Sjögren’s syndrome in a biopsy of the salivary glands?

Answer 9

Focal lymphocytic infiltration

Question 10

What is Schirmer’s test?

Answer 10

• involves inserting folded filter paper under the lower eyelid the the end hanging out
• moisture from the eyes will diffuse along the paper
• after 5 mins the distance is measured
• 15mm is expected in a healthy adult
• <10mm is significant

Question 11

What impact does Sjögren’s syndrome have on pregnancy?

Answer 11

Pregnant patients with anti-Ro antibodies are at risk of:
- fetal loss
- complete heart block in fetus
- neonatal lupus syndrome in newborn

Question 12

Complications of Sjögren’s syndrome

Answer 12

• corneal ulcers
• dental cavities
• candida infection in oral cavity + vagina
• sexual dysfunction
• non-Hodgkin’s lymphoma
• pneumonia + bronchiectasis
• renal impairment
• vasculitis

Question 13

Management of sjorgen’s syndrome

Answer 13

• avoid dry or smoky atmospheres
• artificial tears + saliva
• sugar free gum/pastilles
• vaginal lubricants
• skin emollients
• pilocarpine to stimulate tear + saliva production

Question 14

What drug can be used in treatment of Sjögren’s syndrome + why?

Answer 14

pilocarpine
Muscarinic receptor agonist > stimulates parasympathetics > promotes salivary + lacrimal gland secretion