Sjogren’s Syndrome

Question 1

What is Sjogren’s syndrome?

Answer 1

Chronic autoimmune inflammatory disorder characterized by diminished lacrimal and salivary gland secretion.

Question 2

What are the two forms of Sjogren’s syndrome?

Answer 2

• Primary form - not associated with other diseases
• Secondary form - associated with another underlying rheumatic disease

More than 80% of patients are women.

Question 3

What mnemonic can be used to remember the common symptoms of Sjogren’s syndrome?

Answer 3

madfred!

• Myalgia
• Arthralgia
• Dry Mouth
• Fatigue
• Raynaud’s phenomenon
• Enlarged parotids
• Dry eyes

Question 4

What are the sicca symptoms associated with Sjogren’s syndrome?

Answer 4

• Xerophthalmia (dry eyes)
• Xerostomia (dry mouth)
• Fatigue

Most patients present with these symptoms.

Question 5

Which antibodies are commonly found in patients with Sjogren’s syndrome?

Answer 5

• Anti Ro
• Anti La
• RF & anti ds-DNA antibodies may also be seen

90% of patients have Anti Ro and Anti La antibodies

Question 6

What is the purpose of the Schirmer’s test?

Answer 6

• insert folded filter paper under the lower eyelid with the end hanging out
• moisture from the eye will travel by diffusion along the filter paper
• after 5 minutes, the distance that the moisture travels along the filter paper is measured
• a healthy young adult, 15mm is expected
• less than 10mm is significant

It is used in the diagnosis of Sjogren’s syndrome.

Question 7

What is the primary treatment approach for Sjogren’s syndrome?

Answer 7

Essentially symptomatic

Treatment focuses on alleviating symptoms rather than curing the condition.

Question 8

What measures can be taken for dry eyes in Sjogren’s syndrome?

Answer 8

Use of artificial tears

This helps to relieve dryness and irritation.

Question 9

What is recommended for managing dry mouth in Sjogren’s syndrome?

Answer 9

• Artificial saliva
• Sugar-free gum/pastilles

These options can help stimulate saliva production.

Question 10

What are some lifestyle recommendations for patients with Sjogren’s syndrome?

Answer 10

Avoid dry or smoky atmospheres

This helps reduce irritation and dryness.

Question 11

What is the risk of B cell lymphoma in patients with Sjogren’s syndrome?

Answer 11

5-10% life time risk

This is a significant concern for patients diagnosed with the syndrome.

Question 12

What risks do pregnant patients with anti Ro/SS-A antibodies face?

Answer 12

• Fetal loss
• Complete heart block in the fetus
• Neonatal lupus syndrome in the newborn

These complications highlight the importance of monitoring in pregnancy.

Question 13

Who described Sjogren’s syndrome and in what year?

Answer 13

Henrik Samuel Conrad Sjogren in 1933

He was a Swedish Ophthalmologist.

Question 14

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

Answer 14

• Rheumatoid Arthritis (RA)
• Systemic Lupus Erythematosus (SLE)

These conditions often co-occur with Sjogren’s syndrome.

Question 15

What does a salivary gland biopsy reveal in Sjogren’s syndrome?

Answer 15

Focal lymphocytic infiltration of exocrine glands

This is a characteristic finding in the condition.

Question 16

what medications may be used to treat Sjogren’s syndrome

Answer 16

• pilocarpine: stimulates muscarinic receptors –> parasympathetic nerves which promotes salivary and lacrimal gland secretion
• hydroxychloroquine: considered in patients who have joint pain

Question 17

what are complications of Sjogren’s syndrome related to exocrine gland dysfunction

Answer 17

• Eye problems, such as keratoconjunctivitis sicca and corneal ulcers
• Oral problems, such as dental cavities and candida infections
• Vaginal problems, such as candida infection and sexual dysfunction