Sjogren's Syndrome

Question 1

In general

Answer 1

Chronic AI dz affecting salivary and lacrimal exocrine glands

1/2 primary and 1/2 secondary

Question 2

Patho

Answer 2

From stimulation of immune systems

Lymphocytes infiltrate glandular and extra glandular sites

Apoptosis and migrations of Ro-60 (SSA) and La (SSB) to cell surface

Induces autoAB formaiton

Will have ANA, anti-Ro/SSa and anti-La/SSB

Apoptosis of ductal and acinar epithelial cells along with interstitial firboriss dimiinishes glandular secretions

Question 3

Epidemiology

Answer 3

Middle aged women

Question 4

CM

Answer 4

Major are keratoconjunctivitis sicca and xerostomia

Most have slow course

Trouble swalling dry food, debtal caries, or change in taste

Dry, red, sticky oral musoca with atorphy of papillae on the tongue

Enlargment of salivary glands

Dilation of bulbar ocnjunctival vessels

1/3 will have myaglia, arthralgia or Raynauds

50% have another rheumatic dz

Question 5

Complications

Answer 5

Lymphoma

MALT of the salivary gland or DLBCL in surrounding LNs

Question 6

Dx

Answer 6

Suspect if dry eyes, mouth, parotid enlargmeent, and increase in dental caries

hyperglobulinemia (IOgG)

ANA, anti-Ro/SSa, anti-La, RF

Ro and La are big ones

May have anemia or increased ESR

Refer to ophto

Salivary biopsy - focal lymphoid infiltration with germinal centers OR interstial fibrosis and acinar atrophy

Question 7

Tx

Answer 7

Sx relief

Hydration

Articifical tear preps