Sjogren's Syndrome Flashcards
What is Sjogren’s Syndrome?
A long-term autoimmune disease in which the moisture-producing glands of the body are affected. This results primarily in the development of a dry mouth and dry eyes
What is the prevalence of Sjogren’s Syndrome?
1/100
What is the general pathophysiology behind Sjogren’s Syndrome?
The exocrine glands are affected in a destructive, fibrosing process leading to failure of gland function. The pathological findings are of focal lymphocytic infiltration in the exocrine glands
- Salivary glands
- Sweat glands
What can Sjogren’s be secondary to?
- RA
- SLE
- Systemic Sclerosis
What are clinical features of Sjogren’s?
- Sicca symptoms
- Vaginal dryness
- Dry cough
- Dysphagia
- Systemic upset
- Arthralgia
What are Sicca symptoms?
Dry eyes and mouth
- Keratoconjunctivitis sicca - eyes
- Xerostomia - mouth
- Polydipsia - due to dry mouth
What percentage of those with Sjogren’s present with Raynaud’s?
13%
What percentage of those with Sjogren’s have arthalgia?
50%
What might you see on examination of someone with Sjogren’s?
- Lymphadenopathy
- Parotid/Salivary Gland enlargement
- Raynaud’s
What are feautures of systemic upset seen in Sjogren’s?
- Fatigue
- Fever
- Myalgia/Myositis
- Arthalgia
- Vasculitis
- Lung, liver, kidney involvement
- Peripheral sensory neuropathy
What investigations would you do if you suspected Sjogren’s?
- Bloods - Ig, Anti-Ro, Anti-La, ANA, RF, ESR, CRP, FBC
- Schirmers tear test
- Rose Bengal staining
- Biopsy
Which sex is Sjogren’s more prevalent in?
Females - 9:1
When is the typical age of onset of Sjogren’s?
4th-5th decade
What is Schirmer’s Tear Test?
Filter paper on inside of lower eyelid
Wetting <5mm in 5 mins is positive
What is Rose Bengal Staining?
A sodium salt is commonly used in eye drops to stain damaged conjunctival and corneal cells and thereby identify damage to the eye. In Sjogren’s, It may show keratitis
Which Antibodies are most commonly associated with Sjogren’s?
- Anti-Ro - 40%
- Anti-La - 26%
- ANA - 74%
- RF - 38%
What can happen in pregnancy with Sjogren’s?
Anti-Ro and Anti-La can cross the placenta and cause foetal congenital heart block. It can also cause neonatal lupus syndrome
What might Biopsy show in Sjogren’s?
Lymphocytic aggregation
What complications can occur from Sjogren’s?
- Lymphoma
- Neuropathy
- Purpura
- Interstitial lung disease
- Renal tubular acidosis
How wouldd you manage Sjogren’s?
- Treat Sicca - Artificial tears/saliva, frequent drinks, gland stimulation (pilocarpine or cevimeline)
- NSAIDS and Hydroxychloroquine - Arthralgia
- Immunosuppression - Severe disease
