Sjogrens

Question 1

Define Sjorgens

Answer 1

Chronic inflammatory disorder mainly characterized by lymphocytic infiltration of exocrine glands prominently.

Usually presents as persistent dryness of the mouth and eyes due to functional impairment of the salivary and lacrimal glands

Primarily effects white perimenopausal women

Question 2

What is the key feature in primary Sjorgrens

Answer 2

Xerostomia

Question 3

A pt with Angular chelitis in the setting of Sjorgens indicates

Answer 3

Candida Infx

• erythematous changes of the hard palate
• Red tongue w/ atrophic papillae

Question 4

How does Sjorgens effect the eyes

Answer 4

Keratoconjunctivitis sicca - “Occular dryness”

-photosensitivity, erythema, eye fatigue, decreased visual acuity

• > increased risk of ocualr infections
• Blepharitis, Bacterial Keratitis, Conjunctivitis, ulcerations, opacification

Question 5

How does Sjorgens effect the eyes

Answer 5

Keratoconjunctivitis Sicca (K. Sicca or xerophthalmia) is subjective feeling of ocular dryness. 
May have photosensitivity, erythema, eye fatigue, decreased visual acuity

May have subsequent ocular infections

• Blepharitis
• Bacterial keratitis
• Conjunctivitis

Some severe eye reactions
-Corneal ulceration, vascularization & opacification

Question 6

What is the most common vascular feature observed in SJS

Answer 6

Raynauds

Question 7

What are the Labs for SJS

Answer 7

ANA -80%

RF- 40-50%

AntiRo- 30-70%
Anti La- 25-40%

Complement level should be decreased with cryoglobuklins present

Question 8

What type of anemia presents with SJS

Answer 8

normochromic, normocytic anemia

With isolated cases of hemolytic anemia

Question 9

What is the ESR and CRP levels in SJS

Answer 9

Elevated ESR
(Especially in pts with hypergammaglobinemia)

NML CRP

Question 10

What are Serum protein levels in SJS

Answer 10

Hypergammaglobinema with a monoclonal band

Question 11

What are the LFTs is SJS

Answer 11

Raised transaminases

Raised alk phos &/or bilirubin

Question 12

What are the UA findings in SJS

Answer 12

Elevated proteins and blood

Question 13

What are the CMP findings in SJS

Answer 13

Low K+, Low Bicarb, low blood ph (renal tubular acidosis)

Question 14

What does a Schrimer test do

Answer 14

Evaluates baseline and reflex secretion of lacrimal gland

Question 15

What is the inclusion criteria for SJS

Answer 15

Patients with ocular and/or oral dryness, defined as a positive response to at least 1 of the following questions:

• Have you had daily, persistent, troublesome dry eyes for more than 3 months?
• Do you have a recurrent sensation of sand or gravel in the eyes?
• Do you use tear substitutes more than three times a day?
• Have you had a daily feeling of dry mouth for more than 3 months?
• Do you frequently drink liquids to aid in swallowing dry food?

Question 16

Exclusion criteria for SJS

Answer 16

Hx of head or neck rads

Active Hep C infection

AIDS

Sacroidosis

Amyloidosis

Graft V. host

igG4 related Dz

Question 17

What two sialogogues are used for dry mouth

Answer 17

Pilocarpine or Cevimeline

Question 18

3 agents to treat dry eyes

Answer 18

Preservative-free Artificial tears
Punctal occlusion
Topical cyclosporine

Question 19

What should be avoided in the treatment of SJS

Answer 19

Tobacco or Alcohol

Anticholinergics

Question 20

When should you use hydroxychlorquine for SJS

Answer 20

When mild extraglandualr s/s :

Fatigue/Arthralgias/Myalgias (mild extraglandular)

Question 21

When should you use prednisone for SJS

Answer 21

With moderate extraglandualr S/s

Moderate extraglandular arthritis, extensive cutaneous purpura, and non-severe peripheral neuropathy)

Question 22

If a part has severe extraglandualr SJS w/ Internal organ involvement (pulmonary alveolitis, glomerulonephritis, or severe neurologic features)

What is the Tx

Answer 22

prednisone + methotrexate

Question 23

What cancer are SJS pts at a higher risk for

Answer 23

Lymphoma