Sjogrens Syndrome Flashcards
What is Sicca Syndrome?
Partial Sjogrens findings
Usually dry eyes or dry mouth but not both
How do you define primary and secondary SJogrens syndrome?
Primary- no connective tissue disease
Secondary
–Connective tissue disease
–SLE, rheumatoid arthritis, scleroderma
What is Sjogrens Syndrome?
Autoimmune disease affecting the salivary glands
Disease is part of connective tissue disorders spectrum
What are some of the consequences of Sjogrens Syndrome?
Gradual loss of salivary/lacrimal gland tissue through inflammatory destruction
–Autoimmune process largely mediated through T lymphocytes which destroys their acini within the salivary glands reducing their ability to produce saliva
Enlargement of major salivary glands - usually symmetrical
Increased risk of lymphoma
Oral effects of loss of saliva (increased caries risk, oral infection risk and loss of lubrication)
What is needed to conclude a diagnosis of Sjogrens syndrome?
Dry eyes/Dry mouth
Autoantibody findings (Anti-Ro or Anti-La)
Imaging findings
–Ultrasound or sialogram
Histopathological findings
What does Sjogrens appear as on sialogram or ultrasonography?
Appears as a snowstorm
Loss of acini has caused holes to appear within the gland where there is no tissue- these holes fill up with dye
On ultrasound- these holes will appear visible called leopard spot appearance
What test is done to diagnose oral Sjogrens?
Abnormal untimulated whole salivary flow (UWS)
<1.5ml in 15 minutes
Patient given tube to spit into
Can be carried out chairside
What are the most common antibodies associated with Sjogrens?
Anti-Ro and Anti-La
What tests do you complete for a patient with suspected Sjogrens?
Firstly look in the patients mouth for dryness
Then the least harmful tests first
–UWS in 15 mins <1.5ml
–Anti-Ro antibody
–Salivary USS
–Baseline MRI of major salivary glands
If still equivocal then do a labial gland biopsy
–risk of area of skin numbness following the procedure
What is the management of a patient with Sjogrens who is presenting early?
Liaise with rheumatologist - multisystem disease
Consider immune modulating treatment- hydroxychloroquinone, methotrexate
What is the management of a patient with Sjogrens who is already presenting with a dry mouth and a salivary deficit?
Oral health needs- Diet advice, OHI, 5000ppm toothpaste (reduce caries and infection risk)
Symptomatic treatment of oral dryness
Salivary stimulants - prilocarpine
What are some unwanted side effects of prilocarpine?
Palpitations and sweating
What are the effects of oral dryness?
Caries risk
Denture retention
Infections
Functional issues- speech and/or swallowing
What can happen to the salivary glands in a patient with Sjogrens?
Sialosis
-Can occur at any time- usually permanent
-Reduction surgery is possible but not advised as there are usually other health issues present
What test can you perform to assess mucosal dryness?
The Challacombe Scale of Mucosal Dryness
measured from 1-10
