Sjogrens Syndrome Flashcards
is sjogrens acute or chronic?
does it progress?
chronic
slowly progressive
what is it characterized by?
lymphocytic infiltration of the exocrine glands (t and b lymphocytes) and b cell hyperactivity.. leads to
xerostomia and dry eyes
what might these pts develop?
malignant lymphoma
what types are there?
primary
secondary - associated with other autoimmune rheumatic disease
what does it lead to destruction and inflammation of?
salivary and lacrimal glands
what is it associated with
autoantibodies ILD vasculitis lymphoma parotid enlargement in 2/3
which autoantibodies do we check
ANA - not specific
RF
SS-A, SS-B (these are specific for sjogrens)
which auto antibodies are specific for sjogrens
SS-A and SS-B
Sjogrens syndrome related antigen
what are some manifestations of the xerostomia
difficulty swallowing food
inability to speak continuously
increase in dental caries
what would u see on PE pertaining to xerostomia
dry, erythematous, sticky oral mucosa, atrophy of papillae on the dorsum of the tongue, enlargement of the parotid gland
whats the fancy name for dry eyes
keraconjunctivitis sicca
how to they describe the dry eye symptoms
sandy/gritty feeling under eyelids, burning, decreased tearing, redness, itching, eye fatigue, photosensitivity
what diagnostic tools will you use to evaluate the dry eye
schrimer’s test
tear composition (tear breakup time or tear lysozyme content)
slit lamp exam - corneal ulcerations
what are some of the extraglandular (systemic) manifestations (seen in 1/3 of patients)
renal involvement = interstitial nephritis, glomerulonephritis
lymphoma (in later disease-leukopenia, purpura, most are extranodal b cell lymphocytes-detected with LIP BIOPSY)
what is the full diagnostic eval
MRI of salivary glands lower lip salivary gland biopsy schrimer's test tear composition slit lamp exam CBC (normo normo anemia) elevated SED rate CM
what do we need to diagnose sjogrens
4/6 criteria as long as histopathology OR serology (antibodies) is pos, or any 3/4 criteria items
- ocular sx
- oral sx
- ocular signs
- histopathology
- salivary gland involvement
- antibodies
what is our treatment goal?
symptomatic relief
what can we replace deficient tears with?
Tearisol, Hypo tears
what drugs should they avoid
ones that my decrease lacrimal and salivary secretions (anticholinergics, diuretics)
best replacement for xerostomia?
water
what can be used to stimulate secretions?
pilocarpine (Salagen)
what is helpful for arthralgias?
hydroxychloroquine
