Sjogrens Syndrome

Question 1

What are diagnostic criteria for primary sjogrens

Answer 1

No other CT or AI disease
+ AntiRo and AntiLa
+ lymphocytic focus (>1 focus) focus = >50mononuclear cells/4mm3

Question 2

What are criteria to diagnose Sjogrens

Answer 2

Ocular symptoms - grittiness/sands/dry/eyedrops
Oral symptoms - dry/difficult to swallow/drinking
Ocular test - rose bengal test for corneal ulceration, Schirmers tear test
Oral test - saliva flow rate 1.5ml in 15mins, + sialography, + scintigraphy
Histopathology - labial biopsy - >1 focus of lymphocytic infiltration (>50mononuclear cells/4mm3)
Antibodies - antiRo, antiLa

Question 3

Whats the presenting symptoms of sjogrens syndrome

Answer 3

Dry eyes

Dry mouth

Question 4

Why is biopsy diagnostics

Answer 4

Shows >1 focus of lymphocytic infiltration (>50mononuclear cells in 4mm3)

Not all Sjogrens will show +ve autoantibodies

Question 5

Imaging to diagnose sjogrens

Answer 5

Sialography - will show dilation of ductal system (sialectasis) fruit ladden branchless tree

Scintigraphy - reduce uptake, reduce salivary flow rate

Question 6

Management of sjogrens syndrome?

Answer 6

Combined tx with rheumatologists
Ophthalmologists, gdp, omfs

Aimed at
Relieving symptoms
Preventing complications
Proper selection of immunosuppressive therapy by rheumatologists

Xerostomia tx:
Sialogogues - chewing gum, sugarless candy
Cholinergic agonist - pilocarpine 5mg tds
Frequent drinking
Salivary substitutes - lactoferrin, lysozyme, lactoperoxidase

Question 7

Complications of sjogrens syndrome

Answer 7

Risk of non Hodgkin b cell lymphoma
Dental caries
Corneal damage
Risk of heart defects in fetus 
Parotid infection

Question 8

Tx of xerostomia

Answer 8

Sialogogues - sugarless candy
Salivary substitutes - lactoferin, lysozyme, lactoperoxidase
Cholinergic agonists - pilocarpine 5mg tds
Frequent drinking