- Clinical science
Sjogren syndrome is a chronic inflammatory autoimmune disease that occurs mainly in middle-aged women. The cause of primary Sjogren syndrome is unknown, whereas secondary Sjogren syndrome is associated with underlying autoimmune diseases (e.g., rheumatoid arthritis). As the immune system mainly attacks lacrimal and salivary glands, patients typically present with xerophthalmia (dry eyes) and xerostomia (dry mouth), the combination of which is also known as sicca syndrome. The disease may also involve the skin, joints, internal organs, and nervous system. It is diagnosed via the detection of autoantibodies (anti-SSA/Ro, ANA) and salivary gland biopsy. Management focuses on supportive measures and, in more severe cases, immunosuppressants.
- Sex: ♀ > ♂ (∼ 9:1)
- Age of onset: : typically 40–60 years
Epidemiological data refers to the US, unless otherwise specified.
- Inflammation of the salivary glands: decreased production of saliva → xerostomia (dry mouth)
Inflammation of the lacrimal glands ( ): decreased secretion of tears → xerophthalmia (dry eyes) →
- Redness, itching, burning of eyes
- Sensation of sand or foreign body in the eyes
- Blurred vision
- Sicca syndrome: combination of dry mouth and dry eyes
- Nasal dryness → chronic rhinitis, nosebleeds
- Pharyngeal, tracheal, and bronchial dryness → persistent, dry cough
- Vaginal dryness → dyspareunia (painful intercourse) and increased risk of infections
- General symptoms: : fatigue and arthralgias (∼ 70% of cases)
- Skin manifestations: xerosis ; Raynaud's phenomenon (∼ 15–30% of cases)
- Vasculitis (∼ 10% of cases)
- Neurological and psychiatric manifestations
- Gastrointestinal manifestations: e.g., dyspepsia, reflux esophagitis
Sjogren syndrome is diagnosed based on the typical clinical features and is confirmed via detection of specific antibodies and a pathologically low tear production. Biopsy of the salivary gland is the most accurate test, but is not needed to establish the diagnosis.
- Nonspecific findings: ↑ ESR; , normocytic anemia, leukopenia, eosinophilia, hypergammaglobulinemia
- Immunological findings (also found in )
- Urinalysis: possible signs of glomerulonephritis or interstitial nephritis (e.g., proteinuria, red cell casts)
Schirmer's test: : shows decreased tear production
- < 5 mm of moisture on the filter paper after 5 minutes are indicative of Sjogren syndrome
- Slit lamp examination
- Method: usually taken from the labial salivary glands
Ultrasound of the parotid gland
- Honeycomb or cloud-like structure of the glandular parenchyma
- Alternating hypoechoic areas and band-like hyperechoic septa and cysts
- Treat the underlying disease in secondary Sjogren syndrome.
- For dry mouth
- For dry eyes
- Treatment of extraglandular disease depends on the specific manifestation: arthralgia may be managed with NSAIDs or hydroxychloroquine, whereas neurological manifestations, for instance, often require aggressive immunosuppression.
- Risk of developing associated conditions (e.g., systemic lupus erythematosus, rheumatoid arthritis)
- Corneal scarring, ulcer, rupture, and infection
- Pregnancy: fetal loss, infant with neonatal lupus syndrome and associated complete heart block
We list the most important complications. The selection is not exhaustive.