Sjogren's Syndrome

Mer som dette

Aniridia

Ved Nikki Brodbeck

Coronary Artery disease

Ved Richard Agjei

Orthodontics

Ved sarah reimann

What you are going to learn next week

Ved Marco Bertolini

Sjogren's Syndrome

Health Promotions

Vitamin D supplementation to decrease risk of neuropathy & lymphoma

Chew sugar-free gum

Increased fluid intake

Treatment

Pilocarpine or Cevimeline (cholinergics aka muscarinic antagonists)

MOA: increases lacrimation and salivation

SE: diaphoresis, flushing, bradycardia, diarrhea, N/V, incontinence, blurred vision (2/2 pupil constriction), bronchoconstriction

Cevimeline has less of an effect on cardiac & lung tissue

Artificial saliva, fluoride

Artificial tears

Symptoms

Constitutional symptoms:

generalized pain, arthralgias

fatigue, weakness, sleep disturbances, anxiety, depression

Dyspareunia 2/2 decr vaginal secretions

Keratoconjunctivitis sicca 2/2 decreased tear production

Xerostomia

Gi symptoms

ENT symptoms: nasal dryness, chronic cough

Signs

Sensorineural hearing loss

Peripheral neuropathy

Raynauds

Nonerosive arthritis

Fever

Dry mucous membranes

Pericarditis

Ocular findings: Xerophthalmia, conjunctivitis, corneal ulcers

Oral findings: Decreased salivation, oral ulcers, dental caries, periodontal disease, bilateral parotid gland enlargement & tenderness

Diagnostics

Screening labs:

ANA: Anti SSA/Ro, Anti SSB/La

Could have + rheumatoid factor, elevated ESR

Ocular tests:

Positive Schirmer test (decreased tear production - wetting <5mm of filter paper)

Rose Bengal stain: abnormal corneal epithelium

Minor salivary gland biopsy or parotid gland biops

Findings of gland fibrosis & lymphocytic infiltration confirm diagnosis

Pathophysiology

Inflammatory destruction of the exocrine glands characterized by focal lymphocyte infiltration of exocrine glands

Aggregation of lymphocytes, primarily CD4+ T-cells and memory cells

Genetics

Associated with HLA-SR52 gene

Epidemiology

one of the three most common systemic autoimmune diseases

Most common in females (90%), 40-60 yo

Etiology

Secondary: associated w/ other autoimmune disorders such as rheumatoid arthritis, Hashimotos, SLE

Primary: occurs alone as a solitary process