15- SJOGREN SYNDROME

• Sjögren's syndrome


  • Immunologically mediated destruction of epithelial exocrine glands, especially the lacrimal and salivary glands
  • Predominantly affects middle-aged women
  • May be an isolated disorder (primary Sjögren's syndrome) or in association with another autoimmune disease (secondary Sjögren's syndrome), commonly rheumatoid arthritis or SLE
• Symptoms


  • Dry eyes (keratoconjunctivitis sicca)
  • Dry mouth (xerostomia)
• Clinical clues


  • Difficulty eating a dry biscuit
  • Absence of pooling of the saliva when the tongue is lifted
• Risks


  • High risk of dental caries
  • Bilateral parotid gland enlargement
• Other features of the condition


  • Arthritis
  • Raynaud's phenomenon
  • Renal tubular defects (diabetes insipidus and renal tubular acidosis)
  • Pulmonary fibrosis
  • Vasculitis
  • Increased incidence of non-Hodgkin's B cell lymphoma
• Serum autoantibodies in Sjögren's syndrome


  • Antinuclear (in 80% of patients)
  • Anti-Ro (60–90%)
  • Rheumatoid factor in primary Sjögren's syndrome
• Labial gland biopsy in Sjögren's syndrome


  • Shows characteristic changes of lymphocyte infiltration and destruction of acinar tissue
• Schirmer test


  A standard strip of filter paper is placed on the inside of the lower eyelid; wetting of < 10 mm in 5 min is positive
• Schirmer test result


  Defective tear production
• Management of Sjögren's syndrome


  1. Artificial tears

  2. Saliva replacement solutions

  3. Pilocarpine