Sjögren’s syndrome is an autoimmune condition affecting the exocrine glands, notably the lacrimal and salivary glands,
Symptoms:
Dry mouth
Dry eyes
Dry vagina
Dry skin
Joint pain/stiffness
Dry eyes and dry mouth can be called sicca symptoms.
Causes of secondary Sjogren's:
SLE
RA
Antibodies associated with Sjögren’s are:
Anti-SS-A antibodies (also called anti-Ro)
Anti-SS-B antibodies (also called anti-La)
Schirmer test:
Folded filter paper under the lower eyelid
Moisture from the eye will travel by diffusion along the filter paper
After 5 minutes <10mm is significant
The diagnosis is typically made based on the clinical features and presence of antibodies. Salivary gland biopsy may be used to confirm the diagnosis but is not usually necessary.
Treatment options include:
Artificial tears (e.g., polyvinyl alcohol eye drops during the day and carbomer gel at night)
Artificial saliva
Vaginal lubricants
Pilocarpine (oral) can be used to stimulate tear and saliva production
Hydroxychloroquine may be considered, mainly in patients with associated joint pain
Pilocarpine stimulates muscarinic receptors, stimulating the parasympathetic nerves and promoting salivary and lacrimal gland secretion.
Complications related to exocrine gland dysfunction include:
Eye problems, such as keratoconjunctivitis sicca and corneal ulcers
Oral problems, such as dental cavities and candida infections
Vaginal problems, such as candida infection and sexual dysfunction
Sjögren’s can rarely affect other organs, causing complications such as: