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Sjogren's Syndrome

Sjorgren's Syndrome is an autoimmune condition characterised by decreased lacrimal and salivary gland secretion, leading to dry eyes and mouth. It's due to a lymphocyte-mediated autoimmune destruction (type IV hypersensitivity) of minor salivary and lacrimal glands, leading to atrophy and fibrosis.


Types:

  • Primary – Occurs alone

  • Secondary – Occurs related to SLE or RA

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“Signs and symptoms of Sjögren syndrome or “dryness”” © Scientific Animations CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0/)

Complications

  • Eye – Reduced tear secretion (causing dry, gritty eyes that may appear red)

    • Superimposed bacterial conjunctivitis often occurs

  • Mouth – Dry mouth (causing difficulty talking or swallowing), Swollen parotids

    • Cavities and candida infection often occurs

  • Vagina – Dryness, Candida infection, Sexual dysfunction


Patients here are at a much higher risk of Lymphoma, therefore patients with new/changing lymphadenopathy should be investigated promptly.


Investigations

  • CRP/ESR, Anti-Ro, Anti-La

  • Schirmer’s Test - Demonstrates reduced tear secretion - Paper put under lower eyelid. After 5 minutes, the distance that becomes moist is measured

    • A result of < 10mm (NR >15mm) is significant

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“Schirmer's test, placing the strip in the lower eyelid pouch” © Jmarchn CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0/)

Management

Symptomatic relief:

  • Dry eyes - Artificial tears and saliva

  • Dry mouth - Artificial saliva, hydration, and good dental hygiene

  • Vaginal dryness - Topical lubricants




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