About Sicca/Sjogren’s Disease

Sjogrens is a chronic, inflammatory autoimmune disease involving exocrine gland inflammation.

  • Extra-glandular symptoms affect up to 40% of patients
  • Female:Male = 9:1
  • Peak age 50-60yo

Important to rule out mimics: oral candidiasis, medications, smoking, contacts overuse

25-60% of neuropathy precedes Sjogren’s diagnosis

If sicca but SSA/SSB neg: consider cancer, need biopsy

Sjogren’s can be associated with cryoglobulinemic vasculitis (consider this diagnosis if new rash, labs will show LL C4, normal C3, high RF)

  • Exocrine glands
  • Sicca = dry eyes and/or  dry mouth in >85% pts
  • Ocular:
    • Dry
    • Itching
    • Foreign body/gritty sensation
    • Abnormal vision
  • Dry mouth → frequent cavities
  • Salivary gland enlargement
  • Neuropathy

Lab workup

  • SSa/SSb+ in  60-80%
  • Other rheum labs nonspecific for Sjogren’s: ANA+, RF+

Objective testing

  • Ocular surface staining
  • Salivary gland scintigraphy
  • Whole sialometry
  • Salivary gland biopsy
  • Schirmer test
Sicca:

  • Age related sicca
  • Medication-sicca
  • Oral candidiasis
  • Contact use
  • Smoking

Endo: DM2, Thyroid

Viral: HCV, HIV

Lymphoma, other cancer

Avoid contributing medications and desiccants

Oral Symptoms

  • Good hydration
  • Salivary stimulants
  • Artificial saliva
  • Muscarinic agonist: pilocarpine, cevimeline
  • 1.1% sodium fluoride

Ocular Symptoms

  • Artificial tears/ointment
  • Ophtho referral:
    • Topical cyclosporine
    • Punctal plugs

Extra-Glandular Manifestations

  • DMARDs for arthritis: Hydroxychloroquine, methotrexate, etc.
  • IVIG for neuropathy

Poor prognostic factors

  • Low complements
  • Salivary gland enlargement
  • Lymphadenopathy

Complications

  • Increased risk of non- Hodgkin lymphoma
  • Vasculitis
  • Cryoglobulinemia