Sjögren's Syndrome: Key Features and Management

00:00 So, let's talk a little bit about some of those key features of Sjogren's syndrome that we were seeing in our patient.

00:06 Rather than referring to her as having just dry eyes, we have a more technical term in medicine.

00:12 It's called keratoconjunctivitis sicca. "sicca" comes from an old Latin word for dry.

00:17 Along the same lines, xerostomia means dry mouth, which she was also reporting and had that furrowed tongue as well to support that condition.

00:27 While we may not often think of saliva as being a particularly important part of our body secretions, it turns out that that saliva is really important to clear our bacteria and to maintain hydration in our mouth to prevent dental caries from occurring.

00:42 In addition to saliva and the acidity of the saliva prevents oral candidiasis so if you don't have a lot of saliva around, you're much more prone to cavities and you're much more prone to oral thrush.

00:52 Sjogren's syndrome is also associated with parotid and salivary gland enlargement as we've discussed with our patient and of course, you're gonna have some systemic symptoms just like she was having, some malaise, mialgias, rarely would be some low-grade fevers.

01:09 The arthritis that could be present as well and the family history of Raynaud's disease.

01:15 It's all part of the same family, things with lupus and scleroderma, etc.

01:19 There's also been an association, though fairly mild for getting an increased risk of non-Hodgkin lymphoma so just something to think about in terms of screening over time.

01:29 Now that we've diagnosed this in our patient, we should provide some management -- recommendations.

01:35 She's gonna need close follow-up with dental. Again, because of that risk of getting more cavities over time.

01:40 Ophthalmology, we'll want to have them evaluate her and consider different medications to help with increasing tear production.

01:47 She'll probably need to see a rheumatologist as well to manage her Sjogren's itself. Artificial tears can be helpful.

01:53 Smoking cessation is gonna be really important because smoking both dries out the mouth and it can also exacerbate the symptoms of Sjogren's disease for reasons that aren't entirely clear.

02:03 There are some particular eye drops that an ophthalmologist may recommend that could increase tear production like pilocarpine and lastly, if symptoms are particularly egregious, you can use Glucocorticoids and potentially, even disease-modifying agents to cool down the disease process.

02:20 That being said, there's no cure for Sjogren's syndrome.

02:24 It is only gonna be supportive care and close follow-up over time.

02:27 So, let's highlight some key points.

02:31 Sjogren's syndrome is a chronic, slowly progressive autoimmune disease with a lymphocytic infiltration of the exocrine glands.

02:39 Again, the tears ducts, bilateral parotids, some mandibular glands.

02:43 It's gonna be characterized by dry eyes and dry mouth and those things are universally present.

02:50 The Schirmer test, remember, assessing for tear production, is a good marker for Sjogren's syndrome and you can also check those anti-Ro/SSA antibodies which are relatively specific for Sjogren's syndrome, though can certainly line up with lupus as well. You wanna look for candidiasis, dental caries, and just be mindful of the fact that lymphoma can be higher risk and lastly, you're only providing supportive treatment trying to decrease the symptoms, acknowledging you can't actually make the disease go away.