Sjogren syndrome is an autoimmune disease in which immune cells damage the tear and salivary glands, causing chronic dry eyes and dry mouth. It mostly affects middle-aged women, can occur alone or with diseases such as rheumatoid arthritis or lupus, and raises the risk of lymphoma.
Key symptoms
- Gritty, burning dry eyes
- Dry mouth, needing water to swallow dry food
- Dental cavities and mouth sores
- Fatigue, joint pain, dry skin or vaginal dryness
What you find on exam
- Dry mouth with little pooled saliva and a cracked tongue
- Swollen parotid glands
- Red eyes; check the cornea
- Joints, skin for purpura, lymph nodes
Tests
- Anti-SSA (Ro) and anti-SSB (La), ANA, rheumatoid factor
- Schirmer test for tear production
- Lip salivary gland biopsy when the diagnosis is uncertain
- Blood count, complement, immunoglobulins and urinalysis
Treatment basics
- Artificial tears and cyclosporine eye drops
- Sugar-free gum, saliva substitutes and good dental care
- Pilocarpine or cevimeline to increase saliva
- Hydroxychloroquine for joint and skin symptoms; immune suppression for organ disease
Red flags
- Persistent or growing gland swelling or enlarged lymph nodes, which may signal lymphoma
- Eye pain with vision change
- Numbness, weakness, shortness of breath or kidney problems from organ involvement
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.