oral medicine & Pathology

Sjogren’s Syndrome: Clinical features, Incidence, Etiology, Diagnosis, Management

Sjogren’s Syndrome

 

Clinical features

Dry eyes (keratoconjunctivitis sicca): initially asymptomatic, later gritty sensation, itching, soreness or inability to cry.

– Salivary and lacrimal glands may swell.

– Dry mouth (xerostomia): difficulty in eating dry foods, disturbed taste,
speech and swallowing, rampant caries, candidosis and acute sialadenitis.

– Saliva is frothy and not pooling; parchment-like mucosa and lobulated depapillated tongue.

– There is no connective tissue disease in primary Sjögren’s syndrome, but it is present
in s
econdary: typically rheumatoid arthritis or primary biliary cirrhosis, and occasionally other autoimmune disorders.

– A similar syndrome may be seen in HIV disease.

Incidence

Uncommon: mainly middle-aged or elderly women.

Aetiology

Autoimmune inflammatory exocrinopathy. There may be a viral aetiology and a
genetic
predisposition.

Diagnosis

Clinical. Ro (SS-A), La (SS-B) and other autoantibodies, especially rheumatoid factor.

Salivary flow rates reduced.

– Labial gland biopsy, sialography and/or scintigraphy or ultrasonography.

Differentiate from other causes of xerostomia, especially drugs (anticholinergics such as
tricyclic
antidepressants and sympathomimetics), dehydration, HIV salivary gland disease, irradiation, sarcoidosis.

Management

Control underlying disease: at present experimental (e.g. ciclosporin).

Eyes – methylcellulose eye drops or rarely ligation or cautery of nasolacrimal duct.

Dry mouth – preventive dental care (oral hygiene, limitation of sucrose intake, fluorides, chlorhexidine, xylitol-containing chewing gum) Treat infections.

Sialogogues and/or salivary substitutes (e.g. methylcellulose). Pilocarpine, cevimeline or bethanechol may be used to stimulate salivation.Sjögren’s syndrome. Sjögren’s syndrome. Sjögren’s syndrome.

ــــــــــــــــــــ ⒹⒺⓃⓉⒶⓁⓈⒸⒾⒺⓝⓒⒺ ــــــــــــــــــــ