Clinical Symptoms
It is estimated that 4 million people in the United States suffer from Sjogren’s disease; however, many individuals have never heard of the disease. Sjogren disease is a chronic autoimmune disorder that affects multiple organ systems. It is characterized by impairment of lacrimal and salivary gland function that results in dryness of both the eyes and mouth. It can occur alone but is often associated with systemic lupus erythematosus and rheumatoid arthritis. It usually affects females in the fifth decade of life more than it affects males.
Diagnosis
Unfortunately, there is no single diagnostic test for the disease. Instead, diagnosis is made using a combination of clinical symptoms along with abnormal serologic tests. Serologic tests include the presence of antibodies to SS/Ro and/or SSB/La, however, diagnosis should not be made only on these tests because these antibodies can be found not only in patients with Sjogren’s but also in other rheumatic and connective tissue diseases. Other diagnostic testing includes ophthalmologic consultation, labial salivary gland biopsy, and/or imaging studies. Diagnosis of Sjogren’s should be suspected if patients complain of ocular and oral dryness that has persisted for at least 3 months. Ophthalmologic evaluation should be performed and may include a Schirmer test or slit-lamp examination for tear break-up time along with ocular surface staining. The Schirmer test is a reflex tear production exam that uses a strip of sterile filter paper placed at the lower eyelid. Normally, the eye will produce tears due to the irritation of the paper and should wet the paper. After five minutes the paper is measured and wetting of less than 5 mm without anesthesia indicates aqueous tear deficiency and is a classification of criteria for Sjogren disease.
Treatment
Although there is no cure for Sjogren’s disease, there are several nonpharmacologic and pharmacologic treatment options available. For patients who are smokers, smoking cessation is advised as this may exacerbate the dry mouth and eye symptoms. Anticholinergic medications can aggravate symptoms and should be avoided. Artificial tears and lubricants can be used to help with dry eye symptoms. Lubricants that are gel or ointment-based can blur vision and should only be used before going to sleep. Arthralgias and arthritis can be managed with NSAIDs or glucocorticoid treatment. In patients with fatigue, a low-impact aerobic exercise program along with stress reduction and cognitive behavioral therapy can help improve symptoms. Newer therapies are being introduced soon which brings hope that patients will have more access to treatments to address symptoms. Providers need to identify patient symptoms and perform the necessary tests to provide an accurate diagnosis and give patients options to address their symptoms.
References
Baer, A. (n.d.). Overview of the Management and Prognosis of Sjogren’s Disease. UpToDate. https://www.uptodate.com/contents/overview-of-the-management-and-prognosis-of-sjogrens-disease?search=sjogren&source=search_result&selectedTitle=1%7E150&usage_type=default&display_rank=1 Assessed and Endorsed by the MedReport Medical Review Board