Sjogren's Syndrome

Dry

Step 1: View clinicals

A 45 year old woman presents with a dry mouth, and difficulty in eating, speaking, and swallowing for 5 months. She also complains of burning and itching of her eyes, along with a foreign body sensation. Her medical and drug histories are unremarkable. There is no history of sexual promiscuity.


Step 2: Order all relevant investigations

Ocular Surface Staining

The ocular staining score is 3

Lip biopsy

A biopsy is obtained from the lower lip and associated salivary glands. The lip shows focal periductal and mononuclear cell infiltrate with acinar cell loss in the labial minor salivary glands.

Antibody screening

Anti-Ro (Anti-SSA) antibodies: positive Anti-La (Anti-SSB) antibodies: positive Rheumatoid Factor: negative Antinuclear Antibodies: negative

Parotid Sialometry

Unstimulated whole saliva flow: 0.05 ml/min (normal: < 0.1 ml/min)


Step 3: Select appropriate management

Tear Replacement
Parotidectomy
Immunosuppression
Pilocarpine


Score: ★★☆