Rheumatology Edition | Sjogren’s Syndrome “The Basics”
Feb 1, 2024
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Dr. Alicia M. Hinze discusses Sjogren's Syndrome, an autoimmune disorder with symptoms of dry mouth and dry eyes. It can mimic other medical conditions and is often diagnosed late. Learn about the challenges in diagnosing and treating it, as well as the use of new tests and treatment options. Discover the overlap between Sjogren's Syndrome and inflammatory arthritis, and the importance of ruling out other causes. Treatment options include immunosuppressant medications, but there is an increased risk of lymphoma for patients.
Sjogren's syndrome can be challenging to diagnose due to its varied symptoms and mimicry of other medical conditions, but tests such as antibodies and rheumatoid factor can help confirm the diagnosis.
The typical presentation of Sjogren's syndrome includes dry eyes and dry mouth, but other symptoms like joint pain, fatigue, and neurological complications can also occur, highlighting the importance of evaluating for possible overlapping conditions or mimicking diseases.
Deep dives
Diagnostic Challenges and Treatment Options for Schulgren's Syndrome
Establishing a correct diagnosis of Schulgren's syndrome can be challenging due to its varied and often insidious onset of symptoms. Patients commonly present with dry mouth and dry eyes, but symptoms can vary from person to person. The delayed recognition and mimicry of other medical conditions contribute to the difficulty in diagnosis. Tests such as ANA, SSA, and SSB antibodies, as well as rheumatoid factor, are helpful in confirming the diagnosis. While there is no absolute cure for Schulgren's syndrome, various symptomatic treatments, including over-the-counter dry mouth products and secretagogues, can help manage the dryness. If inflammatory arthritis is present, medications like hydroxychloroquine and methotrexate may be used.
Clinical Presentation of Schulgren's Syndrome and its Extra-Glandular Features
The typical presentation of Schulgren's syndrome includes dry eyes and dry mouth, which can vary in severity. Asking about a gritty or sandy sensation in the eyes can help identify dryness. Joint symptoms may develop in some patients, often accompanied by muscle pain and extreme fatigue. Other manifestations can include neurological complications and cutaneous vasculitis. Some patients may not initially present with dry eyes and dry mouth, but with other symptoms like neuropathy or small fiber neuropathy. It is important to evaluate for possible overlapping conditions or mimicking diseases.
Long-Term Outlook and Management of Schulgren's Syndrome
Schulgren's syndrome is chronic and has no absolute cure, but the long-term prognosis varies. Some patients experience stable symptoms of dry eyes and dry mouth, while others may have fluctuations or worsening of symptoms. Extra-glandular features, such as inflammatory arthritis, rain notes phenomenon, and cutaneous vasculitis, can also affect the course of the disease. Close monitoring is necessary to identify any additional complications that may arise, such as lymphoma. Treatment approaches are individualized based on the specific symptoms and manifestations, and can include medications like hydroxychloroquine, methotrexate, and rituximab, as well as supportive measures to relieve dryness and manage joint pain.
Rheumatologic problems are some of the most common health conditions we see as primary care professionals. In many cases, taking months and sometimes years to properly diagnose, rheumatologic conditions can become frustrating for both the provider and the patient. There are a variety of new tests available to help us establish a diagnosis, as well as multiple new and effective treatment options. This episode is part of a seven-episode mini-series on Mayo Clinic Talks dedicated to rheumatologic health problems to aid in the recognition, diagnosis, and treatment for your patients. Please find these episodes where you listen to podcasts or on ce.mayo.edu.
Sjogren’s is an autoimmune disorder that has a somewhat unusual presentation. In addition to arthralgias, patients often develop a dry mouth and dry eyes and symptoms can vary from person to person. It also commonly mimics other medical conditions, and this may account for its typically delayed diagnosis. Like most other autoimmune diseases, the exact cause isn’t known, but Sjogren’s is treatable. In this podcast, we’ll review the presentation of Sjogren’s, how to establish a diagnosis and how patients with the condition should be managed. Our guest is Alicia M. Hinze, M.D., M.H.S., from the Division of Rheumatology at the Mayo Clinic.