Keyword for Investigation, Referral to specialist, Hospital chart writing by Sjøgren's syndrome 4.8/5 (10)

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The diagnosis is based on

Sickness (* is included in classification criteria)

  • Time for:
    • Symptom debut
    • Diagnosis
  • * Subjective symptoms of dryness
    • *Eyes
      • Daily dry eyes for at least 3 months or
      • Repeated feeling of debris in the eyes
      • Do you use artificial fog fluid at least 3 daily
    • *Mouth
      • Daily feeling of dry mouth for at least 3 months
      • Must drink often to swallow dry foods

Other symptoms

* Investigational Findings

  • * Tear production is reduced
    • Schirmers test less than 5mm on at least one of the eyes
    • Staining score (corneal examination by ophthalmologist)
  • * Saliva (saliva) production is reduced
    • Dry mouth and drink for dry food
  • * Antibody (SSA = Sjøgren's Syndrome A) is present
  • * Focus score on salivary gland biopsy (lip) shows at least 1 foci / 4 square millimeter
    • Tongue sticking, sialometry less than 1,5ml / 15min). Vaginal dryness

Other investigations

  • Weight (reference for later)
  • Palpate:
    • Gland glands
    • Submandibularis glands
    • Lymph nodes on the neck
  • Look in the mouth
  • Heart (rhythm, murmur)
  • Lungs (crepitations)
  • Blood pressure
  • Skin (often dry skin, eczema, purpura)
  • Arthritis (Arthritis)
  • Neurological (sensibility, neuralgia, movements)
  • Schirmer's test (can be performed by a nurse at the rheumatological department)
    • Less than 5mm moisture bilaterally (5mm or lower in just one eye is less specific, but sufficient for classification criteria), more than 10mm is normal
  • Sialometry / Unstimulated Saliva Measurement (Can be Performed by Nursing at Rheumatology Department)
    • Do not drink, eat or chew gum last hour before the examination
    • The patient is at ease
    • Measured over 15 min
    • Less than 1,5ml / 15 is pathologically low

Additional investigation that can be considered

Blood tests

  • SSA (Sjøgrens Syndrome A, Ro antibody) in high titer (over 240) at most. SSA also occurs at SLE and Myositis (often lower titer) and in many healthy ones
  • SSB (Sjøgrens syndrome B, La antibody) occurs with SSA at less than 50%
    • Both SSA and SSB dispose of fetal heart block in fetus in the event of pregnancy
  • Sedimentation rate (ESR) often high at high IgG (common)
  • CRP (often low)
  • TSH, f-T4 (concomitant hypothyroidism),
  • Calcium in high values ​​(hyperparathyroid function can cause drowsiness, nausea and pain)
  • ALT, creatinine, p-amylase (pancreatitis component), CK (myositite component), electrophoresis, complement factors C3 and C4.

Urine-stix

  • To exclude nephritis (more typically by SLE) and glucosuria

Radiological

Lymphoma risk at Sjögren's syndrome

Risk factors for Non-Hodgkin's lymphoma include persistently low numbers of lymphocytes (leukocytes) in blood and low complement factors C3 and C4 (reference: Jonsson MW, 2012).

Pregnancy at Sjøgren's syndrome

Doubt if the diagnosis is correct?

  • Most (more than 90%) with Sjøgren's syndrome are women
  • All (almost) have subjective dryness (sicca phenomena) in the eyes and mouth
  • Most have Antibodies SSA / Ro in high titer (severe rash) in the blood
  • At high age (more than 80 years) approx. 40% dryness off Another reason (Age-related degeneration of exocrine glands, drugs)
  • Differential diagnoses, please see here

Excludes dryness caused by other condition

Drugs that can give dryness

  • Antidepressants
  • Beta-blocker
  • Diuretics
  • Antihistamines
  • Anticolinergic Parkinson's Drugs

Please read about differential diagnoses here

Treatment

referral

Patients resident in Oslo


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