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Sjogren's Disease (Pathogenesis (Genetic Associations (HLA-B8, HLA-DR3…

- - - - Tear production
      - Filter paper wetting over 5 mins
      - < 5mm is (+) for dry eye
    - - Dye stains devitalized areas of eye
      - Score based on areas of involvement
      - Potentially toxic -- rarely used
- - - - Loss previously elevated autoantibody (e.g. +RF)
      - Monoclonal gammopathy (screen by SPEP, urine free light chain ratio)
    - - Parotid enlargement
      - Vasculitis
      - Hypocomplementemia (C4)
      - Cryoglobulinemia
- - - - Oral
        
        Dryness
        
        Mucosal atrophy (80-95%)
        
        Salivary gland enlargement (30-50%)
        
        Recurrent parotiditis
        
        Reduced salivary flow rate (xerostoma; oral sicca): can lead to infection, caries, halitosis, dysphagia, etc.
      - Eye
        
        "Sand/gravel" feeling
        
        Use artificial tears >TID
        
        Oral sicca: 11% 30-60, ~15% >65
        
        Dx by ophthalmologist: "keratoconjunctivitis sicca"
        
        Dryness (not diagnostic)
    - - MSK
      - Many other systems (pulm, cards, GI, renal, heme, endo, etc.)