Sjogren's Syndrome: Multidisciplinary Approach to Diagnosis and Management

Abstract

Purpose: Sjögren’s syndrome (SS) is a chronic and progressive multisystem autoimmune disease typically managed by rheumatologists. Diagnostic delays are common, due in large part to the non-specific and variable nature of SS symptoms and the slow progression of disease. Methodology: This article reviews current understanding of the clinical manifestations, diagnosis and treatment of Sjögren's syndrome and its attendant ocular manifestation. Sjögren's syndrome is a chronic inflammatory disorder of the exocrine glands with multiple non exocrine features. It is found predominantly in middle-aged women but exists throughout the population. The diagnosis of Sjögren's syndrome can be challenging because the cardinal sicca symptoms may be subclinical or attributed to other causes, such as medications or aging. Differential diagnosis of Sjögren's syndrome can be confounded by the multiple exocrine manifestations in the mouth, eyes, ears, nose, skin, vagina, and respiratory and gastrointestinal tracts. Characteristics of SS are dry eye and dry mouth, which are typically the earliest presenting complaints, eye care clinicians such as the optometrists and dental professionals are often the first point of medical contact and can provide critical collaboration with rheumatologists to facilitate both timely diagnosis and ongoing care of patients with SS. Findings: Current diagnostic criteria advocated by the American College of Rheumatology are predicated on the presence of signs/symptoms suggestive of SS along with at least two objective factors such as traditional biomarker positivity, salivary gland biopsy findings, and/or presence of keratoconjunctivitis sicca. Timely diagnosis of SS requires appropriate clinical vigilance for potential SS symptoms, referral and collaborative communication among rheumatology, optometrists, ophthalmology, and oral care professions. Unique Contribution to Theory, Practice and Policy: It is concluded that optometrists can now identify Sjogren’s patients earlier in their dry eye population with a new advanced diagnostic test Sjo,the laboratory test designed for early detection of Sjogren’s syndrome, has been available from Nicox for use by eye care professionals since November,2013. Optometrists have a role to play in the management of ocular manifestations of Sjogren’s syndrome. Such symptoms can lead to discomfort, blurred vision, and visual fatigue if not attended to immediately. For people with immune system disorder, inflammation of tear-secreting glands reduces tear production, resulting in chronic dry eyes. Prescription eye drops such as Tears Naturale, Cyclosporine (Restasis) or Lifetegrast(Xiidra) may be recommended by the eye doctor if you have moderate to severe dry eyes.