This document summarizes Sjogren's syndrome, an autoimmune disease affecting the salivary and lacrimal glands. It causes dryness of the eyes and mouth. The hallmark is infiltration of T4 lymphocytes into the exocrine glands, triggering B lymphocytes to form autoantibodies. Clinical features include dry eyes and mouth, occurring most often in women ages 40-60. Diagnosis involves labial gland biopsy showing lymphocyte infiltration and reduced tear and saliva production on tests. Treatment focuses on lubricating the eyes and mouth, and stimulating saliva production with drugs like pilocarpine.

1. SG-3

2. SJOGREN’s SYNDROME
 Autoimmune disease affecting salivary glands
 Primary sjogrens syndrome involves salivary and lacrimal
glands[exocrine glands]
 Secondary disease involves other connective tissuue
diseases I.e.rheumatoid arthritis. SLE polymyositis along
with salivary and lacrimal glands
2

3. HALLMARK:HISTOLOGY
Infiltration of T4 Lymphocytes into exocrine glands
and triggering B -Lymphocytes to form autoantibodies
3

4. Trigger Factors; [Auto-
antibodies]
 EPISTEN-BARRVIRUS
 RETROVIRUSTYPE-A
 AUTOANTIGENS ON SALIVARY
GLANDS
4

5. CLINICAL FEATURES
 AGE:4th –6th decade
 SEX:F>M [10:1]
 CLINICAL PRESENTATION
 LACRIMAL GLANDS SIGNS & SYMTOMS Dryness of
eyes,feeling of dirt or foreign body are common
symptoms
 Conjuctivitis & corneal ulcers may be seen
5

6. C.F.-SALIVARY GLANDS
 XEROSTOMIA - Common symptom
 Enlargement salivary glands-unilateral/bilateral
 Candidiasis may be seen
 Increased incidence of dental caries
 Dryness of pharynx,larynx may lead to pneumonia
 Vaginal candidiasis in 5% cases
6

7. 7

8. 8

9. 9

10. 10

11. INVESTIGATIONS
 LACRIMAL GLAND
FUNCTIONTESTS
 SCHIRMER’STEST
 BUT[Break uptime]
 ROSE BENGAL DYE
TEST
 SALIVARY GLAND
FUNCTIONTESTS
 SALIVA FLOW RATE
 MINOR SG BIOPSY
 SIALOGRAPHY
 SCINTOGRAPHY
11

12. DIAGNOSTIC TESTS
SCHIRMER’STEST
Place the filter paper in the lower conjuctival sac
Normal pts will wet 15mm of filter paper in 5minutes
Pt’s with SS will wet less than 5mm
12

13. 13

14. 14
BUT TEST:
 Test carried with slit lamp
 Note the interval between the complete blink and
dry spot on the cornea
ROSE BENGAL TEST
 TO detect damaged and denuded area on the cornea
 If two tests are positive then patient is diagnosed
as kerarato conjuctivitis sicca

15. INVESTIGATIONS–SALIVARY GLAND
Salivary flow rate:
Carried out by placing special
fabricated cup”Lashley” cup
Over the orifice of the stensen
duct [parotid]
Saliva can be collected
stimulated or
unstimulated[lemon juice]
Normal range:5ml/min
Pt’s with sjogrens
syndrome;<5ml/5min
 Minor gland biopsy
 1.5 –2cm incision made on
lower labial mucosa
 5 gland lobules are
removed and lymphocytes
focus score made
 Scores are graded;0-4 SS-
2-4 grades
15

16. 16

18. 18

19. SIALOGRAPHY AND MRI
 REDUCED DUCTULES
 PUNCATE OR GLOBULAR SIALECTASIS
 MRI-”SALT AND PEPPER” APPEARENCE
19

20. 20

21. SCINTIGRAPHY
 Radioactive isotopes 99mTC by IV route and salivary gland is
imaged scintilation camera.
 10 milicuries of radioactive isotope
 99mTC pertechnetate is injected througH IV.
 Gland is then imaged by Gamma scintilation camera.
 Photographs are taken for every 2min. For first 10 min and later
every 10 min for 1hr.
 SS patient show reduced uptake and slow execration of Isotope.
21

23. SCINTIGRAPHY

24. Management
24

25. Ocular lubricants-artificial
tears
25

26. TREATMENT : XEROSTOMIA
 Methyl cellulose rinse
 Artificial saliva ;orabase lactoperoxide
 Lysosome
 Saliva stimulants;
1) Pilocarpine -5mg-7.5mg t .i. d [muscarinic
cholinergic agonist
drug]
2) Cevimeline Hcl -parasympathetic agonist
3) Bromhexine –mucolytic agent
 Fluoride –dental caries
 Antifungals –Oral candidiasis
26

27. Ptyalism
 Hypersalivation (also
called ptyalism[1] and
sialorrhea[2]) is excessive
production of saliva. It has
also been defined as
increased amount of
saliva in the mouth, which
may also be caused by
decreased clearance of
saliva.[3
.
Hypersalivation can
contribute to drooling
if there is an inability to
keep the mouth closed
or in difficulty in
swallowing the excess
saliva.

28. Conditions-ptyalism
Rabies
 Gastroesophageal
reflux disease,
 Pregnancy
 Pancreatitis
 Liver disease
 Serotonin syndrome
 Mouth ulcers
 Oral Infections
 Medications that can
cause overproduction
of saliva include:[3]
 clozapine
 pilocarpine
 Ketamine
 TOXINS:
 mercury
 copper

29. DECREASED –CLEARANCE-SALIVA
Infections :
tonsillitis, retropharyngeal
and peritonsillar
abscesses, epiglottitis and
mumps.
jaw fracture/TMJ dislocation
Radiation Therapy

30. Neurological disorders:
 myasthenia
gravis, Parkinson's
disease, Multiple
System
Atrophy, , bilateral
facial nerve palsy and
hypoglossal nerve
palsy.

31. Management
. Removal of cause
atropine sulphate-
0.4mg/6hrly
Scopolamine-.4mg/6hrly
Methantheline-15-
30mg/day
Propantheline-15-
30mg/day

32. Thank u
32