Dry Mouth and Dry Eyes: Sjogren Syndrome

Abstract

Sjogren syndrome (SS) is a chronic autoimmune disease of the exocrine glands characterized by infiltration of the glands with lymphocytes. It can be either primary or secondary. Primary SS consists of xerostomia and keratoconjunctivitis sicca, whereas secondary SS is diagnosed when the sicca symptoms coexist with other systemic autoimmune or connective tissue disease such as rheumatoid arthritis (RA), scleroderma or systemic lupus erythematosus (SLE). The prevalence rate of SS ranges from 0.03% in Japan to 4.8% in Europe. Women are affected more than men with a ratio of 9:1. Middle-aged women, young adults, and children can be affected. The severity of SS varies from mild dryness of the mouth and eyes to severe dryness causing pain, depression, multi-organ involvement, and development of lymphoma. Hair, skin, mucosa of the vagina, gastrointestinal tract, respiratory tract, renal, musculoskeletal, and neurological systems can be involved. The current diagnostic criteria used is the 2016 American College of Rheumatology/European League Against Rheumatism classification criteria for Primary SS. The diagnostic criteria includes anti-SSA/Ro antibody positivity, focal lymphocytic sialadenitis with a focus score of ≥1 foci/4 mm², abnormal ocular staining score of ≥5 (or van Bijsterveld score of ≥4), Schirmer test result of ≤5 mm/5 min and unstimulated salivary flow rate of ≤0.1 mL/min. Patients with SS may require a multidisciplinary team consisting of general dentist, oral medicine specialist, rheumatologist, ophthalmologist, and other specialists to manage their disease.