And’ a slowly progressive autoimmune disease, organ-specific systemic manifestations which is characterized by sweeping, the most important of which are represented by diminished salivary and lacrimal secretion which can cause keratoconjunctivitis Sicca respectively (xerophthalmia) and xerostomia (dry mouth). Often you can see the enlargement of the parotid glands. All Exocrine glands may be involved and therefore this syndrome is also referred to as a "esocrinopatia, autoimmune".
Sjogren's syndrome can exist in isolation (primary forms) or in combination with other immunopathological diseases (secondary forms making up about 60% of cases), predominantly in association with rheumatoid arthritis, systemic lupus erythematosus and systemic sclerosis.
Hits the 2% of the population and mostly female sex with a women:men of 9:1
L ’ salivary gland involvement may cause dry mouth (xerostomia), difficulty in chewing and swallowing difficulties, changes in taste and smell, occurrence of dental caries in rapid evolution. You can highlight fissures at the corners of the mouth, of the tongue and mucous membranes appear erythematous and dry. In 30-40% cases arise applicants asymmetrical swellings, sometimes painful, of the parotid or other salivary glands. Is characteristically absent the normal collection of saliva on the floor of the mouth.
L ’ involvement of lacrimal glands can cause ocular foreign body sensation, redness of the conjunctiva, fatigue and eye strain, clouding of vision
Other events: the involvement of other Exocrine glands, especially of the respiratory system (dryness of nasal mucosa, otitis media, chronic bronchitis, recurrent pneumonias) or gastrointestinal tract (Dysphagia, achlorhydria, acute and chronic pancreatitis, Autoimmune liver diseases). Sometimes there are alterations of renal function (renal tubular acidosis, acute Glomerular nephritis).
Frequent cutaneous and disorders of the female genital system (dry skin, atrophic vaginal changes).
Any associated pathology; This is especially true for joint disorders or primarily. Joint manifestations in Sjogren's syndrome are represented mainly by intermittent Polyarthritis hitting primitively small joints, sometimes asymmetrical. Joint deformations and erosions are rare and this helps to distinguish the primary form of this syndrome from the secondary associated with rheumatoid arthritis. The simple arthralgia are common, a little’ less the myalgia.
Diagnosis Internationally it has been established that the Sjögren syndrome can be diagnosed if there are 4 of these 6 criteria:
- Symptoms of dry eyes. 2. Signs of dry eyes (Schirmer test abnormal results or that the rose Bengal). 3. Symptoms of dry mouth. 4. Defective salivary gland function tests (changes in salivary flow or sialography or scintigraphy). 5. Minor salivary gland biopsy defective. 6. Autoantibodies to SS-A and/or SS-B positive.
Among these 4 criteria must also include the 5 or the 6
Therapy: Initially it is only symptomatic using saliva substitutes and artificial tears, in case of important edema of the salivary glands or important symptoms-inflammatory steroid therapies may be used is not
The role of ’ Ent:
1- diagnosis: the patient often turns all ’ Otolaryngologist or swelling of the salivary glands or symptoms related to dryness of bossa, it is important that the ENT specialist correctly identifies the disease and advice the patient all the exams that will complete the diagnosis.
2- Salivary gland biopsy: When there is a strong clinical suspicion of Sjogren's syndrome but are not yet on the necessary criteria for diagnosing salivary gland biopsy may be necessary, more frequently than minor salivary gh. This is a very simple intervention, almost painless lasting a few minutes; you run a small incision oral mucosa and withdrawing 2-3 glands to make them parse. Are then positioned 1-2 commonly absorbable stitches.
