Sjogren's syndrome

• most age >40
• women 9x > men
• dry eye, dry mouth, autoimmune disorder
• lid hygiene/massage for MGD, AT, Restasis, steroids
• oral Minocycline 50mg bid x 2 weeks then 50mg qd x 1 month, then taper (usually 8 weeks to work); side effects: stained teeth, vaginitis, photosensitivity
• or Doxycycline 50mg bid x 1-2 months then qd x 1 month (side effects: photosensivitiy, sensitivity to dair products/antacids)
• or Periostat (20mg doxy) bid x 1-2 months then qd x 1 month
• Salagen and Evoxac (30mg tid) drugs that stimulate the salivary glands to produce saliva

Classification system:

1. Ocular symptoms:

• daily, persistent, troublesome dry eyes >3 months
• recurrent sensation of sand or gravel in the eyes
• use AT more than tid

2. Oral symptoms:

• daily feeling of dry mouth for >3 months
• recurrent or persistently swollen salivery glands
• need to drink liquids to aid in swallowing dry food

3. Ocular signs:

• Schirmer's test w/o anesthesia (<5>
• Rose bengal or other dry eye findings

4. Histopathology:

• focal lymphocytic sialoadentitis in minor salivary glands, evaluated by histopathologist

5. Salivary gland involvement (send to rheumatologist):

• unstimulated whole salivary flow (<1.5>
• parotid sialography showing diffuse sialectasias without evidence of major duct obstruction
• salivary scintigraphy showing delayed uptake, reduced concentration and/or delayed excretion of tracer

6. Autoantibodies

• presence of antibodies to Ro(SSA) or La(SSB) antigens or both

For primary Sjogren's:

• any 4 of the 6 items as long as item 4 or 6 is positive
• presence of any 3 of 4 objective criteria items (3 thru 6)

For secondary Sjogern's:

• in patients with a potentially associated disease (e.g. connective tissue disease, RA, lupus) with the presence of item 1 or 2 plus any two from items 3-5