Sjogren's Syndrome â Oral Perspective
Sjogren's Syndrome â Oral Perspective
Sjogren's Syndrome â Oral Perspective
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Sjogren’s <strong>Syndrome</strong> –<br />
<strong>Oral</strong> <strong>Perspective</strong><br />
Dr Gill Smith<br />
<strong>Oral</strong> Medicine<br />
Glasgow<br />
Conflicts of interest - none
Referrals to <strong>Oral</strong> Medicine<br />
• Primary care<br />
• Tertiary care<br />
‘dry mouth’<br />
rheumatology<br />
ophthalmology<br />
?Sjogren’s<br />
request for labial gland biopsy
Referrals to <strong>Oral</strong> Medicine<br />
• Objectively dry?<br />
• Another cause?<br />
e.g. medication
'I won't let it beat me:' Venus Williams opens up about being<br />
diagnosed with incurable <strong>Sjogren's</strong> syndrome at 31<br />
•Switched to raw vegan diet after diagnosis<br />
By Rachel Quigley<br />
Last updated at 11:42 PM on 28th December 2011
Diagnosis
Diagnostic criteria - oral<br />
• subjective<br />
• objective<br />
unstimulated saliva production<br />
sialography<br />
scintiscan<br />
ANA<br />
lymphocytic foci in labial glands
Salivary gland imaging<br />
With thanks to Dr Neil Heath<br />
<strong>Oral</strong> & Maxillofacial Radiology<br />
Glasgow
Ultrasound<br />
Philips iU22
Sialograms (conventional)
Normal Parotid sialogram<br />
panoramic
Sialectasia<br />
CAVITATORY<br />
SACCULAR<br />
PUNCTATE<br />
Som et al 1981
MR Sialogram
Labial gland biopsy<br />
Dr J McGinn, emedicine
Labial gland biopsy<br />
Dr J McGinn, emedicine
Labial Gland Bx<br />
• 1990-2003<br />
• 59 patients with xerostomia biopsied<br />
• 5 had positive results (~8%)<br />
• 3 were smokers<br />
• 10% labial nerve damage
Labial Gland Bx<br />
• 2011-present<br />
• 6 patients with xerostomia<br />
• ANA negative<br />
• 0 positive biopsies<br />
• 1 labial nerve damage
Management
Management<br />
• no evidence-based guidelines<br />
• topical<br />
• systemic
Management - topical<br />
• saliva substitutes<br />
• fluoride<br />
• IFN-α lozenges<br />
• pilocarpine mouthwash
Management - systemic<br />
• Pilocarpine<br />
3 placebo controlled trials<br />
5-7.5 mg 6-hourly<br />
significant improvements<br />
sweating, urinary frequency<br />
Ramos-Casals et al 2010
Management - systemic<br />
• Cevimeline<br />
3/4 placebo-controlled trials<br />
15-60 mg 8-hourly<br />
significant improvements<br />
reduced lymphocytic infiltrate<br />
nausea, sweating<br />
Ramos-Casals et al 2010
Management - systemic<br />
• oil of evening primrose<br />
NS improvement over placebo<br />
• hydroxychloroquine<br />
NS improvement<br />
• prednisolone<br />
NS improvement
Management<br />
• Saliwell GenNarino saliva stimulating<br />
device<br />
• stimulation of lingual nerves<br />
• approval for marketing in EU
•
Management<br />
• biologicals
Outcome measures?<br />
• Quantitative<br />
proteomic analysis of saliva?<br />
• QOL<br />
SF36, SF20, WHO<br />
psychological status
Recurrent parotitis of childhood<br />
• ?aetiology<br />
• pain, swelling , fever, no pus<br />
• ~ 3 days duration<br />
• sialography may show sialectasis (80%)<br />
• consider Sjogren’s<br />
• ?immune deficiency
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