Sjögren's syndrome

Sjögren's syndrome is a chronic autoimmune disorder in which lymphocytes infiltrate and damage exocrine glands, especially lacrimal (tear) and salivary. Symptoms span from purely glandular (xerophthalmia, xerostomia) to systemic — fatigue, polyarthralgia, Raynaud's, interstitial lung disease, peripheral neuropathy, and a 5–20 fold increased risk of non-Hodgkin lymphoma. Primary Sjögren's stands alone; secondary forms accompany rheumatoid arthritis, lupus or systemic sclerosis. Predominantly affects women (9:1) in the 40s–60s. Diagnosis combines symptoms, objective dryness measurement (Schirmer test, salivary flow), autoantibody profile (anti-Ro/SSA, anti-La/SSB, ANA) and minor salivary gland biopsy when needed.

• ANA — positive in 60–80%; often speckled pattern.
• Anti-Ro/SSA, anti-La/SSB — specific autoantibodies; combined positive in ~50% (most diagnostic).
• ESR, CRP — often mildly elevated; CRP usually only modestly so.
• Liver enzymes (ALT, ALP, GGT) — sometimes raised when overlap with primary biliary cholangitis.
• Rheumatoid factor — positive in ~50% even without RA.
• CBC — mild cytopenias possible.

• Persistent dry, gritty eyes; sensation of foreign body
• Dry mouth, difficulty swallowing dry food, accelerated dental caries
• Bilateral parotid swelling
• Joint pain without destructive arthritis
• Profound fatigue out of proportion to other symptoms
• Raynaud's phenomenon; vaginal dryness; chronic non-productive cough