Case Studies

 Case 10.11 Sjögren's syndrome

A 38-year-old woman was referred to an oral surgeon for investigation of a dry mouth. She had a sister with arthritis. Examination and investigations were unremarkable except for a raised ESR (42mm/h). Six months later, she developed a mild conjunctivitis and complained of sore eyes. On testing, rheumatoid factor was now positive (Rose-Waaler titre 1/64); total serum proteins were raised (98g/l); and immunoglobulin levels showed a raised IgG of 28g/l (NR 7.2-19.0), with a slightly raised IgM of 2.8g/l (NR 0.5-2.0) and a normal IgA. Schirmer's test was performed (see Section 10.8.2). The test was markedly abnormal as only 3.5mm of the filter strip in the right eye and 1.5mm of that in the left eye became wet.

She was treated with methylcellulose eye drops to prevent corneal ulceration. Over a period of many years, her rheumatoid factor titre steadily increased and ANA and antibodies to the extractable nuclear antigens Ro and La became detectable. Seven years after the development of the dry mouth and dry eyes (together known as the sicca complex), she developed a mild, bilateral non-erosive polyarthritis of her hands, wrists and knees. A diagnosis of Sjögren's syndrome was made. The disease has remained mild. Non-steroidal anti-inflammatory drugs have been given for the arthritis but have had no effect on the sicca complex.