Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Systemic organ disease or lymphoma signal
Rapid neuropathy, glomerulonephritis, pulmonary decline, vasculitis, severe cytopenia, persistent unilateral salivary swelling, lymphadenopathy or systemic decline requires urgent specialist evaluation.
Action: Assess the threatened organ, obtain FBC, renal, urine, complement, immunoglobulin and targeted imaging or tissue, exclude infection, and involve rheumatology with neurology, renal, respiratory or haematology before empirical immunosuppression.
Synopsis
Confirm autoimmune exocrine disease using objective ocular, salivary and immunological evidence, relieve dryness without avoidable toxicity, identify systemic organ involvement, and maintain vigilant lymphoma, dental, pregnancy and treatment surveillance.
Ask about gritty or burning eyes, reduced tears, water needed to swallow dry food, nocturnal drinking, dental decay, gland swelling, vaginal dryness, fatigue and systemic symptoms.
Review anticholinergic and drying medicines, hydration, diabetes, thyroid disease, hepatitis C, HIV, sarcoidosis, IgG4 disease, radiotherapy and local ocular or salivary disorders before applying an autoimmune label.
Anti-Ro supports Sjogren disease but is neither universally present nor sufficient; objective ocular testing, unstimulated salivary flow and minor salivary-gland biopsy provide complementary evidence.
Key red flags
Persistent, hard or asymmetric parotid or submandibular enlargement, lymph nodes, splenomegaly, weight loss or night sweats requires urgent lymphoma assessment.
Salivary gland disease
Recurrent bilateral soft swelling may accompany disease, while persistent unilateral firmness or nodes demands infection, obstruction and lymphoma investigation.
Investigation priorities
01
Anti-Ro, anti-La, ANA, RF and immunoglobulinsFirst step
Support autoimmune classification and identify B-cell activation or monoclonal change.
Management branches
Confirmatory assessmentObjectify sicca and exclude mimics
Persistent eye or mouth dryness occurs with autoimmune or systemic features.
Document symptom duration, dental and ocular damage, glands, medicines, hydration and systemic phenotype and test anti-Ro with baseline FBC, renal, urine, complement and immunoglobulins.
Arrange Schirmer and ocular staining plus unstimulated salivary flow; use minor salivary-gland biopsy when serology or objective findings leave meaningful uncertainty.
First-line surface protectionReplace, stimulate and prevent damage
Dryness is present without current corneal emergency or systemic organ threat.
Key medicines
Preservative-free artificial tearsInstil one drop into each symptomatic eye as needed, commonly four to six times daily; use preservative-free single-dose or multidose systems when application exceeds four times daily.
PilocarpineStart 5 mg orally three times daily with food and water; if tolerated and still needed, increase to 5 mg four times daily, not exceeding 30 mg/day.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.