Sjogren syndrome — Rapid | Doctor’s Passport

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.
Use validated 2016 ACR/EULAR criteria to organise objective findings, but diagnosis remains clinical and criteria are not a substitute for excluding mimics.
Treat eyes stepwise with preservative-free lubricants, lid care and ophthalmology-directed anti-inflammatory or serum options when surface disease persists; urgent pain, photophobia or visual loss needs same-day review.
For mouth dryness use frequent water, saliva substitutes, sugar-free gum when residual function exists and pilocarpine in suitable patients; avoid sugary acidic sweets that worsen caries.
Arrange high-fluoride dental prevention, meticulous interdental care and regular dental review because symptom relief alone does not replace remineralisation and plaque control.
Do not use hydroxychloroquine routinely for dryness or fatigue without objective inflammatory disease; systemic treatment is matched to arthritis, lung, renal, neurological, vasculitic or haematological involvement.
Persistent salivary-gland enlargement, lymphadenopathy, purpura, low C4, cryoglobulin, monoclonal protein, cytopenia or systemic decline requires lymphoma assessment.
Test anti-Ro and anti-La before pregnancy planning and coordinate hydroxychloroquine and fetal-heart surveillance with rheumatology and maternal medicine.

Key red flags

Persistent, hard or asymmetric parotid or submandibular enlargement, lymph nodes, splenomegaly, weight loss or night sweats requires urgent lymphoma assessment.

Palpable purpura, low C4, cryoglobulinaemia, monoclonal gammopathy or persistent cytopenia identifies higher systemic and lymphoma risk.

New foot drop, rapidly progressive sensory loss, severe neuropathic pain or autonomic failure may indicate vasculitic neuropathy requiring urgent treatment.

Haematuria, proteinuria, declining eGFR, acidosis, hypokalaemia or stones suggests glomerulonephritis or tubulointerstitial renal disease.

A painful photophobic red eye, corneal defect or reduced vision needs urgent ophthalmology because severe dryness can ulcerate or infect the cornea.

Salivary gland disease

Recurrent bilateral soft swelling may accompany disease, while persistent unilateral firmness or nodes demands infection, obstruction and lymphoma investigation.

Vasculitic neuropathy

Acute painful asymmetric sensory or motor deficits, foot drop or mononeuritis multiplex is organ-threatening and requires urgent neurological-rheumatology assessment.

Investigation priorities

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.
Apply classification evidence after excluding hepatitis C, HIV, sarcoidosis, IgG4 disease, radiotherapy and anticholinergic effects, then agree organ ownership and follow-up.

First-line surface protectionReplace, stimulate and prevent damage

Dryness is present without current corneal emergency or systemic organ threat.

Use preservative-free tears at the frequency needed, lid care and environmental measures; refer persistent surface inflammation or frequent-drop need to ophthalmology.
Use water, neutral-pH saliva substitute, sugar-free gum and pilocarpine when residual function and cardiopulmonary safety permit.
Arrange high-fluoride dental prevention, interdental cleaning and recall, and diagnose candidiasis or reflux before adding specific treatment.

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.Blurred vision can occur briefly. Persistent pain, photophobia, discharge or reduced vision requires urgent examination; ointment is useful at night but impairs vision and cannot treat infection or severe inflammation.

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.Avoid uncontrolled asthma, acute iritis and important cardiorenal disease; sweating, flushing, urinary frequency, diarrhoea, bradycardia, bronchospasm and visual accommodation effects limit use. Review benefit after two to three months.

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