Myths, Pearls, and Tips Regarding Sjögren’s Syndrome

Abstract

Although SS is among the three most common rheumatologic disorders, there are few double-blind, placebo-controlled studies to rationally guide either topical or systemic therapy. Therefore, we wish to share some of the clinical "myths and pearls" that we have encountered, including the following: (a) Although the diagnostic criteria of SS depend on a positive anti-SS-A/B antibody, there is significant variation among laboratories in the sensitivity and specificity of these tests. SS patients may have other autoantibodies (such as anti-centromere) antibodies and should not be excluded from diagnosis of SS. (b) Many pathologists do not have experience in reading minor salivary gland biopsies. Outside review of biopsies at a center with expertise is frequently required. (c) The severity of symptoms, as assessed by the patient, is strongly influenced by "fibromyalgia" (central pain sensitization), and this may partly explain the poor correlation between objective measurements of glandular (tear/mouth) and extraglandular (neuropathic) symptoms. (d) The key extraglandular concerns among SS patients are lymphoma and central nervous system involvement. Development of cost-effective strategies to screen patients for these relatively uncommon complications is necessary. (e) Oral dryness leads to change in socialization habits, when the patient can no longer eat with friends, family, or business colleagues. Ocular dryness interferes with work efficiently as patients increasingly sit in front of computer screens in low-humidity office buildings. Therapy must recognize that these problems not only are more than an "irritation" to the patient but also strongly influence their quality of life.