Fast Five Quiz: Sjögren Disease Differential Diagnoses

Medscape

4 days ago

Learn more about oral dryness in Sjögren disease.
Dry eye, or xerophthalmia, is another other classic symptom of Sjögren disease. Similarly, several factors can also cause dry eye, which must be ruled out for accurate diagnosis. For example, data indicate that androgen can significantly influence the lacrimal gland/tear production and overall optical health. Hypoandrogenemia is a known cause of dry eye along with Vitamin A deficiency; hyperandrogenemia is another known cause of dry eye, especially in females and those with polycystic ovary syndrome.
Hypercalcemia, anemia, and Vitamin B deficiency are usually associated with dry mouth, rather than dry eye. Elevated CRP does not appear to be specifically associated with dry eye, and levels are usually normal in Sjogren disease.
Learn more about dry eye in Sjögren disease.
According to the most recent ACR classification guidelines, dry eyes and/or mouth must persist for more than 3 months after controlling for differential diagnoses. Their criteria suggest Sjögren disease can be confirmed by a classification score of at least 4 points from factors such as histology of the labial salivary gland (up to 3 points), detection of SS-A/Ro antibodies (3 points), pathological Schirmer test (1 point), whole saliva flow rate ≤ 0.1ml/min (1 point), and abnormal ocular staining score (1 point).
Although various diseases can cause chronic dry eye, external factors such as drug use and environmental factors can be excluded upon resolution when the patient is removed from exposure.
Learn more about classification criteria for Sjögren disease.
Experts note that Sjogren disease is typically diagnosed based on 'the patient's subjective sicca symptoms if these cannot be explained by other differential diagnoses, after excluding certain diseases and using the objective classification criteria.'
Graft versus host disease, along with amyloidosis, sarcoidosis, HIV, HCV, and history of head and neck radiation therapy, is specifically recommended by the ACR classification system to be excluded when diagnosing Sjögren disease. Further, pre‐existing lymphoma is no longer part of this exclusion criteria.
Although fatigue is common in both Sjogren disease and fibromyalgia, presentation of subjective sicca usually prompts the differential diagnosis for Sjögren disease in the ACR classification. Chronic pancreatitis and rheumatic fever are also not typically associated with sicca symptoms.
Learn more about differential diagnosis for Sjögren disease.
Contrast is a rare but often overlooked cause of salivary gland enlargement, another characteristic Sjogren disease symptom. It is most often associated with iodine contrast media, leading to its nickname of 'Iodide mumps.' Other potential causes of salivary gland enlargement include several types of infections and inflammatory conditions, neoplasms, and immunosuppression.
Though parotid enlargement can occur with gadolinium use, the association is not as frequent as iodine. Barium and microbubble use have not been consistently shown to directly cause parotid enlargement.
Learn more about parotid gland enlargement in Sjögren disease.
Editor's Note: This article was created using several editorial tools, including generative AI models, as part of the process. Human review and editing of this content were performed prior to publication. Lead image: Peakstock/Science Source