August 5, 2016

Sjögren’s syndrome (SS) is a somewhat rare systemic autoimmune condition that’s often under–diagnosed. However, optometrists must be keenly aware of its impact on tear film production and ocular surface health. A new test may improve how clinicians detect and diagnose the condition.

Patients who are diagnosed with Sjögren's syndrome typically will complain of dry eyes and xerostomia (dry mouth). But make no mistake, the eyes and mouth are just two of many systems affected, because the condition can have a deleterious impact on any body part that requires significant moisture or fluids for proper function.1

For example, because of reduced saliva production, SS patients often develop tooth decay. Further, they can have significant gastro–intestinal issues, renal disease, dry skin, chronic obstructive pulmonary disease and Raynaud’s disease (reduced blood flow to and sensation in various areas of the skin).2 Additionally, in the secondary form of SS, patients may manifest a secondary autoimmune condition, such as rheumatoid arthritis, lupus or thyroid disease.3

Previously, only a positive antibody test to anti–SS–A (Ro) and anti–SS–B (La), or perhaps an evaluation for rheumatoid arthritis via RF and ANA testing, could help confirm a diagnosis of SS. Fortunately, a novel in-office specimen collection test called Sjö (Bausch + Lomb) can be of tremendous assistance.

Sjö evaluates for the presence of the four aforementioned antibodies, as well as three new proprietary markers—salivary protein–1, carbonic anhydrase-6 and parotid secretory protein (PSP). It’s important to note that these markers provide a higher specificity and sensitivity for early SS. Testing can be completed in an optometric office or sent to a lab.

1. Akpek EK, Mathews P, Hahn S, et al. Ocular and systemic morbidity in a longitudinal cohort of Sjögren's syndrome. Ophthalmology. 2015 Jan;122(1):56-61.
2. García-Carrasco M1, Ramos–Casals M, Rosas J, et al. Primary Sjögren syndrome: clinical and immunologic disease patterns in a cohort of 400 patients. Medicine (Baltimore). 2002 Jul;81(4):270-80.
3. Zintzaras E, Voulgarelis M, Moutsopoulos HM. The risk of lymphoma development in autoimmune diseases: a meta-analysis. Arch Intern Med. 2005 Nov 14;165(20):2337-44.

"When the student is ready, the teacher will appear. "
    –Buddhist Proverb

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