musculoskeletal and connective tissue disorders
Sjögren Syndrome
Symptoms and Signs of Sjögren Syndrome
Sjögren syndrome often affects the eyes or mouth initially and sometimes exclusively (sicca syndrome). Dry eyes can cause a sandy, gritty sensation without pruritus. In advanced cases, the cornea is severely damaged, epithelial strands hang from the corneal surface (keratitis filiformis), and vision can be impaired. Diminished saliva ( Xerostomia ) results in difficulty chewing and swallowing, secondary Parotid glands enlarge in 33% of patients and are usually firm, smooth, and mildly tender. Enlargement can be asymmetric, but highly disproportionate; persistent enlargement of one gland may indicate a tumor and should be evaluated. Chronic salivary gland enlargement is rarely painful unless there is obstruction or infection. Joint disease in Sjögren syndrome is typically nonerosive and nondeforming. Arthralgias occur in about 50% of patients. Arthritis occurs in about 33% of patients and is similar in distribution to rheumatoid arthritis but is not erosive. Other extraglandular manifestations include generalized lymphadenopathy, Raynaud Syndrome , interstitial lung involvement (which is common but infrequently serious), pancreatic insufficiency, and Alopecia may occur. Fatigue is often present. 