PECAA Practice Pearl

By: Paul M. Karpecki, OD, FAAO
Clinical Director – PECAA

Sjögren’s syndrome (SS) is a fairly common systemic autoimmune condition. 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.


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).Additionally, in the secondary form of SS, patients may manifest a secondary autoimmune condition, such as rheumatoid arthritis, lupus or thyroid disease.

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 test called Sjö (Bausch + Lomb) is commercially available. The test 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.

There are a number of reasons it makes sense to test for this condition in patients with severe dry eye, patchy corneal staining, patients with dry mouth in addition to dry eye or an autoimmune disease. First systemic medications, most often prescribed by a rheumatologist, can help the patients body and also contribute to helping with the dry eye. Secondly this condition has so many systemic issues as mentioned above, that it may help explain a person’s chronic GI problems and get them addressed. Finally patients with Sjogren’s syndrome have a significant risk for B-cell non-Hodgkin’s Lymphoma.Diagnosing this form of cancer early can greatly affect the prognosis.

Summary:

  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.

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