Thread by @rheum_cat

#ACR22 #ReviewCourse
Dr Sara McCoy on #Sjogrens & mimics

Nomenclature: Sjogren's disease

Tear films are complex, with 3 layers

Comorbidities & meds can deplete the tear film too

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Oral exam:

👄r/o other causes of dry mouth, e.g. angular cheilitis
👅check under tongue for salivary pooling
👅do a thorough tongue exam (lack of papillae)
🦷eval the dentition

#ACR22 #ReviewCourse

How do to unstimulated salivary flow? Simple - just need Dixie cups and a scale

Passively collect saliva (aka drool) into cup x 5 min

Weigh it; 1g = 1mL of saliva

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A bit on salivary gland ultrasound, which can improve Sn, Sp of classification criteria

Looking at echogenicity, the Sjogren's scan looks like swiss cheese 🧀

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More on salivary gland ultrasound:



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When considering the bx in #Sjogrens think of the DDX

🔍Benign lymphoepithelial lesion: can be a MALT precursor; take special notice of it

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Back to the importance of the DDX for dry eye👁️ & dry mouth 👄

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Case to illustrate differentiating SjD from HCV

What can help?
🔹SSA/B positivity
🔹infiltrate type on bx (CD8+ T ly in HCV)
🔹salivary gland US

HCV, HIV both implicated in SjD tho

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What about SjD vs DILS in HIV?

🔹Salivary gland US: more diffuse infiltration with HIV
🔹Infiltrate on bx: CD8+ T ly in HIV

❗️Both can have LIP type of ILD!

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SjD vs sarcoidosis or IgG4RD: often comes down to histopathology

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Side note:
In past years @BharatKumarMD and #ACRKnowledgeBowl organizers would pull facts from the #ReviewCourse as questions

Which was esp fun the year I did not attend the Review Course!

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This is that potential #ACRKnowledgeBowl question

Eosinophilic sialodochitis

❗️history of expressing mucous plugs from the salivary glands

⬆️peripheral eos, IgE

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