Sg 3

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A short journey into sjogrens syndrome

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Sg 3

  1. 1. SG-3
  2. 2. SJOGREN’s SYNDROME  Autoimmune disease affecting salivary glands  Primary sjogrens syndrome involves salivary and lacrimal glands[exocrine glands]  Secondary disease involves other connective tissuue diseases I.e.rheumatoid arthritis. SLE polymyositis along with salivary and lacrimal glands 2
  3. 3. HALLMARK:HISTOLOGY Infiltration of T4 Lymphocytes into exocrine glands and triggering B -Lymphocytes to form autoantibodies 3
  4. 4. Trigger Factors; [Auto- antibodies]  EPISTEN-BARRVIRUS  RETROVIRUSTYPE-A  AUTOANTIGENS ON SALIVARY GLANDS 4
  5. 5. CLINICAL FEATURES  AGE:4th –6th decade  SEX:F>M [10:1]  CLINICAL PRESENTATION  LACRIMAL GLANDS SIGNS & SYMTOMS Dryness of eyes,feeling of dirt or foreign body are common symptoms  Conjuctivitis & corneal ulcers may be seen 5
  6. 6. C.F.-SALIVARY GLANDS  XEROSTOMIA - Common symptom  Enlargement salivary glands-unilateral/bilateral  Candidiasis may be seen  Increased incidence of dental caries  Dryness of pharynx,larynx may lead to pneumonia  Vaginal candidiasis in 5% cases 6
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  11. 11. INVESTIGATIONS  LACRIMAL GLAND FUNCTIONTESTS  SCHIRMER’STEST  BUT[Break uptime]  ROSE BENGAL DYE TEST  SALIVARY GLAND FUNCTIONTESTS  SALIVA FLOW RATE  MINOR SG BIOPSY  SIALOGRAPHY  SCINTOGRAPHY 11
  12. 12. DIAGNOSTIC TESTS SCHIRMER’STEST Place the filter paper in the lower conjuctival sac Normal pts will wet 15mm of filter paper in 5minutes Pt’s with SS will wet less than 5mm 12
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  14. 14. 14 BUT TEST:  Test carried with slit lamp  Note the interval between the complete blink and dry spot on the cornea ROSE BENGAL TEST  TO detect damaged and denuded area on the cornea  If two tests are positive then patient is diagnosed as kerarato conjuctivitis sicca
  15. 15. INVESTIGATIONS–SALIVARY GLAND Salivary flow rate: Carried out by placing special fabricated cup”Lashley” cup Over the orifice of the stensen duct [parotid] Saliva can be collected stimulated or unstimulated[lemon juice] Normal range:5ml/min Pt’s with sjogrens syndrome;<5ml/5min  Minor gland biopsy  1.5 –2cm incision made on lower labial mucosa  5 gland lobules are removed and lymphocytes focus score made  Scores are graded;0-4 SS- 2-4 grades 15
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  18. 18. SIALOGRAPHY AND MRI  REDUCED DUCTULES  PUNCATE OR GLOBULAR SIALECTASIS  MRI-”SALT AND PEPPER” APPEARENCE 19
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  20. 20. SCINTIGRAPHY  Radioactive isotopes 99mTC by IV route and salivary gland is imaged scintilation camera.  10 milicuries of radioactive isotope  99mTC pertechnetate is injected througH IV.  Gland is then imaged by Gamma scintilation camera.  Photographs are taken for every 2min. For first 10 min and later every 10 min for 1hr.  SS patient show reduced uptake and slow execration of Isotope. 21
  21. 21. SCINTIGRAPHY
  22. 22. Management 24
  23. 23. Ocular lubricants-artificial tears 25
  24. 24. TREATMENT : XEROSTOMIA  Methyl cellulose rinse  Artificial saliva ;orabase lactoperoxide  Lysosome  Saliva stimulants; 1) Pilocarpine -5mg-7.5mg t .i. d [muscarinic cholinergic agonist drug] 2) Cevimeline Hcl -parasympathetic agonist 3) Bromhexine –mucolytic agent  Fluoride –dental caries  Antifungals –Oral candidiasis 26
  25. 25. Ptyalism  Hypersalivation (also called ptyalism[1] and sialorrhea[2]) is excessive production of saliva. It has also been defined as increased amount of saliva in the mouth, which may also be caused by decreased clearance of saliva.[3 . Hypersalivation can contribute to drooling if there is an inability to keep the mouth closed or in difficulty in swallowing the excess saliva.
  26. 26. Conditions-ptyalism Rabies  Gastroesophageal reflux disease,  Pregnancy  Pancreatitis  Liver disease  Serotonin syndrome  Mouth ulcers  Oral Infections  Medications that can cause overproduction of saliva include:[3]  clozapine  pilocarpine  Ketamine  TOXINS:  mercury  copper
  27. 27. DECREASED –CLEARANCE-SALIVA Infections : tonsillitis, retropharyngeal and peritonsillar abscesses, epiglottitis and mumps. jaw fracture/TMJ dislocation Radiation Therapy
  28. 28. Neurological disorders:  myasthenia gravis, Parkinson's disease, Multiple System Atrophy, , bilateral facial nerve palsy and hypoglossal nerve palsy.
  29. 29. Management . Removal of cause atropine sulphate- 0.4mg/6hrly Scopolamine-.4mg/6hrly Methantheline-15- 30mg/day Propantheline-15- 30mg/day
  30. 30. Thank u 32

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