Sjogren's syndrome: A critical review of clinical management

Sjogren's syndrome (SS) is greatly under recognized in clinical practice, p rimarily for 2 reasons: its presentations are variable and often nonspecifi c and there are still no clear, uniform diagnostic criteria for this clinic al entity. The prevalence, natural history, pathogenesis, and clinical taxo nomy of SS are still not well understood. Potential criteria include both s ubjective symptoms and objective criteria such as measurements of salivary and tear flow, minor salivary gland biopsy, and an increasing variety of se rological markers. Physicians often fail to appreciate the profound impact of SS on quality of life. Therefore, screening for SS should include questi ons exploring symptoms in terms of their effect on the patient's daily life . At present, there is no curative treatment for SS. For symptom relief, lo cal treatments (such as artificial tears or oral topical sprays) are limite d in their effects, whereas systemic treatment offers the advantage of addr essing a wider range of symptoms. Controlled studies show that oral pilocar pine significantly improves sicca symptoms in the eyes, mouth, and other si tes. Clinical experience to date suggests it is safe and well tolerated, wi th no serious adverse effects, tachyphylaxis, or drug to drug interactions of concern. The most frequent adverse effects are sweating, urinary frequen cy, diarrhea, and other parasympathomimetic effects, but these do not lead to substantial drug withdrawal rates. Patients should be forewarned that su bjective improvement may lag behind improvement in objective measures. Beca use management often spans several specialties, coordination among them is essential. Dental, gynecological, and ophthalmological perspectives on diag nosis and management are discussed; the primary practitioner has the opport unity to play both a coordinating role and a direct role in early diagnosis and treatment.