Are You Missing the Early Signs of Sjögren’s Syndrome?

Collaboration Among Specialties Crucial to Helping Sjögren’s Patients By Paul M. Karpecki OD, FAAO

Even with new diagnostic tests that allow primary eyecare providers to determine the presence of Sjögren’s syndrome, the role of rheumatologists and other healthcare providers hasn’t diminished. To improve the quality of life of Sjögren’s patients, each specialty must contribute to the management of the systemic component of the disease, ensure optimal communication on behalf of the patient and monitor for life threatening co-morbidities.

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Systemic Disease Management

Patients with ocular manifestations of a systemic disease rarely experience complete resolution of ocular symptoms until the systemic disease is controlled. In patients with primary or secondary Sjögren’s sydrome, although it’s essential to address the health of the ocular surface, these patients often have an autoimmune dysfunction, such as rheumatoid arthritis (RA) or systemic lupus erythematosus, which must be controlled as well. In many patients, the ocular symptoms will only improve fully once the RA or lupus is treated and controlled.

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Communication

Optometry must take a ‘seat at the table’ for all patients who have systemic diseases with ocular manifestations. We must establish strong communication lines with other healthcare providers, so patients can benefit from each practitioner’s area of expertise. Remember, too, that good communication can lead to increased referrals to optometric practices that manage a high number of patients with advanced ocular surface diseases.

Monitoring for Life-threatening Conditions

Research shows that the incidence of non-Hodgkins lymphoma in patients with Sjögren’s Syndrome is very high. Kassan and colleagues1 first documented this link in 1978 when it was found that patients with SS keratoconjunctivitis sicca (KCS) had a 43.8 times greater incidence of lymphoma compared to age- and gender-matched controls in the general population.

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Also, the average age of onset of Sjögren’s is in the late 40s, so these patients, mostly female, will likely require ongoing systemic follow-up.2 It’s imperative that we work with rheumatologists or internal medicine specialists to ensure that patients are aware of this link and their doctors are monitoring them yearly.

Secondary Sjögren’s is related to an autoimmune or connective tissue disorder. Thus, all patients with secondary Sjögren’s will have associated diseases, including RA or lupus, that require systemic management.

Dentists should also be included in the treatment of patients with Sjögren’s, because associated salivary gland dysfunction can lead to a wide range of oral manifestations.3

Understanding any systemic disease, providing effective communication and monitoring for life-threatening conditions is critical to managing Sjögren’s patients. Fortunately, new point-of-care diagnostic capabilities will allow us to make an accurate diagnosis earlier, so we can be more confident in managing the disease.

References

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