Review Question - QID 109175

The patient is presenting with dyspareunia and dental caries suggesting a diagnosis of Sjogren’s syndrome.

Sjogren’s syndrome is an autoimmune disorder that targets salivary and lacrimal glands. The most common symptoms that patients present with are dry eyes (keratoconjunctivitis sicca), dry mouth (xerostomia), arthritis, and dyspareunia. Biomarkers that are indicative of the disease include anti-Ro (anti-SSA) and anti-La (anti-SSB). Anti-nuclear antibodies (ANA) and rheumatoid factor (RF) may also be positive.

Figure A shows a photograph of dental caries.

Incorrect Answers:
Answer 1: Anti-microsomal autoantibodies are associated with Hashimoto thyroiditis. Patients may present with fatigue, constipation, depression, dry/cold skin, hoarseness, and menstrual irregularities. Hashimoto thyroiditis and hypothyroidism can be associated with type I diabetes mellitus and abnormal oral manifestations (macroglossia, delayed teeth eruption, poor periodontal health, and altered tooth morphology).

Answer 2: Anti-nuclear autoantibodies (ANA) are associated with systemic lupus erythematosus. They may be present in Sjogren’s syndrome, but are largely non-specific.

Answer 3: Anti-DNA topoisomerase I (or Anti-Scl-70) autoantibodies are associated with diffuse scleroderma. Disease presentation is related to sclerosis of certain organ systems, which can range from hardening of the skin and fingertip pitting, to renal, digestive, pulmonary, and musculoskeletal symptoms.

Answer 5: Rheumatoid factor is positive in 70% of patients with Sjogren’s syndrome, but it is not specific. It can be elevated in many autoimmune connective tissue diseases as well as other chronic inflammatory diseases.

Bullet Summary:
Sjogren’s syndrome presents with dry eyes, dry mouth, dyspareunia, and dental caries, and is associated with anti-Ro (anti-SSA) and anti-La (anti-SSB) autoantibodies.