What are the diagnostic criteria for Sjögren's syndrome

When diagnosing Sjögren's syndrome, it is necessary to pay attention to the symptoms it presents, such as the common foreign body sensation in the eyes, dry and itchy eyes, and easy lip peeling, chapped corners of the mouth, as well as dry, sore and uncomfortable throat and hoarseness.

1. Keratoconjunctivitis sicca: patients often experience a foreign body sensation in the eye, burning sensation, itchy eyes, and dry eyes. In the early stages, excessive tearing often occurs. As the disease progresses, vision gradually becomes blurred, the eyes become red and painful, and it is difficult to open the eyes in the morning. Later, when stimulated by foreign objects or when emotionally excited, tears cannot be produced.

Ophthalmological examination may reveal pericorneal hyperemia and sometimes enlarged lacrimal glands. In the late stage, small blood vessels may form in the cornea, accompanied by clouds and then ulcers. Sometimes blindness may occur due to perforation or iridocyclitis, panophthalmitis, or pus accumulation in the eye.

2. Dry mouth: In the early stages of the disease, patients often feel a lack of saliva, dry mouth or sticky mouth, followed by a lack of saliva when eating. Decreased sense of taste, cracking and pain in the tongue and corners of the mouth, difficulty chewing and swallowing, etc. Dry mouth may wake you up at night. Because the patient has a dry mouth and drinks too much water, it may present similarly to diabetes insipidus. When food adheres to the dry oral mucosa, oral mucosal peeling and oral bleeding may occur, and sometimes Candida albicans infection may occur. Due to the reduction of saliva, tooth decay is more likely to occur. Oral examination often reveals the absence of salivary glands around the frenulum of the tongue, and massage of the salivary glands also results in no saliva secretion.

3. Parotid gland enlargement: Less than 1/3 of patients may experience parotid gland enlargement, and most patients feel mild local discomfort. The parotid glands are firm and nontender but may be tender in the presence of secondary infection. The most common type of parotid gland enlargement is simple dry mouth and eyes. Parotid gland angiography shows that almost all cases have segmental dilatation or stenosis of the parotid duct to varying degrees. Parotid gland swelling may be due to calcification or secondary infection and can be easily misdiagnosed as mumps. Each attack of parotid gland swelling may be accompanied by varying degrees of fever, which may be an acute attack of the disease itself or due to secondary infection.

4. Ear, nose and throat manifestations: As the disease progresses, dry changes often affect the mucous membranes that secrete mucus in the ears, nose, and throat, causing epistaxis, dry and scabbing nasal cavity, mucosal atrophy, loss of smell, dry and sore throat, and hoarseness. A small number of patients may develop nasal septum perforation, which can be easily misdiagnosed as Wegener's granuloma.

5. Joint manifestations: Most patients may have joint symptoms, manifested as joint pain and swelling, a few have joint effusion, and sometimes peri-articular muscle pain and muscle atrophy may also occur. Joint swelling and pain usually precede dryness symptoms by months or even years. Dryness of the mouth and eyes may occur first, and joint symptoms may appear many years later.