Sjogren syndrome: Pathology review


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Sjogren syndrome: Pathology review

Musculoskeletal system

Pediatric musculoskeletal conditions

Radial head subluxation (Nursemaid elbow)

Developmental dysplasia of the hip

Legg-Calve-Perthes disease

Slipped capital femoral epiphysis

Transient synovitis

Osgood-Schlatter disease (traction apophysitis)

Musculoskeletal injuries and trauma

Rotator cuff tear

Dislocated shoulder

Radial head subluxation (Nursemaid elbow)

Winged scapula

Thoracic outlet syndrome

Carpal tunnel syndrome

Ulnar claw

Erb-Duchenne palsy

Klumpke paralysis

Iliotibial band syndrome

Unhappy triad

Anterior cruciate ligament injury

Patellar tendon rupture

Meniscus tear

Patellofemoral pain syndrome

Sprained ankle

Achilles tendon rupture



Degenerative disc disease

Spinal disc herniation


Compartment syndrome


Bone disorders

Osteogenesis imperfecta


Pectus excavatum


Genu valgum

Genu varum

Pigeon toe

Flat feet

Club foot

Cleidocranial dysplasia



Bone tumors




Osteomalacia and rickets


Paget disease of bone


Lordosis, kyphosis, and scoliosis

Joint disorders



Spinal stenosis

Rheumatoid arthritis

Juvenile idiopathic arthritis


Calcium pyrophosphate deposition disease (pseudogout)

Psoriatic arthritis

Ankylosing spondylitis

Reactive arthritis


Septic arthritis


Baker cyst

Muscular disorders

Muscular dystrophy



Inclusion body myopathy

Polymyalgia rheumatica



Neuromuscular junction disorders

Myasthenia gravis

Lambert-Eaton myasthenic syndrome

Other autoimmune disorders

Sjogren syndrome

Systemic lupus erythematosus

Mixed connective tissue disease

Antiphospholipid syndrome

Raynaud phenomenon


Limited systemic sclerosis (CREST syndrome)

Musculoskeletal system pathology review

Back pain: Pathology review

Rheumatoid arthritis and osteoarthritis: Pathology review

Seronegative and septic arthritis: Pathology review

Gout and pseudogout: Pathology review

Systemic lupus erythematosus (SLE): Pathology review

Scleroderma: Pathology review

Sjogren syndrome: Pathology review

Bone disorders: Pathology review

Bone tumors: Pathology review

Myalgias and myositis: Pathology review

Neuromuscular junction disorders: Pathology review

Muscular dystrophies and mitochondrial myopathies: Pathology review


Sjogren syndrome: Pathology review

USMLE® Step 1 questions

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USMLE® Step 1 style questions USMLE

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A 52-year-old woman comes to the physician complaining of pain during sexual intercouse for the last 2 months. She also has difficulty swallowing food, especially bread and crackers, and she needs to chew food for longer periods of time before swallowing it. The patient has no significant past medical history. Temperature is 37.3°C (99.1°F), pulse is 73/min, and blood pressure is 138/76 mmHg. Physical examination reveals diffuse, nontender enlargement of the parotid glands bilaterally. Oropharyngeal examination reveals multiple new dental caries and halitosis. Ophthalmologic examination reveals 20/40 visual acuity in both eyes. Laboratory studies reveal the following findings:
Laboratory value  Result
 Hemoglobin  10.2 g/dL 
 Hematocrit  31% 
 Platelet count  350,000/mm3 
 Leukocyte count  3,000/mm3 
 Erythrocyte sedimentation rate  52 mm/h 
 Antinuclear antibodies   Positive 
 Rheumatoid factor  Negative 
 Anti-dsDNA  Negative 
 Anti-Ro/La  Positive 
If this patient remains untreated, which of the following is she at increased risk of developing?

Memory Anchors and Partner Content


Content Reviewers

Yifan Xiao, MD


Daniel Afloarei, MD

Evan Debevec-McKenney

Salma Ladhani, MD

Ursula Florjanczyk, MScBMC

On your rounds, you see a 55-year-old female named Patricia who presents with fatigue, dry skin, and red eyes. She mentions that she's had a recurrent sensation of sand in her eyes and dry mouth every day for the past three months. She also mentioned that when it’s cold outside, the tips of her fingers turn white and hurt. On examination, there are signs of tooth decay and purpura on both lower extremities. Sialometry was performed, which detected salivary hypofunction.

Ok, so Patricia’s clinical picture is suggestive of Sjogren syndrome. Now, Sjogren syndrome is an autoimmune disorder that mostly affects middle-aged females. The high yield concept here is that the immune system attacks various exocrine glands, especially salivary and lacrimal glands. If Sjogren syndrome is primary or occurs alone, it’s called sicca syndrome. Alternatively, it can be secondary when it is accompanied by other autoimmune diseases like lupus, rheumatoid arthritis, and scleroderma. Now, the exact cause of Sjogren syndrome is unknown, but both genetic and environmental factors are involved.

In Sjogren syndrome, some helper T-cells perceive nuclear components that leak out of dead or damaged cells in the body as antigens. These T-cells become active and proliferate and then activate B-cells which start producing anti-nuclear antibodies, or ANAs, against the nuclear antigens. A high yield fact to remember is that the two types of ANA formed in Sjogren syndrome are anti-SSA/RO and anti-SSB/LA antibodies, which are formed against ribonucleoproteins SS-A and SS-B. Next, both T-cells and antibodies enter the circulation and reach the exocrine glands, where activated T-cells secrete cytokines to recruit even more immune cells. This results in a lymphocytic infiltration of the exocrine glands, which ends up damaging the exocrine gland tissue. Eventually, the secreted cytokines also activate fibroblasts, which produce fibrous tissue that replaces the damaged tissue. The end result is a loss of secretory cells in the glands.



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