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
Spondylolysis
Spondylolisthesis
Degenerative disc disease
Spinal disc herniation
Sciatica
Compartment syndrome
Rhabdomyolysis
Bone disorders
Osteogenesis imperfecta
Craniosynostosis
Pectus excavatum
Arthrogryposis
Genu valgum
Genu varum
Pigeon toe
Flat feet
Club foot
Cleidocranial dysplasia
Achondroplasia
Osteomyelitis
Bone tumors
Osteochondroma
Chondrosarcoma
Osteoporosis
Osteomalacia and rickets
Osteopetrosis
Paget disease of bone
Osteosclerosis
Lordosis, kyphosis, and scoliosis
Joint disorders
Osteoarthritis
Spondylosis
Spinal stenosis
Rheumatoid arthritis
Juvenile idiopathic arthritis
Gout
Calcium pyrophosphate deposition disease (pseudogout)
Psoriatic arthritis
Ankylosing spondylitis
Reactive arthritis
Spondylitis
Septic arthritis
Bursitis
Baker cyst
Muscular disorders
Muscular dystrophy
Polymyositis
Dermatomyositis
Inclusion body myopathy
Polymyalgia rheumatica
Fibromyalgia
Rhabdomyosarcoma
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
Scleroderma
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
Assessments
Sjogren syndrome: Pathology review
USMLE® Step 1 questions
0 / 3 complete
Questions
USMLE® Step 1 style questions USMLE
of complete
| 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 |
Memory Anchors and Partner Content
Transcript
Content Reviewers
Yifan Xiao, MDOn 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.
Summary
Sources
- "Robbins Basic Pathology" Elsevier (2017)
- "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
- "Sjögren syndrome" Nature Reviews Disease Primers (2016)
- "Rate, risk factors and causes of mortality in patients with Sjögren's syndrome: a systematic review and meta-analysis of cohort studies" Rheumatology (Oxford) (2016)
- "Immunopathogenesis of Sjögren's Syndrome" Clinical Reviews in Allergy & Immunology (2003)
- "Sjögren's syndrome" Lancet (2005)
- "Clinical, Immunologic, and Molecular Factors Predicting Lymphoma Development in Sjogren’s Syndrome Patients" Clinical Reviews in Allergy & Immunology (2007)
- "Sjögren syndrome" Nature Reviews Disease Primers (2016)
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