Practical guidelines for the early diagnosis of Sjögren’s syndrome in primary healthcare
A. Sisó-Almirall1, J.M. Meijer2, P. Brito-Zerón3, L. Conangla4, A. Flores-Chavez5, L. González De Paz6, H. Bootsma7, M. Ramos-Casals8
- Permanent Board of the Catalan Society of Family and Community Medicine (CAMFiC), Barcelona; Primary Care Centre Les Corts, Consorci d’Atenció Primària de Salut Barcelona Esquerra (CAPSBE), Barcelona; and Primary Healthcare Transversal Research Group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain. firstname.lastname@example.org
- General Practitioners Research Institute, Groningen, The Netherlands.
- Autoimmune Diseases Unit, Department of Medicine, Hospital CIMA-Sanitas, Barcelona, and Department of Autoimmune Diseases, ICMiD, Hospital Clínic, Barcelona, Spain.
- Permanent Board of the Catalan Society of Family and Community Medicine (CAMFiC), Barcelona, Spain.
- Department of Autoimmune Diseases, ICMiD, Hospital Clínic, Barcelona, Spain, and Consejo Nacional de Ciencia y Tecnología (CONACYT), México DF, México.
- Primary Care Centre Les Corts, Consorci d’Atenció Primària de Salut Barcelona Esquerra (CAPSBE), Barcelona, Spain.
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Centre Groningen, the Netherlands.
- Department of Autoimmune Diseases, ICMiD, Hospital Clínic, Barcelona, Spain.
2021 Vol.39, N°6 ,Suppl.133
PI 0197, PF 0205
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PMID: 34874832 [PubMed]
Accepted : 08/08/2021
In Press: 29/11/2021
Primary care physicians can play a crucial role by recognising Sjögren’s syndrome (SS) in the early stages identifying those patients with the greatest probability of being diagnosed with SS. SS has a very specific epidemiological profile at presentation (female aged 30-50 years), which may aid an early diagnosis. Although the disease may be expressed in many guises, there are three predominant clinical presentations that should be considered as key clues to increased clinical suspicion (multiple symptoms of dryness, asthenia-polyalgia syndrome and systemic organ-specific manifestations). The physical examination may provide important clues to systemic involvement (parotid gland enlargement, skin lesions suggestive of purpura or annular erythema, respiratory crackles, arthritis, neurological sensory or motor deficits). Simple laboratory studies may be very useful in reinforcing the clinical suspicion of SS, and the triad of cytopenia, raised erythrocyte sedimentation rate and high serum gamma globulin levels is a very specific “biological” pattern suggesting SS. A solid clinical suspicion of SS requires both the patient reporting sicca symptoms and objective evidence that these symptoms are associated with dysfunction of the lachrymal and salivary glands. Ultrasonography of the parotid glands, a non-invasive method, may be a major advance in the diagnostic approach to SS in primary care. Primary care physicians must be considered essential members of the multidisciplinary team in charge of the follow-up of SS patients, due to their key role in the continuum of patient care and their cross-sectional knowledge of common diseases that frequently coexist in patients with SS.