Sjogren’s Syndrome with Rheumatoid Arthritis

What is Rheumatoid Arthritis?

Rheumatoid arthritis (RA) is an autoimmune disease that affects the joints. The symptoms of rheumatoid arthritis include joint pain, swelling, fatigue, weakness, and stiffness (stiffness especially in the morning), and they can lead to loss of joint function and permanent joint damage. Early treatment for rheumatoid arthritis can help manage symptoms, improve joint function, and help stop progressive joint damage.

Tests for rheumatoid arthritis include positive rheumatoid factor (RF), ANA, sedimentation rate, and C-reactive protein tests in the blood. These tests can show abnormal results due to RA or due other systemic autoimmune and inflammatory conditions. Therefore, abnormalities in these blood tests alone are not sufficient for a firm diagnosis of rheumatoid arthritis.

Rheumatoid Arthritis and Sjogren’s Syndrome – “Secondary Sjogren’s”

When people with Sjogren’s syndrome also have rheumatoid arthritis, it is called Secondary Sjogren’s.

Sjogren’s syndrome is classified as either primary or secondary. Primary Sjogren’s syndrome is diagnosed when the disease occurs in the absence of another underlying rheumatic disorder.The secondary form is diagnosed in people who already have another autoimmune disease such as systemic lupus erythmatosus (Lupus) or rheumatoid arthritis (RA). Statistically, Sjogren’s syndrome cases are fairly equally divided between the primary and secondary forms.

Given the overlap of Sjogren’s syndrome with many other autoimmune disorders, it is sometimes difficult to determine whether a clinical manifestation is solely a consequence of Sjogren’s syndrome or is due to one of its overlapping disorders.

Primary Sjogren’s syndrome moves more quickly and causes decreased function in the lacrimal (for the eyes) and salivary glands (for the mouth). Secondary Sjogren’s syndrome generally causes less severe dryness in the mouth and eyes; however, patients must manage both the effects of their primary disease and the effects of their secondary Sjogren’s.

Primary Sjogren’s Syndrome Diagnosis

The diagnosis of primary Sjogren’s syndrome is based on the following factors, including:

  • Presence of dry eyes and mouth. An eye specialist can detect dry eyes by measuring tear volume and looking at the cornea of the eye.
  • Laboratory tests indicating dry eyes and mouth are caused by autoimmune mechanisms include positive auto-antibodies in the blood, known as anti-SSA or anti-SSB (also called anti-Ro or anti-La).
  • Biopsy of the inner lip (performed in some cases to prove the diagnosis of primary Sjogren’s syndrome). The biopsy may show inflammation that is damaging salivary glands.

Secondary Sjogren’s Syndrome Diagnosis

Secondary Sjogren’s syndrome is generally diagnosed when someone with an established autoimmune disease, such as rheumatoid arthritis or lupus, develops extreme dryness of the eyes and mouth. This diagnosis only rarely requires a lip biopsy.

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