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Primary Sjögren Syndrome: Case report

Year 2013, Volume: 38 Issue: 4, 818 - 822, 01.12.2013

Abstract

The importance of systemic evaluation of dry eye patients and choosing appropriate treatment based on the severity of disease were emphasized with this case. 48 years old woman complained about decreased vision, burning, itching in both eyes which got worse over the years, for about 20 years. Schirmer I test value was 0 mm/5min in both eyes. Slit lamp examination revealed filamentary keratitis in both eyes. Anti-Ro/ SSA, anti-La/ SS-B antibodies and salivary gland biopsy for Sjögren syndrome were positive. Temporary punctal occlusion and oral hydroxychloroquine were added to her treatment. After 10 days, her overall dry eye condition improved and permanent punctual plugs were inserted in both lower puctums.Dry eye patients should be evaluated systemically and severity of disease should be considered before treatment is started. Addition to topical application of artificial tears, punctal occlusion may be a proper option in dry eye patients with Sjogren syndrome.

References

  • The definition and classification of dry eye disease: Report of the definition and classification subcommittee of the international dry eye workshop. Ocul Surf. 2007;5:75-92.
  • Akpek EK, Klimava A, Thorne JE, Martin D, Lekhanont K, Ostrovsky A. Evaluation of patients with dry eye for presence of underlying Sjogren’s Syndrome. Cornea. 2009; 28:493-7.
  • Nakamura H, Kawakamu A, Eguchi K. Mechanisms of autoantibody production and the relationship between autoantibodies and the clinical manifestations in Sjogren’s syndrome. Trans Res. 2006; 148:281-8.
  • Hayashi Y, Arakaki R, Ishimaru N. The role of caspase cascade on the development of primary Sjogren’s syndrome. J Med Invest. 2003; 50:32-8
  • Zoukhri D. Effect of inflammation on lacrimal gland function. Exp Eye Res. 2006; 82:885-98. [Epub 2005 Nov 23]
  • Dawson L, Tobin A, Smith P, Gordon T. Antimuscarinic antibodies in Sjogren’s syndrome: where are we, and where are we going? Arthritis Rheum. 2005; 52:2984-95
  • Dawson LJ, Stanbury J, Venn N, Hasdimir B, Rogers SN, Smith PM., Antimuscarinic antibodies in primary Sjogren’s syndrome reversibly inhibit the mechanism of fluid secretion by human submandibular salivary acinar cells. Arthritis Rheum. 2006; 54:1165-73
  • Vitali C, Bombardieri S, Moutsopoulos HM, Balestrieri G, Bencivelli W, Bernstein RM, et al. Preliminary criteria for the classification of Sjogren’s syndrome. Results of a prospective concerted action supported by the European Community. Arthritis Rheum. 1993; 36:340-7.
  • Fox RI, Robinson CA, Curd JG, Kozin F, Howell FV,et al. Sjogren’s syndrome. Proposed criteria for classification. Arthritis Rheum. 1986; 29:477-585
  • Dogru I, Toklu Y, Sarac O, Cakmak HB. Long-Term Results of Punctal Plug Applied to Dry Eye Patients. Turk J Ophthalmol. 2011; 41:225-9.
  • Canan Aslı Utine, Esen Karamursel Akpek. Immunopathology of Sjogren’s Syndrome and Associated Dry Eye Syndrome. Turk J Ophthalmol. 2010; 40: 97-106.
  • Gunduz K, Ozdemir O. Topical cyclosporin treatment of keratoconjunctivitis sicca in secondary Sjogren’s syndrome. Acta Ophthalmol (Copenh). 1994; 72:438
  • Gottsch JD, Akpek EK. Topical cyclosporine stimulates neovascularization in resolving sterile rheumatoid central corneal ulcers. Trans Am Ophthalmol Soc. 2000; 98:81-90.
  • Toker E, Acar N, Kozako.lu H. The efficacy of topical 0.1% Cyclosporine A in the treatment of dry eye disease associated with Sjogren’s Syndrome. T Oft Gaz. 2003; 33:324-30.
  • Avunduk AM, Avunduk MC, Varnell ED, Kaufman HE. The comparison of efficacies of topical corticosteroids and nonsteroidal anti-inflammatory drops on dry eye patients: a clinical and immunocytochemical study. Am J Ophthalmol. 2003; 136:593-602.
  • Creuzot-Garcher C, Lafontaine PO, Brignole F, Pisella PJ, d'Athis P, Bron A, et al. Treating severe dry eye syndromes with autologous serum. J Fr Ophtalmol. 2004; 27:346-51.
  • Ozdemir FA, Erkam N, Aksu O. Application of autologous serum in dry eye MN-Oftalmoloji Dergisi. 2005;12:58-62.
  • Yılmaz S, Saklamaz A, Demir C, Mermut İ, Şener G, Maden A. Application of utologous serum in dry eye patients. İzmir Atatürk Eğitim Hastanesi Tıp Dergisi. 2004; 42:161-5.
  • Yazışma Adresi / Address for Correspondence: Dr. Aysel Pelit Başkent Üniversitesi Tıp Fakültesi Göz Hastalıkları Anabilim Dalı e-mail: aypelit@yahoo.com geliş tarihi/received :12.05.2013 kabul tarihi/accepted:31.05.2013

Primer Sjögren sendromu: Olgu sunumu

Year 2013, Volume: 38 Issue: 4, 818 - 822, 01.12.2013

Abstract

Bu vaka ile kuru gözde sistemik değerlendirmenin ve hastalığın ciddiyetine göre tedavi seçiminin önemi vurgulandı. Kırksekiz yaşında kadın hastanın yaklaşık yirmi yıldır var olan ve giderek kötüleşen yanma, kaşıntı ve görme azlığı şikayetleri vardı. Schirmer I test sonuçları iki gözde 0mm/5 dakika idi. Ön segment muayenesinde iki gözde filamentöz keratit saptandı. Sjögren sendromu tanısı için yapılan lakrimal bez biyopsisi ve serumda Anti-Ro/ SSA, anti-La/ SS-B antikorları pozitifti. Hastanın tedavisine geçici punktum tıkaçları ve oral hidroksiklorokin eklendi..10 gün sonra göz kuruluğu şikayetleri geriledi ve iki göz alt punktumuna kalıcı plaklar yerleştirildi. Tüm kuru göz hastaları sistemik olarak değerlendirmeli ve tedaviden önce hastalığın ciddiyeti belirlenmelidir. Sjögren sendromuna bağlı kuru göz tedavisinde yerine koyma tedavisine ek olarak punktum tıkacı uygulaması da uygun bir seçenektir.

References

  • The definition and classification of dry eye disease: Report of the definition and classification subcommittee of the international dry eye workshop. Ocul Surf. 2007;5:75-92.
  • Akpek EK, Klimava A, Thorne JE, Martin D, Lekhanont K, Ostrovsky A. Evaluation of patients with dry eye for presence of underlying Sjogren’s Syndrome. Cornea. 2009; 28:493-7.
  • Nakamura H, Kawakamu A, Eguchi K. Mechanisms of autoantibody production and the relationship between autoantibodies and the clinical manifestations in Sjogren’s syndrome. Trans Res. 2006; 148:281-8.
  • Hayashi Y, Arakaki R, Ishimaru N. The role of caspase cascade on the development of primary Sjogren’s syndrome. J Med Invest. 2003; 50:32-8
  • Zoukhri D. Effect of inflammation on lacrimal gland function. Exp Eye Res. 2006; 82:885-98. [Epub 2005 Nov 23]
  • Dawson L, Tobin A, Smith P, Gordon T. Antimuscarinic antibodies in Sjogren’s syndrome: where are we, and where are we going? Arthritis Rheum. 2005; 52:2984-95
  • Dawson LJ, Stanbury J, Venn N, Hasdimir B, Rogers SN, Smith PM., Antimuscarinic antibodies in primary Sjogren’s syndrome reversibly inhibit the mechanism of fluid secretion by human submandibular salivary acinar cells. Arthritis Rheum. 2006; 54:1165-73
  • Vitali C, Bombardieri S, Moutsopoulos HM, Balestrieri G, Bencivelli W, Bernstein RM, et al. Preliminary criteria for the classification of Sjogren’s syndrome. Results of a prospective concerted action supported by the European Community. Arthritis Rheum. 1993; 36:340-7.
  • Fox RI, Robinson CA, Curd JG, Kozin F, Howell FV,et al. Sjogren’s syndrome. Proposed criteria for classification. Arthritis Rheum. 1986; 29:477-585
  • Dogru I, Toklu Y, Sarac O, Cakmak HB. Long-Term Results of Punctal Plug Applied to Dry Eye Patients. Turk J Ophthalmol. 2011; 41:225-9.
  • Canan Aslı Utine, Esen Karamursel Akpek. Immunopathology of Sjogren’s Syndrome and Associated Dry Eye Syndrome. Turk J Ophthalmol. 2010; 40: 97-106.
  • Gunduz K, Ozdemir O. Topical cyclosporin treatment of keratoconjunctivitis sicca in secondary Sjogren’s syndrome. Acta Ophthalmol (Copenh). 1994; 72:438
  • Gottsch JD, Akpek EK. Topical cyclosporine stimulates neovascularization in resolving sterile rheumatoid central corneal ulcers. Trans Am Ophthalmol Soc. 2000; 98:81-90.
  • Toker E, Acar N, Kozako.lu H. The efficacy of topical 0.1% Cyclosporine A in the treatment of dry eye disease associated with Sjogren’s Syndrome. T Oft Gaz. 2003; 33:324-30.
  • Avunduk AM, Avunduk MC, Varnell ED, Kaufman HE. The comparison of efficacies of topical corticosteroids and nonsteroidal anti-inflammatory drops on dry eye patients: a clinical and immunocytochemical study. Am J Ophthalmol. 2003; 136:593-602.
  • Creuzot-Garcher C, Lafontaine PO, Brignole F, Pisella PJ, d'Athis P, Bron A, et al. Treating severe dry eye syndromes with autologous serum. J Fr Ophtalmol. 2004; 27:346-51.
  • Ozdemir FA, Erkam N, Aksu O. Application of autologous serum in dry eye MN-Oftalmoloji Dergisi. 2005;12:58-62.
  • Yılmaz S, Saklamaz A, Demir C, Mermut İ, Şener G, Maden A. Application of utologous serum in dry eye patients. İzmir Atatürk Eğitim Hastanesi Tıp Dergisi. 2004; 42:161-5.
  • Yazışma Adresi / Address for Correspondence: Dr. Aysel Pelit Başkent Üniversitesi Tıp Fakültesi Göz Hastalıkları Anabilim Dalı e-mail: aypelit@yahoo.com geliş tarihi/received :12.05.2013 kabul tarihi/accepted:31.05.2013
There are 19 citations in total.

Details

Primary Language Turkish
Journal Section Research
Authors

Eylem Yaman Pınarcı This is me

Aysel Pelit This is me

Duygu Bozkırlı This is me

Emine Tuba Canbolat This is me

Publication Date December 1, 2013
Published in Issue Year 2013 Volume: 38 Issue: 4

Cite

MLA Pınarcı, Eylem Yaman et al. “Primer Sjögren Sendromu: Olgu Sunumu”. Cukurova Medical Journal, vol. 38, no. 4, 2013, pp. 818-22.