Making the diagnosis of Sjögren’s syndrome in patients with dry eye

Making the diagnosis of Sjögren’s syndrome in patients with dry eye

Kenneth A Beckman,1,2 Jodi Luchs,3,4 Mark S Milner5,6 1Comprehensive EyeCare of Central Ohio, Westerville, OH, 2The Ohio State University, Columbus, OH, 3Hofstra University School of Medicine, Hempstead, NY, 4South Shore Eye Care, Wantagh, NY, 5The Eye Center of Southern Connecticut, PC, Hamden, CT...

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Autores principales: Beckman KA, Luchs J, Milner MS
Formato: article
Lenguaje:EN
Publicado: Dove Medical Press 2015
Materias:
Dry eye
Sjogren's Syndrome
evaporative dry eye
aqueous-deficient dry eye
biomarkers
Sjo Test
Ophthalmology
RE1-994
Acceso en línea:https://doaj.org/article/420090b5adf74e2495ec10e860634856
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spelling oai:doaj.org-article:420090b5adf74e2495ec10e8606348562021-12-02T07:44:52ZMaking the diagnosis of Sjögren’s syndrome in patients with dry eye1177-5483https://doaj.org/article/420090b5adf74e2495ec10e8606348562015-12-01T00:00:00Zhttps://www.dovepress.com/making-the-diagnosis-of-sjoumlgrenrsquos-syndrome-in-patients-with-dry-peer-reviewed-article-OPTHhttps://doaj.org/toc/1177-5483Kenneth A Beckman,1,2 Jodi Luchs,3,4 Mark S Milner5,6 1Comprehensive EyeCare of Central Ohio, Westerville, OH, 2The Ohio State University, Columbus, OH, 3Hofstra University School of Medicine, Hempstead, NY, 4South Shore Eye Care, Wantagh, NY, 5The Eye Center of Southern Connecticut, PC, Hamden, CT, 6Yale University School of Medicine, New Haven, CT, USA Abstract: Sjögren’s syndrome (SS) is a chronic and progressive systemic autoimmune disease that often presents initially with symptoms of dry eye and dry mouth. Symptoms are often non-specific and develop gradually, making diagnosis difficult. Patients with dry eye complaints warrant a step-wise evaluation for possible SS. Initial evaluation requires establishment of a dry eye diagnosis using a combination of patient questionnaires and objective ocular tests, including inflammatory biomarker testing. Additional work-up using the Schirmer test and tear film break-up time can differentiate between aqueous-deficient dry eye (ADDE) and evaporative dry eye. The presence of ADDE should trigger further work-up to differentiate between SS-ADDE and non-SS-ADDE. There are numerous non-ocular manifestations of SS, and monitoring for SS-related comorbid findings can aid in diagnosis, ideally in collaboration with a rheumatologist. The clinical work-up of SS can involve a variety of tests, including tear function tests, serological tests for autoantibody biomarkers, minor salivary gland and lacrimal gland biopsies. Examination of classic SS biomarkers (SS-A/Ro, SS-B/La, antinuclear antibody, and rheumatoid factor) is a convenient and non-invasive way of evaluating patients for the presence of SS, even years prior to confirmed diagnosis, although not all SS patients will test positive, particularly those with early disease. Recently, newer biomarkers have been identified, including autoantibodies to salivary gland protein-1, parotid secretory protein, and carbonic anhydrase VI, and may allow for earlier diagnosis of SS. A diagnostic test kit is commercially available (Sjö®), incorporating these new biomarkers along with the classic autoantibodies. This advanced test has been shown to identify SS patients who previously tested negative against traditional biomarkers only. All patients with clinically significant ADDE should be considered for serological assessment for SS, given the availability of new serological diagnostic tests and the potentially serious consequences of missing the diagnosis. Keywords: dry eye, Sjögren’s syndrome, evaporative dry eye, aqueous-deficient dry eye, biomarkers, Sjö testBeckman KALuchs JMilner MSDove Medical PressarticleDry eyeSjogren's Syndromeevaporative dry eyeaqueous-deficient dry eyebiomarkersSjo TestOphthalmologyRE1-994ENClinical Ophthalmology, Vol 2016, Iss Issue 1, Pp 43-53 (2015)
institution DOAJ
collection DOAJ
language EN
topic Dry eye
Sjogren's Syndrome
evaporative dry eye
aqueous-deficient dry eye
biomarkers
Sjo Test
Ophthalmology
RE1-994
spellingShingle Dry eye
Sjogren's Syndrome
evaporative dry eye
aqueous-deficient dry eye
biomarkers
Sjo Test
Ophthalmology
RE1-994
Beckman KA
Luchs J
Milner MS
Making the diagnosis of Sjögren’s syndrome in patients with dry eye
description Kenneth A Beckman,1,2 Jodi Luchs,3,4 Mark S Milner5,6 1Comprehensive EyeCare of Central Ohio, Westerville, OH, 2The Ohio State University, Columbus, OH, 3Hofstra University School of Medicine, Hempstead, NY, 4South Shore Eye Care, Wantagh, NY, 5The Eye Center of Southern Connecticut, PC, Hamden, CT, 6Yale University School of Medicine, New Haven, CT, USA Abstract: Sjögren’s syndrome (SS) is a chronic and progressive systemic autoimmune disease that often presents initially with symptoms of dry eye and dry mouth. Symptoms are often non-specific and develop gradually, making diagnosis difficult. Patients with dry eye complaints warrant a step-wise evaluation for possible SS. Initial evaluation requires establishment of a dry eye diagnosis using a combination of patient questionnaires and objective ocular tests, including inflammatory biomarker testing. Additional work-up using the Schirmer test and tear film break-up time can differentiate between aqueous-deficient dry eye (ADDE) and evaporative dry eye. The presence of ADDE should trigger further work-up to differentiate between SS-ADDE and non-SS-ADDE. There are numerous non-ocular manifestations of SS, and monitoring for SS-related comorbid findings can aid in diagnosis, ideally in collaboration with a rheumatologist. The clinical work-up of SS can involve a variety of tests, including tear function tests, serological tests for autoantibody biomarkers, minor salivary gland and lacrimal gland biopsies. Examination of classic SS biomarkers (SS-A/Ro, SS-B/La, antinuclear antibody, and rheumatoid factor) is a convenient and non-invasive way of evaluating patients for the presence of SS, even years prior to confirmed diagnosis, although not all SS patients will test positive, particularly those with early disease. Recently, newer biomarkers have been identified, including autoantibodies to salivary gland protein-1, parotid secretory protein, and carbonic anhydrase VI, and may allow for earlier diagnosis of SS. A diagnostic test kit is commercially available (Sjö®), incorporating these new biomarkers along with the classic autoantibodies. This advanced test has been shown to identify SS patients who previously tested negative against traditional biomarkers only. All patients with clinically significant ADDE should be considered for serological assessment for SS, given the availability of new serological diagnostic tests and the potentially serious consequences of missing the diagnosis. Keywords: dry eye, Sjögren’s syndrome, evaporative dry eye, aqueous-deficient dry eye, biomarkers, Sjö test
format article
author Beckman KA
Luchs J
Milner MS
author_facet Beckman KA
Luchs J
Milner MS
author_sort Beckman KA
title Making the diagnosis of Sjögren’s syndrome in patients with dry eye
title_short Making the diagnosis of Sjögren’s syndrome in patients with dry eye
title_full Making the diagnosis of Sjögren’s syndrome in patients with dry eye
title_fullStr Making the diagnosis of Sjögren’s syndrome in patients with dry eye
title_full_unstemmed Making the diagnosis of Sjögren’s syndrome in patients with dry eye
title_sort making the diagnosis of sjögren’s syndrome in patients with dry eye
publisher Dove Medical Press
publishDate 2015
url https://doaj.org/article/420090b5adf74e2495ec10e860634856
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