Sjögren's syndrome

That would be a smooth red tongue, angular cheilitis, mucosal pallor, or vitamin, vitamin B12 deficiency, where you have a beefy red tongue, burning sensation in the mouth, even recurrent aphthous ulcers.

Autoimmune signaling, Sjogren's syndrome, where y- I would see tongue fissuring.

A dentist may identify atrophy of the papilla, angular cheilitis, and a medical doctor would be looking in this area too if they look in the mouth and look for signals.

Systemic lupus erythematosus, where there are oral ulcers often on the p- palate, honeycomb plaques, erythema, and again, angular cheilitis.

Saliva is a complex biological fluid, not merely lubricant.

The flow, pH, buffering capacity, and the proteins and enzymes all matter clinically and diagnostically.

For instance, a decrease in flow is seen in Sjogren's syndrome.

It's seen in post head and neck radiation, and many several xerogenic medications cause this, making it hard to speak and swallow and, of course, increases the caries rate.

So, and with fibro, it's inflamed muscles that move around.

It's definitely a real disease, but I was at a lecture one time somewhere in another big city, and it was a Stanford rheumatology professor, and He was lecturing, this was an older guy, he was lecturing on all the various rheumatologic diseases like rheumatoid arthritis, lupus, Sjogren's, all those.

And then he broached the subject of now how do you what about fibromyalgia everybody perked up because everybody wants to know how to treat this and nobody knows how to do it so you have their listening or their pens you know ready to write stuff down and he goes there's only one one way to treat it and um He goes, exercise.

That's all he said about it.

Now, today's topic I thought would be really, really helpful because I've had conversations quite regularly in the last few weeks about it.

And the topic is how do we diagnose Sjogren's disease? Now, here's something that surprises most people.

If you have dry eyes that never seem to quit, the odds that it's caused by an autoimmune disease such as Sjogren's are only about 1 in 10.

So why do we take dryness so seriously in rheumatology? Well, that's because that for one person in 10, the dryness isn't the whole story.

It can affect the lungs sometimes, as well as the kidneys.

And it can even raise the long-term risk of lymphoma.

So today we're going to talk about how I, as a rheumatologist, actually walk through and think about Sjogren's disease with my patients.

Now, diagnosing Sjogren's, it sounds like it should be simple.

Okay.

Do they have autoimmune thyroid? Do they have other autoimmune diseases? Do they have a history of Sjogren's or other autoimmunes? Like, where's their genetic lean? So you can gleam it from their personal story, their personal labs, and just looking at their family history.

And you put all that information together, and you've got a pretty good idea of where things are going to hit

Okay, so good to know.

But that's actually perhaps the best example of the utility of my MD when I was studying in med school and I would read, I read, you know, to study for the, the, the step exams, um, you have to, you have to memorize all these things.

And so you memorize and certain in, in part of that, you know, what are the, what are the, uh, auto antigens that you are associating with lupus or Sjogren's or these other disorders.

And, um, you know, when you, when I, when I read, you know, law protein or the row protein, I was like, I know what those proteins are.

Like I've heard of those, uh, cause of course I knew about sort of classical small RNA, you know, non-coding RNA biology.