Sjögren's syndrome

• Dry gritty eyes, dry mouth with caries and swallowing difficulty, parotid swelling; fatigue, arthralgia, Raynaud's, purpura, ILD, renal tubular acidosis, neuropathy, cytopenias, MALT lymphoma.

• Investigations: ANA, anti-Ro/SSA, anti-La/SSB, Schirmer's test, salivary gland biopsy; ACR/EULAR 2016 score 4 or more.

Management

• Artificial tears and saliva, dental hygiene and check-ups, frequent fluids, sugar-free gum; avoid tobacco, cannabis, caffeine and cola.

• Dry mouth: D: pilocarpine (PO) 5 mg every 8 hours.

• Fatigue or arthralgia: S: hydroxychloroquine (PO) 200–400 mg once daily.

• Systemic involvement (e.g. vasculitis): A: prednisolone 0.5–1 mg/kg once daily, OR S: methotrexate 10–25 mg weekly, OR S: azathioprine 1.5–2.5 mg/kg/day.