Sjogren's syndrome and the need for cooperation of medical specialties for its treatment

Sjogren's syndrome (SS) is an autoimmune disease that is classified as a rheumatic disease and causes inflammation of the exocrine glands, mainly affecting the salivary and lacrimal glands, leading to significant loss of function. It is the second most common systemic autoimmune disease after rheumatoid arthritis and is mainly characterized by a triad of clinical features, namely dry keratoconjunctivitis, dry mouth, and a connective tissue disease (usually Rheumatoid Arthritis). It can also affect many other tissues and organs, especially the glandular tissues and the musculoskeletal system. The cause of SS is multifactorial. The etiology is considered to be related to a combination of genetic, environmental, viral infections and modifications of the immune system. The disease destroys through the immune system the glandular epithelium of the exocrine glands, especially the salivary and lacrimal glands. The clinical picture includes intraoral manifestations (dry mouth, angular cheilitis, secondary infections, significantly increased rate of caries and erosive lesions on the teeth, etc.), ocular manifestations (dry eye, burning sensation in the eyes, etc.). manifestations from the musculoskeletal, gastrointestinal, nervous system etc. Dry skin and rash may also coexist. Treatment of the disease is symptomatic. Patients should take various general measures, such as very meticulous oral hygiene, frequent use of artificial tears and saliva substitutes, lip lubricants, etc. Systemic manifestations and pain (eg arthralgias) are treated with drugs used to treat other autoimmune diseases, such as NSAIDs, corticosteroids, immunosuppressants, etc. The difficulty of diagnosis, the unknown etiology, the complexity of the manifestations of the syndrome, the need for early treatment indicate the need for cooperation of many specialties for both diagnosis and treatment of the syndrome. The dentist, as well as the physician, the otolaryngologist or the ophthalmologist will probably be the first doctors who will be called to diagnose the syndrome, to note the symptoms and to refer patients to more competent doctors or to the appropriate examinations. This requires a good knowledge of the pathophysiology of the syndrome, the methods of diagnosis and the therapeutic approaches, and the present review aims to contribute to this need.