Dr. Ashaq Hussain Parrey
Rheumatology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I am a 45-year-old male. I had a physical examination done ten months ago. My reports came normal. I began having dry eyes, dry throat, and mouth. My antibody test results came negative. My doctor said the ANA is a false positive, although I have lingering dryness of the throat, mouth, and nose, primarily at night. I have no issues with eating food; that makes things better. The ophthalmologist did not see much in terms of dry eye, but he told me that I might have eye mites. I do not have any eye issues during the day, but I have problems at night. This is because the mites are active at night. My dentist said my mouth looked good, and I had no cavities. Are my laboratory reports and symptoms suggestive of Sjogren's syndrome? My doctor thinks it is possible as I have some silent reflux-causing symptoms. I do not have any chronic conditions except EoE. However, I am mostly asymptomatic. Lastly, I take the tablet Klonopin 5 mg for sleep three to four times per week. I took it the night before the blood test, but I did not take it the night before the blood test that showed an ANA of 1:80. Please give your opinion regarding Sjogren's syndrome.
Hello,
Welcome to icliniq.com.
You have dry eyes and mouth symptoms with positive ANA (antinuclear antibody) test. ANA is positive in 5 % of the general population and carries little significance unless associated with clinical symptoms. However, Sicca syndrome's symptoms need to be evaluated by sialometry and Schimer's test.
Patient's Query
Hello doctor,
The ophthalmologist did not perform Schimer's test. She said that my eyes looked good. She said that I have eye mites. I do not have any issues during the day with my eyes. I will specifically ask the ophthalmologist about SS evaluation. My dentist did not perform any tests. My ANA improved on the follow-up to 1:80. Does that have any meaning? Also, my symptoms are largely at night, although not only at night. Not sure if my symptom history is more or less indicative of SS?
Hello,
Welcome back to icliniq.com.
ANA (antinuclear antibody) titer of 1:80 is considered positive, but as I said, 5 % of the general population has positive ANA, which has no significance if not associated with symptoms. Schimer's test does documentation of dry eyes as it gives objective evidence. The dentist will not perform scintigraphy.
Patient's Query
Hello doctor,
If Schimer's test and sialometry are negative, would you recommend further evaluation for SS or focus on other causes?
Hello,
Welcome back to icliniq.com.
If SSA and SSB antibody test is negative and the sialometry and Schimer's test is normal, no more tests are needed for Sjogren's syndrome. One more thing you need to remember is that 25 % of the general population does suffer from dry mouth symptoms. So this could be normal.
Patient's Query
Hello doctor,
I will make sure that both tests are done. I do not have fatigue or joint pain. Do I have a dry mouth due to a lack of saliva?
Hello,
Welcome back to icliniq.com.
The gritty sensation of the eyes and frequent sips of water while eating solid food are two important symptoms. Clinically you do not seem to have any autoimmune disease; however, it is always better to rule it out and be sure.
Patient's Query
Hello doctor,
I could not find anything online. Please guide me regarding the saliva test procedure.
Hello,
Welcome back to icliniq.com.
I will guide you about the procedure.
Patient's Query
Thank you doctor for the reply,
Please explain about the procedure.
Hello,
Welcome back to icliniq.com.
The steps of the procedure are:
Patient's Query
Hello doctor,
We had a 10 ml syringe. My mouth was dried, and I sat for 15 minutes with the base of the syringe in my mouth, and the end plugged. The total volume generated was 1.5 mL. The saliva was transparent but not as clear as water and was slightly thicker. Dry mouth sensation, perhaps, is more subjective. Although it feels drier at times than it does today.
Hello,
Welcome back to icliniq.com.
From the attached reports (attachments removed to protect the patient's identity), the test is negative, which means there is no dry mouth. So the sensation is subjective; as I mentioned earlier that 25 % of the normal population complains of dry mouth. So this test confirms that there is no xerostomia.
Patient's Query
Hello doctor,
I will consult an ophthalmologist.
Hello,
Welcome back to icliniq.com.
Thank you for your appreciation and for consulting me, and let me know once the test is done.
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