We started the day with Dr Arthur Bookman giving us an overview of the criteria for the diagnosis of Sjogren's Syndrome. He described it as an immunological storm. Dr Bookman is also to thank for the inspired naming of the conference.
He told us that hypertrophied salivary glands are often seen in Sjogren's. If the salivary ducts are injected with a tracer dye you can see damage and abnormal arborization.
He also talked about the length of time it takes to get a diagnosis of Sjogren's Syndrome based on experiences of people who attended the multidisciplinary clinic at Toronto Western Hospital. It takes 27 to 31 months for the diagnosis and from 2.9 to 3.2 different doctors. This leads to patients being unhappy with the medical profession. On the Devins Illness Intrusiveness Scale Sjogren's ranks very near Multiple Sclerosis.
He also said that systemic treatments such as prednisone, hydroxychloroquine, immunosuppressants and TNF inhibitors are ineffective, though Rituximab is sometimes effective. It has been seen to improve dry mouth/salivary symptoms and dry eye and fatigue. Future treatments may include Benlysta and allogenic mesenchymal stem cell transplantation (Sun, Nanjing abstract 2557, ACR 2012)