Sjögren's syndrome: diagnosis and therapeutic challenges in the elderly

Sjögren's syndrome (SS) is a chronic autoimmune rheumatic disease characterized by keratoconjunctivitis sicca and xerostomia as a result of lymphocytic infiltration of the lacrimal and salivary glands. Extra-glandular manifestations occur in about one-third of patients with SS. The diagnosis of SS in the geriatric population is not straightforward and consideration needs to be given to exclusion of other conditions that may have similar presenting symptoms. The presence of autoantibodies, in particular anti-Ro and anti-La antibodies, may aid in the diagnosis of SS. Salivary gland biopsy findings represent one of the objective criteria included in the widely accepted American-European classification diagnostic criteria. However, SS-like histological changes can also be present in the healthy elderly, adding to the dilemma in diagnosing this condition in the geriatric population. Management of SS involves local treatment of dry eyes and mouth with replacement and stimulation therapies. Patients with more serious systemic involvement may require immunosuppressive therapy. Medications that are routinely used in the treatment of patients with SS often have limited use in the elderly population because patients in the latter group may have complex co-morbid conditions and be taking multiple medications. Recently, use of newer targeted therapies has been explored in SS. This article provides an update on recent developments in the diagnosis and management of SS, with emphasis on issues that may arise when treating elderly patients with this condition.