Abstract
Secondary sjogrens syndrome is an autoimmune disorder leading to destruction of exocrine glands with resultant classical clinical triad of dry eye, dry mouth and parotid gland enlargement in association with other systemic autoimmune diseasecommonly rheumatoid arthritis. This report highlights the unintended effect of systemic immunosuppresants given for the treatment of rheumatoid arthritis, in improving the coexistant corneal thinning and other ocular manifestation in a case ofsecondary sjogrens syndrome, which has been rarely reported. Modification of the immune response with systemic immunosuppressive agents improves severe keratoconjunctivitis sicca in recalcitrant secondary Sjogren syndrome.
Highlights
Sjogren’s syndrome is an autoimmune disease characterized by lymphocytic infiltration and destruction of lacrimal glands, salivary glands and other exocrine glands leading to classical triad of keratoconjunctivitis sicca, xerostomia and parotid gland enlargement
Primary exists in isolation whereas secondary Sjogren syndrome is associated with other systemic autoimmune disease
After 5 months, with improvement in arthralgia, systemic medications were tapered; all of a sudden, she presented with worsened ocular symptoms and corneal thinning, forced us to step up the treatment
Summary
Sjogren’s syndrome is an autoimmune disease characterized by lymphocytic infiltration and destruction of lacrimal glands, salivary glands and other exocrine glands leading to classical triad of keratoconjunctivitis sicca, xerostomia and parotid gland enlargement. RA factor and anti CCP antibody were positive confirming secondary Sjogren’s according to revised International classification criteria for Sjogren’s syndrome and ACR criteria for rheumatoid arthritis. She was initially started on topical lubricant eye preparations and later topical immunosuppressant (cyclosporine) was added. After 5 months, with improvement in arthralgia, systemic medications were tapered; all of a sudden, she presented with worsened ocular symptoms and corneal thinning, forced us to step up the treatment She was followed up for a period of 1 year and is presently under remission with systemic methotrexate, hydroxychloroquine, methyl prednisolone, topical cyclosporine and lubricant eye drops (Figure 2)
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