It's not Just Growing Pains: A Guide to Childhood Muscle, Bone, and Joint Pain, Rheumatic Diseases, and the Latest Treatments

By Thomas J. A. Lehman | Go to book overview

13
Sjogren’s Syndrome
Children with Dry Eyes and Dry Mouth

The combination of dry eyes and dry mouth may be the result of inflammation of the glands that produce tears and saliva (lacrimal glands produce tears; parotid and submandibular glands produce saliva). The parotid glands are the large glands at the side of the face, just over the corner of the jaw. Normally, you do not notice the parotid glands. They lie flat against the face. However, if they are swollen they stick out on both sides of the face, just above the jaw line.

Children with Sjogren’s syndrome are often sent to the rheumatologist by a dentist who has noted that they have unusually severe cavities or by an ophthalmologist who has noted that their complaints of eye discomfort are due to chronically dry eyes and poor tear production. Most of these children are antinuclear antibody (ANA)-positive. The majority of children with Sjogren’s syndrome test positive for antibodies to Ro (see below). Other children with Sjogren’s syndrome are sent to the rheumatologist because of Raynaud’s syndrome and a positive ANA or rheumatoid factor.

When they are evaluated, some of the children with Sjogren’s syndrome clearly have SLE; these children are said to have secondary Sjogren’s syndrome. Sjogren’s syndrome is also a known complication of rheumatoid arthritis in adults, but it rarely occurs in children with juvenile arthritis. I have seen children with sarcoidosis who had Sjogren’s syndrome and arthritis. Children who have dry eyes and dry mouth but lack other findings suggestive of connective tissue disease have primary Sjogren’s syndrome. However, over time some children with what was thought to be primary Sjogren’s syndrome ultimately develop more find-

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