Læknaneminn - 01.04.1997, Page 12

Björn Guðbjörnsson
sjúkdómsmynd hafi einn ábyrgan lækni með góða
þekkingu á sjúkdómsástandinu og sjúklingnum.
SJÚKDÓMAR ER LÍKJAST
HEILKENNUM SJÖGRENS
Margir bandvefssjúkdómar líkjast pSS og er þar fyrst
að nefna rauða úlfa og blandaðan bandvefssjúkdóm
(MCTD). Sjúklingar með pSS hafa oft jákvæð gigtar-
próf og vegna liðeinkenna sinna getur sjúkdómurinn á
byrjunarstigi líkst iktsýki. Eins og fyrr segir einkennist
pSS af vöðvaverkjum og þreytu, auk sicca einkenn-
anna, þetta getur misleitt hugann að fjölvefjagigt. Aug-
ljóst er að mismunagreining er mikilvæg, svo að sjúkl-
ingar með pSS fái réttar upplýsingar um sjúkdóm sinn,
meðferð og eftirlit (ath. hættu á eitlaæxlum).
Aðrir sjúkdómar, t.d. sarklíki, frum- eða bólgu-
mýildi, lifrarbólga, blóðfitusjúkdómar og Hodgkin’s
sjúkdómur geta einnig líkst pSS. Á sama hátt getur
græðlings vs. hýsils viðbragð og upphafsstig alnæmis
verið sláandi líkt pSS. Margt þarf því að hafa í huga,
áður en sjúkdómsgreiningin primary Sjögren’s syn-
drome er staðfest.
SAMANTEKT
Hér að framan hefur verið gerð grein fyrir sögu heil-
kenna Sjögrens. Ahersla hefur verið lögð á að vandi
Sjögrens sjúklinganna er ekki eingöngu sicca einkenn-
in, heldur er sjúkdómsmyndin margbreytileg frá einu
sjúkratilfelli til annars, sem gerir sjúkdómsgreiningu oft
á tíðurn erfiða.
ÞAKKIR
Höfundur þakkar próf. Rolf Manthorpe og félögum íyrir leyfi birtingar
mynda (að frátalinni mynd nr. 6). Einnig þakkar höfundur Maríu S. As-
grímsdóttur fýrir góða ritarahjálp.
TILVÍSANIR
1. Sjögren H. Zur Kenntnis der Karatoconjunctivitis sicca [Thesis].
Karolinska Institute, Stockholm, Sweden, 1933.
2. For RI, Howell FV, Bone RC, Michelson P, Primary Sjogren syn-
drome; clinical and immunopathologic features. Semin Arthritis
Rheum 1984; 14.77-105-
3. Strand T, Talal N, Advances in the diagnosis and concepts of Sjög-
rens syndrome (autoimmune exocrinopathy). Bull Rheum Dis
1980;30:1046-1952.
4. Markusse HM, Oudkerk M, Vroom TM, Breedveld FC. Primary
Sjogrens syndrome: clinical spectrum and mode of presentation ba-
sed on an analysis of 50 patients selected from a department of
rheumatology. Neth J Med 1992;40:125-34.
5. Sjögren H. A new conception of keratoconjunctivitis sicca. Sydney:
Flamilton JB, ed. Aust Med Publ Co LTD, 1943.
6. Moutsopoulos HM, Webber BL, Vlagopoulos TP, Chused THM,
Decker JL. Differences in the clinical manifestations of sicca syn-
drome in the presence or absence of rheumatoid arthritis. Am J Med
1979;66:733-736.
7. Alspaugh MA, Tan EM. Antibodies to cellular antigens in Sjögrens
syndrome. J Clin Inves 1985;55:1067-1073.
8. Moutsopoulos HM, Mann DL, Johnson AH, Chused TM. Genetic
differences between primary and secondary sicca syndreom. N Eng
J Med 1979;301:761-763.
9. Arnett R, Edworthy S, Bloch D. The American Rheumatism Associ-
ation 1987. Revised criteria for the classification of rheumatoid art-
hritis. Arthritis Rheum 1988;26:315-24.
10. Tan EM, Cohen AS, Fries JF, et al. The 1982 revised criteria for the
classification of systemic lupus erythema. Arthritis Rheum
1982;25:1271-7.
11. Skopouli FN, Drosos AA, Papaioannou T, Moutsopoulos HM.
Preliminary diagnostic criteria for Sjogrens syndrome. Scand J
Rheumatol 1986;6l (suppl) :22-5.
12. Fox RI, Robinson CA, Curd JG, Kozin F, Howell FV. Sjogren’s syn-
drome. Proposed criteria for classificatin. Arthritis Rheum
1986;29:577-85.
14. Homma M, Tojo T, Akizuki M, Yamagata H. Criteria for Sjogren’s
syndrome in Japan. Scand J Rheumatol 1986;6l(suppl):26-7.
15. Halberg GP, Berens C. Standardized Schirmer tear test kit. Am J
Ophthalmol 1961;51:840-2.
16. van Bijsterveld OP. Diagnostic test in the sicca syndrome. Arch
Ophthal 1969;82:10-4.
17. Norn MS. Desiccation of the precorneal film I. Corneal wetting-
time. Acta Ophthalmol 1969;47:5-11.
18. Vitali C, Bombardieri S, Moutsopoulos HM, et al. Preliminary
criteria for the classification of Sjögren’s syndrome. Results of a
prospective concerted action supported by the European Comm-
unity. Arthritis Rheum 1993;36:340-47.
19. Workshop on diagnostic Criteria for Sjögren’s syndrome: I
Questionnaires for dry eyes and dry mouth. II Manual for methods
and procedures. Clin Exp. Rheumatol 1989;7:212-219.
20. Chisholm DM, Mason DK. Labial salivary gland biopsy in Sjögren’s
disease. J Clin Pathol 1968;21:656-660.
21. Daniels TE. Labial salivary gland biopsy in Sjögren’s syndrome.
Assessment as a diagnostic in 362 suspected cases. Arthritis Rheum
1984;27:147-56.
22. Drosos AA, Andonopoulos AP, Costopoulos Js, Papadimitriou CS,
Moutsopoulos HM. Prevalence of primary Sjogren’s syndrome in an
elderly population. BrJ Rlieumatol 1988;27:123-7.
23. Strickland RW, Tesar J, Berne B, Hobbs B, Lewis D, Welton R. The
frequency of sicca syndrome in an elderly female population. J
Rlieumatol 1985;14:766-771.
24. Whaley K, Williamsson J, Wilson T, et al. Sjögren’s syndrome and
autoimmunity in a geriatric population. Age Ageing 1972; 1:197-
206.
25. Hochberg MC. Systemic lupus erythematosus. Rheum Dis Clin
NorthAm 1990;16:617-39.
26. Jacobsson LT, Axell TE, Hansen BU, et al. Dry eyes or mouth—an
epidemiological study in Swedish adults, with special reference to
primary Sjogren’s syndrome. J Autoimmun 1989;2:521-7.
27. Zhang NZ. Primary Sjögren’s syndrome, a highly misrecognized
disease in China. VII Asian Pacific League Against Rheumatism.
Bali, Indonesia, 1992:199-202.
28. Manthorpe R, Frost-Larsen K, Isager H, Prause JU. Sjogren’s syn-
drome. A review with emphasis on immunological features. Allergy
1981;36:139-53.
29. Pavlidis NA, Karsh J, Moutsopoulos HM. The clinical picture of
primary Sjogren’s syndrome: a retrospective study. J Rheumatol
1982;9:685-90.
30. Chudwin DS, Daniels TE, Wara DW, et al. Spectrum of Sjogren’s
syndrome in children. J Pediatr 1981;98:213-7.
31. Deprettere AJ, Van AK, De Clerck L, Docx MK, Stevens WJ, Van
LÆKNANEMINN
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