Adults
Sjögren's disease with systemic features
Dry eyes and mouth plus parotid swelling, purpura, neuropathy, cytopenias, kidney or lung involvement.
What to look for
- Persistent dry eyes and mouth, plus systemic features
- Salivary or parotid gland swelling, lymphadenopathy
- Purpura, peripheral neuropathy, interstitial nephritis or renal tubular acidosis, ILD, inflammatory arthritis
- Anti-SSA/Ro, RF, hypergammaglobulinemia, low C4, cryoglobulins
What to do
- Send ANA, SSA/Ro, SSB/La, RF, CBC, metabolic panel, urinalysis, serum protein electrophoresis or IgG, and C3/C4. Add cryoglobulins if there is purpura or neuropathy.
- Persistent parotid enlargement, new lymphadenopathy, purpura, low C4 or a monoclonal protein raise concern for lymphoma. Refer these promptly.
- Sicca alone with mild serology is a routine referral (see below).
About this urgency level
Early specialist assessment changes outcomes. Send the usual workup with the referral, but don't hold the referral while waiting for results.
Timeframes are typical targets. Local pathways, capacity and clinical judgment come first.