Medscape: The Neurology of Sjogren's Syndrome and the Rheumatology of Peripheral Neuropathy and Myelitis

I thought this article from Medscape Nurses was extremely interesting. It's entitled The Neurology of Sjögren's Syndrome and the Rheumatology of Peripheral Neuropathy and Myelitis written by Aaron L Berkowitz and Martin A Samuels. It can be found on Medscape, here. (For those of you who are unable to view the article, it will be available after completion of the free registration and login for Medscape.)

The article was originally published in Practical Neurology 2014;14(1):14-22. . Here's the abstract:

Neurological symptoms occur in approximately 20% of patients with Sjögren's syndrome, and may be the presenting manifestations of the disease. Here, we review several neurological conditions that can occur in Sjögren's syndrome: sensory ganglionopathy, painful small fibre neuropathy, and transverse myelitis (independently or as part of neuromyelitis optica). We present the symptoms, signs, differential diagnoses, recommended diagnostic evaluation, and treatment of each of these, highlighting the features that should alert neurologists to consider Sjögren's syndrome.

What I found remarkable about this article is twofold: first, it goes into great detail about how neurologists evaluate a patient for various types of neuropathies. But secondly, the intent of the article is to encourage physicians to consider Sjogren's syndrome in the differential diagnosis of patients presenting with neurological problems:

Sjögren's syndrome can affect any component of the peripheral or central nervous system. We recommend evaluating for Sjögren's syndrome in all patients presenting with sensory ganglionopathy, small fibre neuropathy, or other neuropathies with unrevealing initial evaluation, as well as in patients with longitudinally extensive transverse myelitis and/or demyelinating-appearing brain lesions in patterns atypical for multiple sclerosis. All patients with these neurological disorders should be screened for sicca symptoms and other symptoms and signs of rheumatologic disease (eg, arthralgias, rash, Raynaud's phenomenon). Initial laboratory testing should include antinuclear antibodies, anti-SSA, and anti-SSB, but these may be insensitive, and one should proceed to lip minor salivary gland biopsy if serology is non-diagnostic. Patients with known Sjögren's syndrome who develop CNS disease should undergo testing for NMO-IgG. Patients with neurological manifestations of Sjögren's syndrome are ideally evaluated and cared for through collaborations between rheumatologists and neurologists to provide definitive diagnosis, as well as to optimise disease-specific and symptomatic treatment.