Practical Guideline for General Practitioners (GP) to approach to the Patients Suspected to have Primary Sjogren’s Syndrome

Jogren' Syndrome (SS) is a chronic autoimmune disease presenting with clinical hallmark of dry eyes, dry mouth and salivary gland swelling and histological hallmark of lymphocytic infiltration of exocrine glands. There are three key items for approaching towards Sjogren's Syndrome (SS) including: • Dry eyes • Dry mouth • Salivary gland swelling A. If there are at least 2 items of above in a patient he/she has to be referred to a Rheumatologist by General Practitioners (GP). B. If there is only one item of above in a patient, he/she will be referred to a Rheumatologist, when a GP i. Confirms that the finding is pathologic and ii. Rule outs its other causes in cooperation with related specialists. C. If there is not any item of above: the GP should forget about Sjogren's syndrome for the time being. The dryness of eyes is pathologic if there is at least one of below features: • Duration of at least 3 months • Gritty or sandy sensation in the eyes • Use of a tear substitute more than 3 times daily Dry mouth is pathologic if there is at least one of below features: • Duration of at least 3 months • Patient has to wake up at night to drink water because his/her mouth is too dry • Patient frequently drinks liquids to help in swallowing dry foods We have to know that salivary gland swelling is always pathologic and chronic or recurrent bilateral parotid glands enlargement is the compatible state with Sjogren's syndrome when its other etiologies can be ruled out.