What are the key clinical features to consider when diagnosing Sjögren's Syndrome in a primary care setting?

Key clinical features to consider when diagnosing Sjögren's Syndrome in primary care include:

• Ocular dryness (keratoconjunctivitis sicca): Patients typically report persistent dry eyes, gritty or burning sensation, and may have signs of dry eye disease on examination such as reduced tear production or conjunctival redness NICE CKS.
• Oral dryness (xerostomia): Dry mouth symptoms including difficulty swallowing dry foods, increased dental caries, and recurrent oral infections are common presenting features NICE CKS.
• Systemic symptoms: Fatigue and arthralgia are frequent and may precede glandular symptoms, reflecting systemic autoimmune involvement Seror et al. 2012.
• Salivary gland enlargement: Parotid gland swelling or tenderness may be observed, although less common in early disease NICE CKS.
• Exclusion of other causes: It is important to exclude other causes of sicca symptoms such as medication side effects, sarcoidosis, or rheumatoid arthritis, which may present similarly NICE CKS,NICE NG100.
• Additional clinical clues: Recurrent dental caries, oral candidiasis, and signs of systemic autoimmune disease (e.g., arthropathy) support the diagnosis Seror et al. 2014.

In summary, primary care diagnosis relies on recognizing the hallmark sicca symptoms of dry eyes and dry mouth, supported by systemic features and careful exclusion of mimics. Early identification facilitates timely referral for specialist assessment and management NICE CKS Seror et al. 2012Seror et al. 2014.