This month’s focus on our eLearning platform is Sjögren’s syndrome. We speak to our former President, Dr Elizabeth Price, a consultant rheumatologist at Great Western Hospital NHS Foundation Trust. Dr Price runs a specialist Sjögren’s clinic and has a wealth of experience in this area. She tells us what we all need to consider when treating patients.
When did you develop an interest in Sjögren’s?
I trained at Charing Cross under Prof Patrick Venables, who ran the Sjögren’s clinic. I learnt so much about the condition and spent two years there conducting research into Sjögren’s. It’s an area that’s growing and changing.
There used to be an assumption that you can’t do much about it but working with Prof Venables showed me you can make a real difference.
Tell us about running a Sjögren’s clinic
I run a dedicated Sjogren’s clinic, seeing a combination of new and follow-up patients, and offer a lip biopsy service to diagnose those who are Ro negative. I give them a 30-minute appointment because many of them will have come a long way to see me and it’s so important to spend that time with them.
I tend to often have someone with me when I’m in clinic, usually students or trainees. I actually had my secretary with me today because she was keen to get more knowledge about what the clinic involves. I also teach registrars how to do lip biopsies and encourage them to learn about the condition.
Once a month I work with an ophthalmologist, Mr Guy Smith, who has a special interest in the cornea. As well as the usual tests he does serum osmolality which is helpful to monitor levels of dryness and response to treatment. The difference between a Sjögren’s dry eye and an age-related dry eye is the level of inflammation which is much higher in the Sjogren’s patients. This is why patients benefit so much from proactive treatment and the knowledge and experience of an ophthalmologist.
Do you have a message to members about Sjögren’s?
It’s important to do the little things well. If you’re looking after Sjögren’s patients and you want to make them better, you need to learn to use eye drops, how to talk to them about vaginal dryness, and explain how to clean their teeth properly. As rheumatologists, we can get swept up in using second-line drugs, but most of the time in clinic I’m talking to patients about the small differences and incremental gains that will improve their quality of life.
The drugs we use, like hydroxychloroquine, take the edge off the joint pain and help skin rashes. But in terms of fatigue, studies show that the things that make a difference are mindfulness and exercise, so you must think holistically.
Can you tell us about the update to the Sjögren’s guidelines?
We published the original guidelines in 2017 and now we are working on an update. We’ve expanded the scope to include children and young people. Also, our understanding has moved on in terms of the underlying disease mechanisms which helps us predict what drugs might help and there are also new treatments and products available.
Although there are American and European guidelines for Sjögren’s, the UK version takes into account the treatments we have access to here and will be a pragmatic guide that a non-specialist rheumatologist can pick up and use.
Many thanks to Dr Price for sharing her Sjögren’s expertise.
Improve your knowledge on the condition by visiting our eLearning platform: this month's spotlight on Sjögren’s features practical talks from Dr Price, a case-based podcast with Dr Frances Hall, a paediatric and adolescent Sjögren’s podcast with Dr Matt Bassiaga and interesting journal articles to review.