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51: SJÖGREN SYNDROME

Debra F. Stern, DPT, DBA, MSM, PT; Eric Shamus, PhD, DPT, PT, CSCS

CONDITION/DISORDER SYNONYMS

  • Primary Sjögren’s (dry eyes and mouths only)

  • Secondary Sjögren’s (associated with other immune disorders)

ICD-9-CM CODES

  • 710.2 Sicca syndrome

  • PT diagnoses/treatment diagnoses that may be associated with immune disorders affecting movement

    • 315.4 Developmental coordination disorder

    • 718.03 Articular cartilage disorder, forearm

    • 718.04 Articular cartilage disorder, hand

    • 718.07 Articular cartilage disorder, ankle and foot

    • 718.45 Contracture of joint, pelvic region and thigh

    • 719.39 Palindromic rheumatism involving multiple sites

    • 719.4 Pain in joint

    • 728.2 Muscular wasting and disuse atrophy, not elsewhere classified

    • 728.89 Other disorders of muscle, ligament, and fascia

    • 729.1 Myalgia and myositis, unspecified

    • 729.9 Other and unspecified disorders of soft tissue

    • 729.9 Other disorders of soft tissue

    • 736.9 Acquired deformity of limb site unspecified

    • 780.7 Malaise and fatigue

    • 781.2 Abnormality of gait

    • 782.3 Edema

    • 786.0 Dyspnea and respiratory abnormalities

    • 786.05 Shortness of breath

ICD-10-CM CODES

  • M35.00 Sicca syndrome, unspecified

  • M35.01 Sicca syndrome with keratoconjunctivitis

FIGURE 51-1

Sites of blood pressure control and actions of the major classes of antihypertensive drugs. (From Panus PC, Katzung B, Jobst E, Tinsley S, Masters S, Trevor A. Pharmacology for the Physical Therapist. New York, NY: McGraw-Hill; 2009.)

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FIGURE 51-2

Treatment algorithm for Sjögren syndrome. (From Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J, eds. Harrison’s Principles of Internal Medicine. 18th ed. New York, NY: McGraw-Hill; 2012.)

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PREFERRED PRACTICE PATTERNS1

  • 4D: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Connective Tissues Dysfunction

  • 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Localized Inflammation

  • 7B: Impaired Integumentary Integrity Associated with Superficial Skin Involvement

PATIENT PRESENTATION

A 40-year-old female is referred to PT with onset of pain in both hands and wrists. Her pain started 2 weeks before when she was preparing food for a large house party and doing a lot of “chopping and slicing” with a large chef’s knife. Her family history includes a mother with rheumatoid arthritis (RA) and father with OA. She describes “self diagnosed” wrist tendinitis in the past for which she used wrist splints for short periods of time and took NSAIDs until the pain resolved. The tendinitis was episodic and often followed the hours at the computer (she is a full-time receptionist). She recently had pink eye that has resolved with medication. She also related that she complained to her dentist several years ago that her mouth was always dry and he recommended hard, sugar free sucking candies as well as staying well hydrated. X-rays of her hands taken 1 week prior were negative. At this time she is taking NSAIDs, but they are not helping so her physician referred her ...

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