Robert Fox, MD

Disclosures

August 16, 2000

Question

In Sjögren's syndrome, is there any enlargement of the lingual papillae? A 65-year-old woman has osteoporosis, severe xerostomy from Sjögren's syndrome, and dysphagia caused by enlargement of the papillae of the distal portion of the tongue. Corticosteroids were suggested but would not be appropriate, given the presence of osteoporosis.

Response from Robert Fox, MD

Enlargement of the papillae on the distal tongue would be a very unusual manifestation of Sjögren's syndrome. I would be concerned that another process may be present. Enlargement of the tongue may reflect amyloid or another infiltrative process. Difficulty in swallowing may result from mechanical factors (eg, decreased deglutition) due to an associated process such as a myositis or scleroderma (although scleroderma involvement usually occurs in the distal esophagus).

Also, strokes that involve gag reflex must be considered. Thus, the patient should have barium swallowing studies and perhaps computed axial tomographic imaging to determine the presence of amyloid or other infiltrative diseases. If the lingulae are enlarged, an oral pathologist may consider a biopsy to rule out a carcinomatous process; this abnormality cannot be explained simply by Sjögren's syndrome.

Patients with Sjögren's syndrome with difficulty swallowing due to dryness may benefit from simple oral saliva substitutes (such as Mouthkote) before meals. Patients with dentures have particular problems with solid foods, and the process may be exacerbated by low-grade oral yeast infections that cause pain.

In terms of osteoporosis, I would not be inclined to empirically use steroids in the absence of more information about the cause of the enlargement of lingular tonsils.

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