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Primary Sjögren’s syndrome manifesting as sclerotic metabolic bone disease
  1. Hiya Boro1,
  2. Alpesh Goyal1,
  3. Shailendra Singh Naik2 and
  4. Nikhil Tandon1
  1. 1Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, Delhi, India
  2. 2Radiodiagnosis, Institute Rotary Cancer Hospital, New Delhi, Delhi, India
  1. Correspondence to Dr Alpesh Goyal; alpeshgoyal89{at}


Primary Sjögren’s syndrome (pSS) is a chronic slowly progressive autoimmune disease characterised by lymphocytic infiltration of salivary and lacrimal glands with varying degree of systemic involvement. Renal involvement, a recognised extraglandular manifestation of pSS, is commonly related to tubular dysfunction and generally manifests as distal renal tubular acidosis (RTA), proximal RTA, tubular proteinuria and nephrogenic diabetes insipidus. Untreated long-standing RTA is known to cause metabolic bone disease. Here, we present the report of a patient with sclerotic metabolic bone disease related to pSS with combined distal and proximal RTA and negative workup for other causes of sclerotic bone disease. A significant clinical and biochemical improvement, including recovery of proximal tubular dysfunction, was noted with alkali therapy. This case suggests the need to consider pSS in the diagnostic algorithm of a patient presenting with sclerotic bone disease.

  • sjogren's syndrome
  • calcium and bone

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  • Contributors HB, AG and NT evaluated and managed the patient. SSN analysed the radiological images. HB, AG and SSN reviewed the literature. The initial drafts were edited by NT. All authors approved the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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