1/ I presented the following multiple choice question to about 20 rheumatologists and only one got it right. Why not see how you do & then read on for the answer & a brief thread on #dryeye in #Sjogrens? A 30 yo woman w/ Sjögren's disease, T2DM, CKD3b, NAFLD presents for an outpatient visit. Her main concern is eye dryness despite liberal use of preservative free artificial tears, erythromycin ointment nightly, cyclosporin eye drops 2x/d, and oral cevimeline 30 mg 4x/day. She did not tolerate lifitegrast eye drops. Insurance will not cover the cost of serum eye drops nor scleral lenses. She has discontinued all medications known to cause dryness and uses a humidifier at home. Her friends with Sjogren’s have recommended intra-nasal varenicline and she is interested in trying it. Which of the following is true for intra-nasal varenicline? a) It activates muscarinic receptors b) There are no contraindications to its use c) Dose should be adjusted for kidney impairment d) Dose should be adjusted for liver impairment e) Pregnancy risk is category D

Join me as I read through "Sjögren's Syndrome: A Clinical Handbook" (edited by Dr. Frederick Vivino) & share what I find interesting in a Q&A format. I am creating this question bank to help train our students, residents, fellows about #Sjogrens. #MedEd #Rheumatology

Join me as I read through "Sjögren's Syndrome: A Clinical Handbook" (edited by Dr. Frederick Vivino) & share what I find interesting in a Q&A format #Sjogren #Sjogrens #MedEd #Rheumatology

@NeuroSjogrens I hear you, @NeuroSjogrens. I try my best to educate as many rheumatologists, internists, fellows, residents, students, patients, family members, and just about anyone else who will listen that Sjogren's is so much more than the just-dry stereotype.

@Janetbirdope @jeffsparks @ORAexec #ILD in #Sjogrens Other significant risk factors: 💧Male sex (OR 1.9) He, et al. PMID 32588976 💧Lip biopsy focus score > 4 (OR 3.95) Kakugawa, et al. PMID 29605220

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@lupuscyclopedia Fantastic find, Don. Much appreciated!

4/ So the answer to the multiple choice question is... b) There are no contraindications to its use. Intra-nasal varenicline is a safe (albeit expensive & "sneezy") option for dry eye. The vast majority of patients in the ONSET-2 trial were able to take it twice a day for the full 4 weeks. I have found that most get acclimated to the medication & the sneezing resolves or at least becomes tolerable. It has been a welcome option for many of my patients. The main question is... will insurance cover it? Thanks for reading! If you learned something, please go to the first post in the thread & retweet! (please note: I have no financial incentive to post this.) #rheumatology #Sjogrens #Sjogren #dryeye

Join me as I read through "Sjögren's Syndrome: A Clinical Handbook" (edited by Dr. Frederick Vivino) & share what I find interesting in a Q&A format. Please like and retweet to help spread Sjogren's education :) 3/3 #Sjögrens #Sjögren

Join me as I read through "Sjögren's Syndrome: A Clinical Handbook" (edited by Dr. Frederick Vivino) & share what I find interesting in a Q&A format Please like and retweet to help spread Sjogren's education :) 3/3 #Sjögrens #Sjögren #Medicalhistory