Originally Posted by en bloc

David,

As some others have already said in reply to your latest post, YES, dryness of eyes/mouth can occur with peripheral neuropathy. But your description would be a severe case. Sure, it can cause these symptoms and many with PN have eye/mouth dryness, but I have not heard of it being this severe with cracking tongue or peeling lips along with dryness so bad that it effects your ability to swallow....unnless of course, your PN is likewise at severe levels or end stage. The type of symptoms you describe are really more common with Sjogren's. Do you have joint pain or profound fatigue...both of these are also common with Sjogren's??

The rheumatologist you saw may be famous, but just as in any condition, there are varying views among physicians on the particulars involved in Dx. Being that up to 40% with Sjogren's have negative labs (called sero-negative), the lip biopsy does end up being the 'gold standard' and provide enough evidence for a proper Dx...as it confirms the presence of autoantibodies in the salivary glands along with visually seeing the inflammation and fibrosis it causes. The lip biopsy looks for actual lymphocytes, histiocytes and plasma cells present in the minor salivary glands...which otherwise should NOT be there. If there is more than one focus (an aggregate of 50 or more of the lymphocytes, etc), then there is NO denying the Sjogren's....no matter what your labs show or doctor says.

But let me also say that the most common cause of dry mouth/eyes is NOT Sjogren's or even PN...it's medication! Seriously, so many medications we take can have this side-effect. SO first, go through each and every medication, OTC supplement you take and see if your symptoms can be explained by something you take. Then, it is not unreasonable to discuss this with your neuro for his/her opinion on the PN causing this level of dryness in your particular case. I would at least ask for his/her thoughts on doing the lip biopsy to rule out the Sjogren's completely (if it shows NO fibrosis or foci present). It also doesn't hurt to talk with another rheumatologist for another opinion. There is another test for Sjogren's...a new one called Sjo by a company called Immco. There are also Schimmer's test for dry eyes, spit tests, ultrasound, but they are not as popular for Dx on their own...without some other test or lab confirming Sjogren's.

Hope this helps.