{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T21:33:36Z","timestamp":1781904816092,"version":"3.54.5"},"reference-count":12,"publisher":"BMJ","issue":"6","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2020,4,30]]},"published-print":{"date-parts":[[2020,6]]},"abstract":"<jats:p>Sjogren\u2019s syndrome (SS) is a chronic, autoimmune, inflammatory disorder affecting primarily the salivary and lacrimal glands with potential for systemic involvement. The disease predominantly occurs in women in the age group of 35\u201345 years and is relatively rare in children. It mainly affects salivary and lacrimal glands with potential for systemic involvement. Children presenting with the severe metabolic bone disease at the very outset has not been reported in the paediatric literature. We report a 13-year-old girl who presented with pain in multiple large joints with predominant involvement of hip joints leading to difficulty in walking for the past 6 months and unintentional weight loss of the same duration. Investigations revealed distal renal tubular acidosis with severe metabolic bone disease as an extra-glandular manifestation of primary SS.<\/jats:p>","DOI":"10.1136\/bcr-2020-234929","type":"journal-article","created":{"date-parts":[[2020,6,2]],"date-time":"2020-06-02T05:59:32Z","timestamp":1591077572000},"page":"e234929","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Primary Sjogren\u2019s syndrome manifesting with distal renal tubular acidosis and severe metabolic bone disease"],"prefix":"10.1136","volume":"13","author":[{"given":"Gitanjali","family":"Jain","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Army Hospital Research and Referral, New Delhi, Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2558-0518","authenticated-orcid":false,"given":"Suprita","family":"Kalra","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Army Hospital Research and Referral, New Delhi, Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gautam","family":"Vasnik","sequence":"additional","affiliation":[{"name":"Department of Pathology, Army Hospital Research and Referral, New Delhi, Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sumit","family":"Bhandari","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Army Hospital Research and Referral, New Delhi, Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,6,1]]},"reference":[{"key":"2025082711535869000_13.6.e234929.1","doi-asserted-by":"publisher","DOI":"10.1177\/0009922807301945"},{"key":"2025082711535869000_13.6.e234929.2","doi-asserted-by":"crossref","first-page":"2225","DOI":"10.1007\/s10067-017-3745-z","article-title":"A systematic review of primary Sj\u00f6gren's syndrome in male and paediatric populations","volume":"36","author":"Virdee","year":"2017","journal-title":"Clin Rheumatol"},{"key":"2025082711535869000_13.6.e234929.3","first-page":"381","article-title":"Primary Sj\u00f6gren's syndrome in children and adolescents: proposal for diagnostic criteria","volume":"17","author":"Bart\u016fnkov\u00e1","year":"1999","journal-title":"Clin Exp Rheumatol"},{"key":"2025082711535869000_13.6.e234929.4","doi-asserted-by":"publisher","DOI":"10.1007\/s10067-005-0059-3"},{"key":"2025082711535869000_13.6.e234929.5","doi-asserted-by":"publisher","DOI":"10.1111\/j.1523-1755.2004.00801.x"},{"key":"2025082711535869000_13.6.e234929.6","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/keu401"},{"key":"2025082711535869000_13.6.e234929.7","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kei110"},{"key":"2025082711535869000_13.6.e234929.8","doi-asserted-by":"publisher","DOI":"10.1136\/bcr-2013-201052"},{"key":"2025082711535869000_13.6.e234929.9","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1007\/s13730-012-0027-0","article-title":"Osteomalacia secondary to renal tubular acidosis due to Sj\u00f6gren's syndrome: a case report and review of the literature","volume":"1","author":"Nagae","year":"2012","journal-title":"CEN Case Rep"},{"key":"2025082711535869000_13.6.e234929.10","doi-asserted-by":"publisher","DOI":"10.1007\/s00296-006-0257-6"},{"key":"2025082711535869000_13.6.e234929.11","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.164.8.905"},{"key":"2025082711535869000_13.6.e234929.12","first-page":"354","article-title":"The diagnosis and treatment of Sj\u00f6gren's syndrome","volume":"114","author":"Stefanski","year":"2017","journal-title":"Dtsch Arztebl Int"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2020-234929","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T18:54:10Z","timestamp":1756320850000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2020-234929"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,6]]},"references-count":12,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2020,6,1]]},"published-print":{"date-parts":[[2020,6]]}},"alternative-id":["10.1136\/bcr-2020-234929"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2020-234929","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,6]]}}}