Sjögren’s Syndrome
Sjögren’s syndrome is a lifelong autoimmune disorder that reduces the amount of moisture produced by glands in the eyes and mouth. It is named for Henrik Sjögren, a Swedish eye doctor who first described the condition.
Types –
There are two types of Sjögren’s syndrome:
• Primary Sjögren’s syndrome develops on its own, not because of any other health condition.
• Secondary Sjögren’s syndrome develops in addition to other autoimmune diseases like rheumatoid arthritis, lupus and psoriatic arthritis.
Symptoms –
The two main symptoms of Sjogren’s syndrome are –
• Dry eyes. Your eyes might burn, itch or feel gritty — as if there’s sand in them.
• Dry mouth. Your mouth might feel like it’s full of cotton, making it difficult to swallow or speak.
Along with extremely dry eyes and mouth, some people experience muscle pain and joint pain all over the body, similar to fibromyalgia. Other symptoms include –
• Abnormal sense of taste.
• Burning or redness in eyes, or grittiness (like sand).
• Blurry vision.
• Difficulty chewing, swallowing or talking.
• Dry cough or hoarseness.
• Dry, itchy skin.
• Enlarged salivary glands.
• Fatigue.
• Tooth decay or early tooth loss.
• Vaginal dryness.
Causes –
The causes of Sjogren’s remain largely unknown.
Studies have indicated that a viral or bacterial infection may trigger the disease, but that the underlying cause is primarily genetic and environmental. The nervous system and the endocrine, or hormone-producing, system have also been implicated in the onset of Sjogren’s.
An environmental factor may change the immune system and cause immune problems later on, such as infection with hepatitis C or the Epstein-Barr virus.
It’s also thought that the female hormone oestrogen could be linked to Sjögren’s syndrome, as more women get the condition than men.
Risk factors –
Sjogren’s syndrome typically occurs in people with one or more known risk factors, including –
• Age. Sjogren’s syndrome is usually diagnosed in people older than 40.
• Sex. Women are much more likely to have Sjogren’s syndrome.
• Rheumatic disease. It’s common for people who have Sjogren’s syndrome to also have a rheumatic disease — such as rheumatoid arthritis or lupus.
Diagnosis –
If you have dry mouth, dry eyes or other signs of Sjögren’s syndrome, your doctor may use these methods to confirm a diagnosis –
• Blood tests: These tests detect specific antibodies in the blood. They look for anti-nuclear antibodies (ANA), anti-Sjögren’s syndrome antibodies (anti-SSA, also called anti-Ro) and anti-Sjögren’s syndrome type B (anti-SSB, also called anti-La). A blood test can also detect rheumatoid factor, an antibody found in many people who have rheumatoid arthritis.
• Biopsy: Your doctor may remove tissue or cells from a salivary gland or the inside of your lip. This biopsy sample goes to a lab to check for signs of inflammation.
• Eye exam: An eye specialist, such as an ophthalmologist, can measure tear production. During an eye exam, your doctor will examine the cornea, the clear part of the eye, for dryness.
• Imaging tests: These include sialometry, which measures how much saliva you produce by using X-rays that can see dye injected into salivary glands. There is also salivary scintigraphy, a way to track how long it takes for a radioactive isotope to travel from an injection point in your vein to your salivary glands.
• Health history: If you have a pre-existing autoimmune disease, plus dry eyes and dry mouth, your doctor may conclude that you have developed secondary Sjögren’s syndrome.
Complications –
The most common complications of Sjogren’s syndrome involve your eyes and mouth.
• Dental cavities. Because saliva helps protect the teeth from the bacteria that cause cavities, you’re more prone to developing cavities if your mouth is dry.
• Yeast infections. People with Sjogren’s syndrome are much more likely to develop oral thrush, a yeast infection in the mouth.
• Vision problems. Dry eyes can lead to light sensitivity, blurred vision and corneal damage.
Less common complications might affect –
• Lungs, kidneys or liver. Inflammation can cause pneumonia, bronchitis or other problems in your lungs; lead to problems with kidney function; and cause hepatitis or cirrhosis in your liver.
• Lymph nodes. A small percentage of people with Sjogren’s syndrome develop cancer of the lymph nodes (lymphoma).
• Nerves. You might develop numbness, tingling and burning in your hands and feet (peripheral neuropathy).
Treatment –
Treatment for Sjogren’s syndrome depends on the parts of the body affected. Many people manage the dry eye and dry mouth of Sjogren’s syndrome by using over-the-counter eyedrops and sipping water more frequently. But some people need prescription medications, or even surgical procedures.
▪︎ Medications
Depending on your symptoms, your doctor might suggest medications that –
• Decrease eye inflammation. Prescription eyedrops such as cyclosporine (Restasis) or lifitegrast (Xiidra) may be recommended by your eye doctor if you have moderate to severe dry eyes.
• Increase production of saliva. Drugs such as pilocarpine (Salagen) and cevimeline (Evoxac) can increase the production of saliva, and sometimes tears. Side effects can include sweating, abdominal pain, flushing and increased urination.
• Address specific complications. If you develop arthritis symptoms, you might benefit from nonsteroidal anti-inflammatory drugs (NSAIDs) or other arthritis medications. Yeast infections in the mouth should be treated with antifungal medications.
• Treat systemwide symptoms. Hydroxychloroquine (Plaquenil), a drug designed to treat malaria, is often helpful in treating Sjogren’s syndrome. Drugs that suppress the immune system, such as methotrexate (Trexall), also might be prescribed.
▪︎ Surgery
A minor procedure to seal the tear ducts that drain tears from your eyes (punctal occlusion) might help relieve your dry eyes. Collagen or silicone plugs are inserted into the ducts to help preserve your tears.
Self-care
Many Sjogren’s syndrome symptoms respond well to self-care measures.
▪︎ To relieve dry eyes
• Use artificial tears, an eye lubricant or both. Artificial tears — in eyedrop form — and eye lubricants — in eyedrop, gel or ointment form — help relieve the discomfort of dry eyes. You don’t have to apply eye lubricants as often as artificial tears. Because of their thicker consistency, eye lubricants can blur your vision and collect on your eyelashes, so you might want to use them only overnight.
• Increase humidity. Increasing the indoor humidity and reducing your exposure to blowing air can help keep your eyes and mouth from getting uncomfortably dry. For example, avoid sitting in front of a fan or air conditioning vent, and wear goggles or protective eyewear when you go outdoors.
▪︎ To help with dry mouth
• Don’t smoke. Smoking can irritate and dry out your mouth.
• Increase your fluid intake. Take sips of fluids, particularly water, throughout the day. Avoid drinking coffee or alcohol since they can worsen dry mouth symptoms. Also avoid acidic beverages such as colas and some sports drinks because the acid can harm the enamel of your teeth.
• Stimulate saliva flow. Sugarless gum or citrus-flavored hard candies can boost saliva flow. Because Sjogren’s syndrome increases your risk of dental cavities, limit sweets, especially between meals.
• Try artificial saliva. Saliva replacement products often work better than plain water because they contain a lubricant that helps your mouth stay moist longer. These products come as a spray or lozenge.
• Use nasal saline spray. A nasal saline spray can help moisturize and clear nasal passages so that you can breathe freely through your nose. A dry, stuffy nose can increase mouth breathing.
▪︎ Oral health
Dry mouth increases your risk of dental cavities and tooth loss. To help prevent those types of problems:
• Brush your teeth and floss after every meal
• Schedule regular dental appointments, at least every six months
• Use daily topical fluoride treatments and antimicrobial mouthwashes
▪︎ Other areas of dryness
If dry skin is a problem, avoid hot water when you bathe and shower. Pat your skin — don’t rub — with a towel, and apply moisturizer when your skin is still damp. Use rubber gloves when doing dishes or housecleaning. Vaginal moisturizers and lubricants help women who have vaginal dryness.
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