SJOGRENS SYNDROME



Sjogrens syndrome, is another systemic auto immune disorder that often accompanies Rheumatoid Arthritis.

Primary Sjogrens is when a patient presents with no other immune disorder. When accompanied by Rheumatoid Arthritis, Lupus or other connective tissue diseases it is referred to as Secondary Sjogrens, often referred to as Sicca Syndrome.

The most common symptoms of Sjogrens syndrome are dry eyes and mouth due to inflammation in glands of the body that are responsible for producing tears and saliva.

Recognized as one of the most prevalent of all auto immune disorders, affecting all ethnic groups equally, with approximately 90% of the people suffering from Sjogren’s syndrome being female; this immune challenge can present to some as mild discomfort, while for others symptoms may appear that greatly impair their functioning. These symptoms could include:
- Dry eyes, corneal ulcerations and infections

- Dry nose, nose bleeds, recurrent sinitus

- Dry mouth, dental decay, mouth sores, difficulty with chewing, speech and taste

- Difficulty swallowing, heartburn

- Lung disease, pneumonia, recurring bronchitis

- Muscle pain, arthritis

- Stomach upset, gastroparesis, auto immune pancreatitis

- Abnormal Liver function tests, chronic active auto immune hepatitis, primary bilary cirrhosis

- Dry skin, vasculitis, Raynaud’s phenomenon

- Vaginal dryness, painful intercourse

- Peripheral neuropathy, tingling and numbness in the extremities.

How is Sjogren’s Syndrome Diagnosed

Sjogrens Syndrome is not easily diagnosed due to the complexity of the disease and the diversity of symptoms. Many of the symptoms of Sjogrens can mimic other auto immune diseases like Rheumatoid Arthritis, Lupus, Fibromyalgia or Multiple Sclerosis.

A dentist might be the first to suspect Sjogren’s due to a change in the health of ones teeth.

When Sjogrens Syndrome is suspected you may be sent to a series of specialists for testing.

A Rheumatologist is generally the primary physician regarding Sjogrens Syndrome but other specialists like dentists, ear nose and throat physicians and ophthalmologists contribute towards the overall management of this disease.

Blood tests may include:

ANA (Anti-Nuclear Antibody) About 70% of patients will have elevated antibodies.

RF (Rheumatoid Factor) 60 – 70% of patients test positive for the Rheumatoid Factor.

SS-A and SS-B, antibodies to SS-A or SS-B are now specified as a criterion for the diagnosis of Sjogren’s Syndrome. Approximately 70% of patients test positive for SS-A anibodies while approximately 40% test positive for the SS-B antibodies.

ESR (Erythrocyte Sedimentation Rate) Measurement of inflammation in the body.

IGs (Immunoglobulins) normal blood proteins that are sometimes elevated with Sjogren’s.



The Ophthamologist

The Ophthamologist will take your history on how your eyes feel, if they are dry and gritty you will be asked how long they have felt this way.

The tests that may follow might include:

Schirmer Test – Estimates the flow of your tears. This is a very simple test where thin strips of filter paper are placed on your lower lid. You are then asked so sit with your eyes closed for 5 minutes. The amount of tears secreted onto these strips is then tested with any amount below 5mm being considered dry eye.

Dyes may be used to test for abnormal cells on the surface of the eye. The staining tests help to learn how many dry spots are on the surface of the eye.

Eye, Ears and Nose Specialist

You may be sent for tests assessing the presence of Dry Mouth, for this you go through a series of Salivary Gland tests.

Parotid Gland Flow, measures the amount of saliva produced over a certain period of time.

Salivary Scintigraphy, measures the salivary gland function.

Sialography, xray of the salivary glands

Lip Biopsy, provides tissue that will help confirm the diagnosis of Sjogrens Syndrome.

TREATMENT

There is no cure for Sjogrens Syndrome so the treatment plan is designed to address the symptoms that are present and towards prevention of complications such as infections.

Dry eyes can be helped with the use of artificial tears. One can use eye lubricant ointments during the night to help prevent the “sticking” together of the eye lids.

Medicated eye drops can be used to reduce inflammation of the tear glands.

Always consult a physician if there are signs of infection, excessive redness, pain or signs of pus.

Dry mouth will require extra attention paid to dental care, as this can lead to rapidly declining health of teeth and gums.Humidifying the air and drinking plenty of fluids throughout the day to help, as well sucking on glycerin swabs or sugarless candy to help stimulate the glands to produce saliva.

Prescription medications for gland stimulation including pilocarpine (Salagen) and ceyimeline (Evoxac) are sometimes advised for patients who do not suffer from certain heart disease, asthma or glaucoma.

Over the counter products for dry mouth include toothpastes, gum and mouthwash.

Saline nasal sprays can be helpful in reducing the dry nasal passage.
Hydroxychloroquine (Plaquenil) may be prescribed to address fatique and muscle or joint pain.
Other medications that may be suggested could include Cordisone (prednisone), Azathioprine (Imuran) or cyclophosphamide (Cytoxan), this are immune suppression medications used for more serious symptoms like vasculitis.

What you can do to minimize this disease

Our bodies are like a very sophisticated machine, by paying special attention to the “pillars of health” listed on this website amazing things can happen. Immune disorders can often be managed without the pain and suffering, and most importantly further complications may be avoided.

All immune disorders have one thing in common, there is no cure, the goal of treatment is to MANAGE THE DISEASE, rather than heal the body.

I encourage you to do all you can towards learning how to heal your body. It takes determination and effort but the rewards are worth the effort.


Return from Sjogrens Syndrome to Living With Rheumatoid Arthritis Home Page




This information is not designed as or intended to be used as medical diagnosis or advice. Patients should consult their physicians about diagnosis and treatment.





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