Sjögren's Syndrome

This condition was first brought out by a Swedish ophthalmologist named Henrik Sjogren in 1933. This ailment causes a lot of symptoms which includes having dry mouth and eyes. These symptoms are the result of having less secretion from bodily glands. The lungs, lymph glands, kidneys, salivary glands, and the nervous system can also be affected in severe cases. The treatment for Sjogren's syndrome is to control the symptoms.
This is an autoimmune disease where the body produces the same antibodies that attack the body's normal cells. The exact reason why this happens is still not very clear. The human body makes antibodies to protect the body from infections and kill cells of bacteria, germs and viral origin which cause infection. The autoantibodies then attack certain glands and their cells. This results in the glands having their secretions hindered or blocked.
The primary Sjogren's syndrome happens when the condition happens by itself while the secondary Sjogren's syndrome happens when it occurs alongside other autoimmune diseases like rheumatoid arthritis and systemic lupus erythematosus. Sjogren's syndrome can affect five out of ten people whi are afflicted with rheumatoid arthritis.
This condition occurs to eight out of one thousand people in UK. Sjogren's syndrome affects women about nine times more than men. The condition usually appears when the patient is fifty years old. Aside from having no cure, there appears to be no preventive measures for this condition either.

Symptoms of Sjögren's Syndrome

The two most common symptoms associated with Sjogren's disorder are the following:

  • Xeropthalmia or the drying of the eyes which may feel uncomfortable and gritty
  • Xerostomia or drying of the mouth. This condition can also lead to the following:
    • Yeast infection in the mouth or thrush
    • Dysphagia or the sensation of having something stuck in the person's throat and  swallowing problems
    • Periodontal disease and tooth decay. This is because saliva has an anti-infective agent so it protects the mouth from infection. Once the amount of saliva is reduced, infection of the mouth is more likely to occur.
    • Taste is usually lost.

The drying of the mouth, eyes and other parts of the body is also known as the sicca syndrome. Sjogren's and sicca syndrome can be a result of radiotherapy treatment or other disorders like the haemachromotosis and sarcoidosis.
Aside from the eyes and mouth, other parts like the vagina, skin and trachea can also become dry. Vaginal dryness causes discomfort during intercourse or dyspareunia while the dryness in the bronchus and trachea leads to chest infections and dry cough.
Symptoms such as the following can also occur:

  • Being tired
  • Aching muscles and joints because Sjogren's syndrome affects people who have autoimmune disorders such as rheumatoid arthritis.
  • The parotid glands begin to swell. This happens because the saliva is found on the cheek areas.
  • The salivary glands are also swollen. The glands are found below the jaw or neck area.

Complications of Sjögren's Syndrome

There are very rare instances where complications arise from Sjogren's syndrome. These would include the following:

  • Salivary glands become infected
  • Development of corneal ulcers – this is a result of dry eyes which can lead to infection and formation of ulcers in the eye surface. If this is not treated at once, it can lead to blindness.
  • Pancreatitis – or the inflammation of pancreas which causes great upper abdominal discomfort and pain.
  • Peripheral neuropathy – this is the loss of feeling in the hands, fingers, arms, feet, legs and toes.
  • Cranial neuropathy – this is the loss of feeling in the facial parts.
  • Kidney problems – this is a very rare complication. Sjogren's syndrome can cause inflammation of the kidneys, development of kidney stones, body fluid imbalance and kidney failure.
  • Pseudolymphoma – this happens in one out of ten people with Sjogren's syndrome. Pseudolymphoma is the enlargement of spleen. The spleen is the organ found in the upper abdomen which fights off infection and gets rid of dying red blood cells. Once pseudolymphoma happens, other lymph glands will also enlarge in the body.
  • Non-Hodgkin's lymphoma – one out of ten people with Sjogren's syndrome who have pseudolymphoma will also have non-Hodgkin's lymphoma. Non-Hodgkin's lymphoma is a cancer in the lymph glands. It progresses slowly and can even regress without any treatment. The first symptom for non-Hodgkin's lymphoma is that he lymph glands are swelling especially in the neck. Once a person is diagnosed with Sjogren's syndrome, he should also look out for swellings in the groin, in the neck and under the arms.
  • Parotid gland tumours – this is common with Sjogren's syndrome. If the parotid glands are starting to swell, then the patient should seek a doctor's advice immediately.

Other problems related to Sjögren's Syndrome

  • Recurrent miscarriage. Sjogren's syndrome can uncommonly cause recurrent miscarriage. Recurrent miscarriage happens when the expectant mother has three or even more miscarriage continuously.  This can be explained by the connection between the Sjogren's syndrome and antiphoshpholipid syndrome.
  • Drug reactions. Patients with Sjogren's syndrome can have side effects when they take drugs like antibiotics.
  • Raynaud's phenomena. This happens when the extremities like the toes and the fingers change color and become painful due to cold temperature.  

Diagnosis for Sjögren's Syndrome

The following can be used by doctors to assess if the patient has Sjogren's syndrome:

  • Schirmer tear test. This test measures the tears that a person can produce. A special filter paper is secured under the lower lid of the patient's eye. The filter is left for five minutes. For people with Sjogren's syndrome, the amount if tears produced is reduced.
  • Slit lamp examination. A dye is utilized to stain the eye temporarily. It allows the eye specialist to see if a reduction of the tear production has occurred or if the patient has some eye damage.
  • Salivary gland biopsy. One salivary gland can be removed for biopsy. This is a simple procedure done using local anaesthesia being injected. Dyes and staining procedures are used in the laboratory to diagnose if the Sjogren's syndrome symptoms are present in the gland.

 

  • Saliva Collection. If the volume of saliva is reduced, this is indicated of having Sjogren's syndrome.
  • Blood tests. This is done to assure that the patient with suspected Sjogren's syndrome has signs that may suggest inflammation or autoimmune disease.

 

Other tests can also be performed using the following:

  • A special scan to peek at the person's lymph and internal organs.
  • Urine test to see if there is anything wrong with kidney function.

Treatment for Sjogren's Syndrome

There is no cure known for this condition and the treatment is bases on controlling the symptoms of the disorder as good as possible.
The patient can be advised to seek many specialists like rheumatologists who have great knowledge regarding Sjogren's syndrome. The patient may also be referred to dentists, lung, eyes and kidney specialists.

Treatment for Dry Eyes

  • Avoid places where the eye infection can get worse:
    • Wind
    • Low humidity
    • Smoke and dust
    • Air conditioning
    • Prolonged reading
    • Contact lenses
    • Staring at the TV or computer.
  • Glasses. A very special type of glasses can be worn to keep the eyes from moisture and away from dryness.
  • Artificial tears. This provides lubrication for the eyes in eye drop form. Using preservative-free eye drop solutions can reduce irritation. Paraffin eye cream is long lasting and is ideal to use at night. But if paraffin is used in the daytime, it may affect and blur the vision.
  • Tear duct treatment. If using eye drops do not work, special treatment for the tear ducts may be an option. A diathermy is utilized to close the tear ducts.

Treatment for Dry Mouth

  • General measures
    • Keep teeth and gums clean as possible.
    • Brush teeth regularly and use dental floss and mouth wash
    • Visit dentist regularly
    • Drink water all day.
    • Use Vaseline for dry lips
    • Chew sugarless bubble gums
  • Artificial saliva. This comes in the form of spray, gel or liquid to keep the moisture in the mouth.
  • Saliva stimulants. Saliva production can be stimulated using pilocarpine tablets.

Treatment for Other Symptoms

  • Lubricants during sex
  • Moisturizers for dry skin and special bath solutions as well
  • Non-steroidal anti-inflammatory drugs for muscle and joint pains

Treatment for Complications

Should Sjögren's syndrome start to progress and involve organs like the kidneys, skin, lymph glands, and lungs, medication should be taken immediately:

  • Steroids. These drugs are orally taken to reduce inflammation. These drugs are prescribed especially when the case is severe.
  • Immunosuppressive agents. These drugs reduce the abnormal production of antibodies in people with Sjogren's syndrome. Drugs like penicillamine, methotrexate, and hydroxychloroquine are used. These drugs are also for the severe cases. Close observation is advised for those patients who will take in these drugs. Blood tests may also be advised while taking the mentioned drugs. Always consult the doctor before buying any medicine.

Prognosis for Sjögren's Syndrome

This condition is not life-threatening. Some patients have mild cases of dry eyes and mouth. Other will develop pain in their joints and muscles. The symptoms can also recur but it is very rare that the patients will develop more serious complications such lung and kidney problems.
One out of one hundred people who have Sjogren's syndrome will develop lymphoma and non-Hodgkin's lymphoma. This type of lymphoma can be easily treated by a doctor.

One out of one hundred people who have Sjogren's syndrome will develop autoimmune disorders like rheumatoid arthritis and polymyositis or systemic lupus erythematosus.

Important notice