Description

Sjogren's (SHOW-grins) syndrome is a disorder of the immune system identified by its two most common symptoms-dry eyes and dry mouth.

The condition often accompanies other immune system disorders, such as rheumatoid arthritis and lupus. In Sjogren's syndrome, the mucous membranes and moisture-secreting glands of the eyes and mouth are usually affected first-resulting in decreased tears and saliva.

Although you can develop Sjogren's syndrome at any age, the majority of the people are older than 40 years at the time of diagnosis. The condition is much more common in women. The treatment is focused on relieving the symptoms.

Symptoms

The two main symptoms of Sjogren's syndrome are:

  • Dryness of the eyes. Your eyes may burn, itch or feel gritty, as if there is sand in them.
  • Dry mouth. Your mouth may feel like you are full of cotton, which makes it difficult to swallow or speak.

Some people with Sjogren's syndrome also have one or more of the following:

  • Pain in the joints, swelling, and stiffness
  • The salivary glands are enlarged. — in particular, located just behind the jaw and in front of the ears
  • Skin rashes or dry skin
  • Vaginal dryness
  • Persistent dry cough
  • Prolonged fatigue

Causes

Sjogren's syndrome is an autoimmune disease. Your immune system mistakenly attacks the body's own cells and tissues.

Scientists are not certain why some people develop Sjogren's syndrome. Certain genes put people at increased risk for the disease, but it seems that a triggering mechanism — such as infection with a particular virus, or strain of bacterium — that is also necessary.

In Sjogren's syndrome, your immune system first targets the glands that produce tears and saliva. But it can also damage other parts of your body, such as:

  • Joints
  • Thyroid
  • The kidneys
  • Liver
  • The lungs
  • Skin
  • Nerves

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 years.
  • Sex. Women are much more likely to have Sjogren's syndrome.
  • Rheumatic disease. It is common for people who have Sjogren's syndrome also have a rheumatic disease such as rheumatoid arthritis or lupus.

Complications

The most common complications of Sjogren's syndrome involve the eyes and the mouth.

  • Dental caries. Because saliva helps protect teeth from cavity-causing bacteria, you are more likely to develop tooth decay if you have a dry mouth.
  • For yeast infections. People with Sjogren's syndrome are much more likely to develop oral thrush, a yeast infection in the mouth.
  • Vision problems. Dryness of the eyes can cause sensitivity to light, blurred vision and corneal damage.

Less common complications can affect:

  • The lungs, the kidneys or the liver. The inflammation can cause pneumonia, bronchitis, and other lung problems; lead to problems with kidney function; and the cause of hepatitis, or cirrhosis of the liver.
  • The lymph nodes. A small percentage of people with Sjogren's syndrome develop cancer of the lymph nodes (lymphoma).
  • Of the nerves. You may develop numbness, tingling, and burning in the hands and feet (peripheral neuropathy).

Diagnosis

Sjogren's syndrome can be difficult to diagnose because signs and symptoms vary from person to person and can be similar to those caused by other diseases. Side effects of a series of drugs that mimic some of the signs and symptoms of Sjogren's syndrome.

The tests can help rule out other conditions and help to determine a diagnosis of Sjogren's syndrome.

Blood tests

Your doctor may order blood tests to check:

  • The levels of different types of blood cells
  • The presence of antibodies common in Sjogren's syndrome
  • Evidence of inflammatory conditions
  • Indications of problems with the liver and kidneys

Eye examinations

Your doctor can measure the dryness of the eyes with a test called the Schirmer tear test. A small piece of filter paper is placed under your lower eyelid to measure the production of tears.

A doctor who specializes in the treatment of disorders of the eyes (eye doctor) could also examine the surface of your eyes with a magnifying device called a slit lamp. He or she may put drops in your eyes that make it easier to see the damage to the cornea.

Images

Certain imaging tests can check the function of the salivary glands.

  • Sialogram. This special X-ray can detect dye is injected into the salivary glands in front of the ears. This procedure shows how a lot of saliva flows into your mouth.
  • The scan salivary. This nuclear medicine test that is given by injection into a vein of a radioactive isotope, which are tracked over an hour to see how quickly it comes in all of their salivary glands.

Biopsy

Your doctor may also do a lip biopsy to detect the presence of groups of inflammatory cells, which may indicate Sjogren's syndrome. For this test, a small portion of tissue is extracted from the salivary glands in your lip and examined under a microscope.

Treatment

Treatment for Sjogren's syndrome depends on the parts of the body affected. Many people deal with dry eyes and dry mouth in Sjogren's syndrome through the use of over-the-counter drops of water and drinking water more often. But some people need prescription drugs, or even surgical procedures.

Drugs

Depending on your symptoms, your doctor may suggest medications to:

  • Decreased ocular inflammation. Prescription eye drops such as cyclosporine (Restasis) or lifitegrast (Xiidra) may be recommended by your eye doctor if you have moderate to severe dry eyes.
  • To increase the production of saliva. Drugs such as pilocarpine (Salagen) and cevimeline (Evoxac) can increase the production of saliva, and sometimes tears. Side effects may include sweating, abdominal pain, skin redness, and increased urination.
  • Address of specific complications. If you develop symptoms of arthritis, you may benefit from nonsteroidal anti-inflammatory drugs (Nsaids), or other medicines for arthritis. Fungal infections in the mouth must be treated with antifungal medications.
  • Treat the system as a whole of the symptoms. Hydroxychloroquine (Plaquenil), a drug designed for the treatment of malaria, it is often useful in the treatment of Sjogren's syndrome. Medications that suppress the immune system, such as methotrexate (Trexall), may also be prescribed.

Surgery

A minor procedure to seal the rupture of the ducts that drain tears out of your eyes (occlusion of the puncta) could help to relieve the dryness in the eyes. The collagen or silicone plugs are inserted into the ducts to help preserve your tears.

Lifestyle and home remedies

Many of the symptoms of Sjogren's syndrome respond well to self-care measures.

To relieve the dryness of the eyes:

  • The use of artificial tears, an eye, a lubricant, or both.Artificial tears — in the form of eye drops — and-eye lubricants — drop, gel or ointment form — to help relieve the discomfort of dry eyes. You do not have to apply to the eye lubricants as often as artificial tears. Because of its thicker consistency, eye lubricants can cloud your vision and you pick up in your eyelashes, so you may want to use only during the night. Your doctor may recommend artificial tears without preservatives, which can irritate the eyes of people with dry eye syndrome.
  • Increase the humidity. The increase of the moisture on the inside and the reduction of their exposure to the blowing air can help to keep the eyes and the mouth from getting too dry. For example, avoid sitting in front of a fan or air conditioning, ventilation and wear safety glasses or goggles when you are outdoors.

The use of artificial tears, an eye, a lubricant, or both. Artificial tears — in the form of eye drops — and-eye lubricants — drop, gel or ointment form — to help relieve the discomfort of dry eyes. You do not have to apply to the eye lubricants as often as artificial tears. Because of its thicker consistency, eye lubricants can cloud your vision and you pick up in your eyelashes, so you may want to use only during the night.

Your doctor may recommend artificial tears without preservatives, which can irritate the eyes of people with dry eye syndrome.

To help with the dryness of the mouth:

  • Do not smoke. Smoking can irritate and dry out the mouth.
  • Increase the intake of fluids. Take sips of fluids, especially water, throughout the day. Avoid drinking coffee or alcohol, which can worsen the symptoms of dry mouth. Also avoid acidic drinks such as colas and some sports drinks because the acid can damage the enamel of your teeth.
  • To stimulate the flow of saliva. Chewing gum without sugar or citrus-flavored hard candies can increase saliva flow. Because Sjogren's syndrome, increases the risk of dental caries, limit sweets, especially between meals.
  • Try to artificial saliva. Saliva replacement products that often work better than pure water, as they contain a lubricant that helps to keep the mouth moist for a longer time. These products come in the form of dew or tablets.
  • The use of a saline nasal spray. A saline nasal spray can help to moisturize and clean the nasal passages so you can breathe freely through your nose. Dry, nasal congestion can increase breathing through the mouth.

Oral health

Dry mouth increases the risk of dental caries and loss of teeth. To help prevent these types of problems:

  • Brushing and flossing after each meal
  • Schedule regular visits to the dentist at least every six months
  • The daily use of topical fluoride treatments and antimicrobial mouthwash

Other areas of dryness

If dry skin is a problem, avoid the hot water to the bath and shower. Pat your skin — do not wipe it with a towel and apply moisturizer when your skin is still damp. Use rubber gloves when doing dishes or cleaning the house. Vaginal moisturizers and lubricants to help women who have vaginal dryness.

Preparing for your appointment

Depending on your symptoms, you may start by seeing your family doctor, dentist, or eye doctor. But, eventually, may be referred to a doctor who specializes in the treatment of arthritis and other inflammatory conditions (rheumatologist).

What you can do

Make a list that includes:

  • Detailed descriptions of your symptoms and when they began
  • Information about your current and past medical problems
  • The information about your parents or siblings of the clinical history
  • All of the medications and supplements you are taking, including dose
  • Questions you want to ask the doctor

For the Sjogren's syndrome, basic questions include:

  • What is likely causing my symptoms?
  • There are other possible causes?
  • What tests do I need?
  • What treatment approach do you recommend?
  • How soon can I expect my symptoms improve with treatment?
  • Am I at risk of long-term complications of this condition?
  • I have other health conditions. How can I best manage them together?
  • Do you have brochures or other printed material I can have? What sites do you recommend?

What to expect from your doctor

Your doctor may ask you a series of questions, including:

  • Did your symptoms follow a pattern that gets worse during the day or when you are outdoors?
  • Do you have chronic conditions such as high blood pressure or arthritis?
  • He has recently started a new medication?
  • Make your close relatives have rheumatoid arthritis, lupus or a similar illness?
Symptoms and treatment of Sjogren's syndrome