WHAT IS SJÖGREN'S SYNDROME?
Sjögren's syndrome is a chronic disorder that causes damage to the salivary glands, resulting in dry mouth, and the tear glands, resulting in dry eyes. It can also affect other parts of the body including joints, muscles and nerves, and organs such as the lungs, and kidneys or glands such as the thyroid gland). Primary Sjögren's syndrome is the term we use when the condition is not associated with another connective tissue disease. We use the term 'secondary' Sjögren's syndrome when it occurs in people who have another connective tissue disease such as lupus (pronounced loo-pus), scleroderma or rheumatoid arthritis
The disease is named after the Swedish eye doctor, Henrik Sjögren, who first described it in 1933. He had been treating a group of women who had chronic arthritis accompanied by dry eyes and mouth.
HOW COMMON IS SJÖGREN'S SYNDROME?
Accurate numbers are difficult to come by, but the general consensus is that either primary or secondary sjogren's syndrome is seen in about 1% of the general population.
Sjögren's syndrome can be found in people of all ages and races. However, 90% of those diagnosed with Sjögren's syndrome are women. Usually it occurs after age 45, which generally coincides with the end of the childbearing years for most women. However, the disease is seen in children and in young adults.
About half the people diagnosed with Sjögren's syndrome also have other rheumatic conditions or connective tissue diseases such as rheumatoid arthritis, lupus or scleroderma.
WHAT ARE THE WARNING SIGNS OF SJÖGREN'S SYNDROME?
The symptoms of Sjögren's syndrome vary from person to person. The most common early symptoms are dry mouth and eyes. For people who have rheumatoid arthritis or another connective tissue disease, the onset of dry eyes and mouth may develop slowly.
If you have Sjögren's syndrome the reduced amount of saliva in your mouth may make it difficult for you to chew and swallow dry food, such as a soda cracker. Your eyes may feel gritty or sandy. Please note however that having these symptoms does not automatically mean that you have Sjögren's syndrome. Dryness of the eyes and mouth can be a result of other conditions such as hormonal disorders, the use of certain medications, anxiety (dry mouth) or aging.
Other problems tha can occurr with Sjögren's syndrome could include swollen salivary glands This occurs most commonly along the jaw line. It can be painless, or painfull. It can come and go, or remain constant. It can occur on one side or both.Sjögren's can cause increased cavities in the teeth because the mouth will produce less saliva to wash away germs.. Dental problems can accelerate.
Sjögren's syndrome can also cause fatigue, joint pain (most often the smaller joints and usually symmetrical - this means affecting the same spot on both sides of the body) and problems in other parts of the body such as the blood vessels (red spots on the skin of the lower legs), nervous system (numb toes), and other organs.
WHAT CAUSES SJÖGREN'S SYNDROME?
Sjögren's syndrome is an autoimmune disease. It appears that it begins when the immune system (which normally protects the body from germs, viruses, and bacteria) malfunctions. The immune system generates white blood cells (lymphocytes - pronounced lim-fo-sites) that attack the moisture-producing glands of the body and other tissues. No one knows for sure what triggers the immune system to do this, though researchers suspect that several factors may be involved, including: viral infections, changes in hormonal levels and stress. There may also be a genetic factor as some people with Sjögren's syndrome have other family members with related connective tissue diseases, such as Lupus.
HOW DO YOU DIAGNOSE SJOGREN'S SYNDROME?
Sjogren's Syndrome is diagnosed by a physician according to whether the patient meets certain criteria (most commonly today we use the "American-European consensus Criteria"). Aside from recording the complaints of dry eye, dry mouth and possible swelling (like mumps….see above) the physician may document that there is diminished tear and/or saliva production with certain predesignated tests. He may also demonstrate that the patient has certain abnormal antibodies in the blood work and/or has specific abnormalities on a biopsy of a "minor salivary gland"(tissue harvested from a small incision made under local anaesthetic in the mouth behind the lower lip).
A 'Schirmer test' can determine the amount of tears being produced by your tear glands. This test involves putting a small strip of filter paper under the lower eyelid. A rose bengal test is often performed. This is a dye that temporarily stains the surface of the eye red if it is dry.
WHAT CAN YOU DO ABOUT SJÖGREN'S SYNDROME?
At this time there is no cure for Sjögren's syndrome. Therefore treatment is designed to control the symptoms and prevent the damage to the teeth or the surface of the eye.. Establishing the correct diagnosis is important because something can be done to manage most forms of arthritis and most therapies work best when started early in the disease.
As there is no cure for Sjögren's syndrome, treatment is aimed at preventing damage to the eyes with artificial tears and other measures. The dry mouth is often best managed by stimulatingsaliva with sugar-free candy or sipping very small amounts of water, Usually, treatment plan will be based on your individual needs. Your active involvement in developing your prescribed treatment plan is essential.
DMARDs target the processes causing the inflammation, but do not reverse permanent damage. In primary Sjogren's Syndrome, hydroxychloroquine is an 'anti-malarial' drug that may ease some systemic features such as mild joint inflammation, blood vessel inflammation in the skin, or profound fatigue. There are some early trials of a new man-made "biologic" that targets the immune cells involved in Sjogren's Syndrome. The drug is called rituximab, and is given only under very specific circumstances to patients who are systemically unwell. Some patients with Sjogren's Syndrome get kidney inflammation with impaired removal of acid from the blood. These patients need to be given sodium bicarbonate and sometimes treated with immune suppressants.
You may find general information in Arthritis Medications: A Consumer's Guide [PDF] even if your disease is not specifically addressed.
Body and Skin Care
If you have a dry mouth as a result of Sjögren's syndrome, ask your doctor or pharmacist about saliva substitutes or mouth coating products. Also consult your pharmacist about medications that can cause dryness, such as antihistamines and antidepressants.
Be sure to see your dentist regularly as the lack of saliva in your mouth can cause an increase in cavities in your teeth.
If you have dry eyes, talk to your doctor or ophthalmologist about artificial tear preparations or lubricating ointments for overnight or long-lasting relief. If your eyes are severely dry your ophthalmologist can perform a simple operation that blocks tear drainage from the eye. This allows tears that are produced to accumulate and moisten the eyes. Moisture chamber eyeglasses, which preserve existing tears and protect the eyes from wind and draft, can also be useful.
If you have a dry nose, ask your doctor or pharmacist about the different types of nasal preparations available that you can use to keep the area moist.
If you are a woman with Sjögren's syndrome and are experiencing vaginal dryness you should talk to your doctor or pharmacist about specially designed lubricants you can use.
- Muscles and the other tissues that hold joints together weaken when they aren't moved enough, so the joint loses its shape and function. Doing certain exercises can help keep your muscles strong and joints moving.
There are different types of exercises:
- Range of motion exercises reduce stiffness and help keep your joints moving. A range of motion exercise for your shoulder would be to move your arm in a large circle.
- Strengthening exercises maintain or increase muscle strength.
- Endurance exercises strengthen your heart, give you energy and keep your body flexible. These exercises include walking, swimming and cycling.
- Moderate stretching exercises help relieve the pain and keep the muscles and tendons around an affected joint flexible and strong.
Always consult your doctor before beginning an exercise program.
Protect Your Body and Joints
Protecting your joints means using them in ways that avoid excess stress. Benefits include less pain and greater ease in doing tasks. The main technique to protect your joints is pacing, by alternating increased activity with easier tasks or breaks, reduces the stress and minimizes fatigue.