Sjögren's Syndrome
Other names: Sicca Syndrome, Mikulicz Disease
Sjögren's is an autoimmune disease that attacks
the glands that produce tears and saliva, called the
exocrine glands. Sjögren's can be a disease on
it's own or can be a secondary condition caused by
a primary autoimmune disease such as Rheumatoid Arthritis,
Lupus, Scleroderma or other autoimmune conditions.
Women are more commonly affected by Sjögren's
then men.
Because Sjögren's attacks the exocrine glands,
the body's ability to produce tears and saliva is
reduced causing dryness of the eyes and mouth and
can also cause dryness in other areas of the body
such as the nose and skin. It can also affect internal
organs, muscles and joints. Symptoms can range from
mild dryness to more severe symptoms including severe
fatigue, malaise, joint pain and muscle weakness.
Symptoms:
Burning in mouth
Difficulty chewing
Difficulty swallowing
Dry eyes
Extremely thirsty
Eyes sensitive to light
Frequent bladder infections
Frequent cold sores
Ghost image or flash of light when moving eyes
Gritty feeling in eyes
Joint pain with swelling and redness
Morning stiffness
Nausea
Pain when moving eyes
Swollen paratoid glands
Swollen salivary glands
Abdominal cramps
Abdominal pain
Abdominal tenderness
Chronic yeast infections
Dry cough
Dry mouth
General body pain
General joint pain and stiffness
Pain in mouth
Vaginal dryness
Diagnosis:
Diagnosing Sjögren's can be very difficult for
physicians. Symptoms vary widely and also very widely
from patient to patient. If Sjögren's is a secondary
condition, very often the primary disease can mask
Sjögren's symptoms, overshadow Sjögren's
symptoms or make it difficult to separate symptoms.
If Sjögren's is suspected, blood tests, examinations,
imaging and other tests may be used to help confirm
a diagnosis. The "Schirmer Test" can be
used to measure tear production and help to diagnose
Sjögren's In the "Schirmer Test", a
strip of filter paper is placed in the lower eyelid
for five minutes and then when removed, the wetness
on the paper is measured with a ruler to determine
how much tear has been produced. This test is not
a sure-fire method, though, since certain eye conditions
and age can also reduce the amount of tear production.
Another test called the "Nonstimulated Whole
Saliva Flow Collection" can be performed to determine
saliva production. In this test, the patient must
spit into a test tube every minute for 15 minutes,
and then the amount collected is measured to determine
a Sjögren's diagnosis. This test takes longer,
but there is no special equipment needed.
Other tests include examining the eye with a special
test to look at the surface of the eye for dryness,
lip biopsies to look for lymphocytes around the saliva
gland or damage to the saliva gland, imaging such
as ultrasound, and blood tests may show:
Positive Anti-SS A
Positive Anti-Salivary Duct Antibody
Positive Anti-SS B
Low Total Serum Iron
Elevated Rheumatoid Factor Quantity
Positive Rheumatoid Factor
Elevated Erythrocyte Sedimentation Rate
Positive Anti-Nuclear Antibody
Treatment:
There is no known cure or specific standard treatment
for Sjögren's Treatment for Sjögren's is
aimed at relief and symptom management. Eye drops
such as Restasis are prescribed to relieve dry eyes
and inflammation. There are also prescriptions to
help manage dry mouth, dry skin, infection and other
symptoms of Sjögren's For severe cases, steroids
such as Prednisone may be prescribed to reduce inflammation,
and immunosuppressant disease-modifying anti-rheumatic
drugs (DMARD's) such as methotrexate and/or hydroxychloroquine
(Plaquenil) may also be used to reduce the immune
response that is attacking the exocrine gland.
Prognosis:
There is no cure for Sjögren's and unlike other
autoimmunes, this disease does not go into remission.
Symptoms can rage from mild to severe and can damage
internal organs, cause infections, swollen glands,
blurred vision, difficulty swallowing, debilitating
fatigue and other complications for the rest of the
patient's life. Treating symptoms effectively is the
only course for relief, however, in some cases patient's
do not respond to treatment.
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