Sjogren's syndrome

[David Baxter PhD]

Sjogren's syndrome
Mayo Clinic
Retrieved July 11, 2017

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

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

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

Symptoms
The two main symptoms of Sjogren's syndrome are:

• Dry eyes. Your eyes may burn, itch or feel gritty ? as if there's sand in them.
• Dry mouth. Your mouth may feel like it's full of cotton, making it difficult to swallow or speak.

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

• Joint pain, swelling and stiffness
• Swollen salivary glands ? particularly the set located behind your jaw and in front of your ears
• Skin rashes or dry skin
• Vaginal dryness
• Persistent dry cough
• Prolonged fatigue

Causes
Sjogren's syndrome is an autoimmune disorder. This means that your immune system mistakenly attacks your body's own cells and tissues.

Scientists aren't certain why some people develop Sjogren's syndrome and others don't. Certain genes put people at higher risk of the disorder, but it appears that a triggering mechanism ? such as infection with a particular virus or strain of bacteria ? is also necessary.

In Sjogren's syndrome, your immune system first targets the moisture-secreting glands of your eyes and mouth. But it can also damage other parts of your body, such as your:

• Joints
• Thyroid
• Kidneys
• Liver
• Lungs
• Skin
• Nerves

Risk factors
Although anyone can develop Sjogren's syndrome, it typically occurs in people with one or more known risk factors. These include:

• Age. Sjogren's syndrome is usually diagnosed in people older than 40.
• Sex. Women are much more likely to have Sjogren's syndrome.
• Rheumatic disease. It's common for people who have Sjogren's syndrome to also have a rheumatic disease ? such as rheumatoid arthritis or lupus.

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

• Dental cavities. Because saliva helps protect the teeth from the bacteria that cause cavities, you're more prone to developing cavities if your mouth is dry.
• Yeast infections. People with Sjogren's syndrome are much more likely to develop oral thrush, a yeast infection in the mouth.
• Vision problems. Dry eyes can lead to light sensitivity, blurred vision and corneal ulcers.

Less common complications may affect your:

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

Tests and diagnosis
Sjogren's syndrome can be difficult to diagnose because the signs and symptoms vary from person to person and can be similar to those caused by other diseases. Side effects of a number of medications also mimic some signs and symptoms of Sjogren's syndrome.

A variety of tests can help rule out other conditions and help pinpoint a diagnosis of Sjogren's syndrome.

Blood tests
Your doctor may order blood tests to check for:

• Levels of different types of blood cells
• Presence of antibodies common in Sjogren's syndrome
• Evidence of inflammatory conditions
• Indications of problems with your liver and kidneys

Eye tests
Your doctor can measure the dryness of your eyes with a test called a Schirmer tear test. In this test, a small piece of filter paper is placed under your lower eyelid to measure your tear production.

A doctor specializing in the treatment of eye disorders (ophthalmologist) may also examine the surface of your eyes with a magnifying device called a slit lamp. He or she may place drops in your eye that make any damage to your cornea easier to see.

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

• Sialogram. A special X-ray called a sialogram can detect dye that's injected into the salivary glands located in front of your ears. This procedure shows how much saliva flows into your mouth.
• Salivary scintigraphy. This nuclear medicine test involves the intravenous injection of a radioactive isotope, which is tracked over the course of an hour to see how quickly it arrives in all your salivary glands.

Biopsy
Your doctor may also want to do a lip biopsy to detect the presence of clusters of inflammatory cells, which can indicate Sjogren's syndrome. For this test, a small sliver of tissue is removed from salivary glands located in your lip and examined under a microscope.

Treatments and drugs
Many people can manage the dry eye and dry mouth associated with Sjogren's syndrome by using over-the-counter eyedrops and sipping water more frequently. But some people may need prescription medications, or even surgery.

Medications
Depending on your symptoms, your doctor may suggest medications that:

• Increase 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, flushing and increased urination.
• Address specific complications. If you develop arthritis symptoms, you may benefit from nonsteroidal anti-inflammatory drugs (NSAIDs) or other arthritis medications. Prescription eyedrops may be needed if over-the-counter drops aren't helpful. Yeast infections in the mouth should be treated with antifungal medications.
• Treat systemwide symptoms. Hydroxychloroquine (Plaquenil), a drug designed to treat malaria, is often helpful in treating Sjogren's syndrome. Drugs that suppress the immune system, such as methotrexate, also may be prescribed.

Surgery
To relieve dry eyes, you may consider undergoing a minor surgical procedure to seal the tear ducts that drain tears from your eyes (punctal occlusion). Collagen or silicone plugs are inserted into the ducts for a temporary closure. Collagen plugs eventually dissolve, but silicone plugs stay in place until they fall out or are removed. Alternatively, your doctor may use a laser to permanently seal your tear ducts.

Lifestyle and home remedies
Many symptoms of Sjogren's syndrome respond well to self-care measures.

To relieve dry eyes:

• Use artificial tears, an eye lubricant or both. Artificial tears (in eyedrop form) and eye lubricants (in eyedrop, gel or ointment form) help relieve the discomfort of dry eyes. You don't have to apply eye lubricants as often as artificial tears. Because of their thicker consistency, though, eye lubricants can blur your vision and collect on your eyelashes. Your doctor may recommend artificial tears without preservatives because the preservatives can be irritating for people with dry eye syndrome.
• Increase humidity. Increasing the indoor humidity and reducing your exposure to blowing air may help keep your eyes from getting uncomfortably dry. For example, avoid sitting in front of a fan or air conditioning vent, and wear goggles or protective eyewear when you go outdoors.

To help with dry mouth:

• Increase your fluid intake. Drinking lots of fluids, particularly water, helps to reduce dry mouth.
• Stimulate saliva flow. Sugarless gum or hard candies can boost saliva flow. Because Sjogren's syndrome increases your risk of dental cavities, limit sweets, especially between meals. Lemon juice in water also can help stimulate saliva flow.
• Try artificial saliva. Saliva replacement products often work better than plain water because they contain a lubricant that helps your mouth stay moist longer. These products may come as a spray or lozenge.
• Use nasal saline spray. A nasal saline spray can help moisturize and clear nasal passages so you can breathe freely through your nose. A dry, stuffy nose can increase mouth breathing.

Oral health
Dry mouth increases your risk of dental cavities and tooth loss. The following precautions may help prevent those types of problems.

• Brush your teeth and floss after every meal.
• Schedule regular dental appointments, at least every six months.
• Use daily topical fluoride treatments and antimicrobial mouthwashes.

Other areas of dryness
If dry skin is a problem, avoid hot water when you bathe and shower. Pat your skin ? don't rub ? with a towel and apply moisturizer when your skin is still damp. Use rubber gloves when doing dishes or housecleaning. Vaginal moisturizers and lubricants help women who experience vaginal dryness.