Definition & Overview

Sjogren’s syndrome is a disease that affects the autoimmune system causing it to attack the salivary and lacrimal glands that produce saliva and tears. This results in xerostomia (dry mouth) and keratoconjunctivitis (dry eyes). If left untreated, the condition can worsen, which will lead to the destruction of the glands.

There are two classifications of Sjorgren’s Syndrome: Primary and Secondary. Primary Sjogren's Syndrome is determined if it occurs on its own. Secondary Sjogren's Syndrome, on the other hand, is when the disease is associated with another disease, such as rheumatoid arthritis, multiple sclerosis, lupus, and fibromyalgia.

Symptoms such as dry mouth and dry eyes can be caused by other conditions, so the doctor will need to diagnose the condition carefully by performing a series of tests.

Sjogren's syndrome can affect people of any age. However, studies suggest that the condition mostly occur in women above the age of 40. Treatment is typically focused on managing the symptoms and usually includes medications to increase the production of saliva and tears, treat the associated diseases, and suppress the immune system. In some cases, minor surgery may be considered.

Causes

The primary cause of Sjogren's syndrome is an autoimmune disorder. This is when the immune system suddenly views the body’s cells as enemies and begins attacking them. However, it is still not clear as to why this happens. Some researchers believe that other diseases or an infection triggers the condition.

Other than attacking the salivary and lacrimal glands, the condition can also affect other parts of the body, such as the skin, nerves, lungs, liver, kidneys, thyroid, and joints.

After years of studying the disease, researchers have been able to determine several risk factors, such as age, gender, and other diseases. Women are more prone to the condition. Those above the age of 40 have a higher risk. Rheumatic diseases, such as rheumatoid arthritis and lupus can trigger the condition. Other factors that are believed to cause the syndrome are genetics, hormones, microchimerism, and environmental.

Key Symptoms

The most noticeable symptoms of Sjogren's syndrome are dry eyes and dry mouth. The patient usually experiences a burning sensation in the eyes and/or a feeling that sand is in them. They also find it difficult to swallow or speak.

Other than the two main symptoms, patients can also experience joint pains, skin rashes or dry skin, fatigue, dry cough, vaginal dryness, and swollen salivary glands. If the condition has also affected other body parts such as the liver and kidneys, the patient will also display symptoms associated with the malfunctioning of those parts.

Who to see & types of treatment available

The first person to see if you experience dry mouth or dry eyes symptoms is your family physician. If he or she suspects the presence of Sjogren's Syndrome, you will likely be referred to specialists, such as a rheumatologist or an ophthalmologist.

In order to diagnose the condition accurately, your doctor will need to perform a series of tests. These include the following:

  • Immunoglobulins test – to check for elevated levels of normal blood proteins. These are usually more active than usual in patients with Sjorgren’s Syndrome.

  • Rheumatoid Factor test – checks for the presence of rheumatoid diseases. The majority of Sjogren's syndrome patients also have a rheumatoid disease.

  • Erythrocyte Sedimentation Rate – This test checks for elevated ESR levels, which indicates that an inflammatory disorder is present.

  • SS-A and SS-B – These tests check for Sjogren's marker antibodies, which are present in over seventy percent of Sjogren's patients.

Patients will also likely undergo ophthalmic and dental tests such as:

  • Schirmer test – to check the tear production levels

  • Rose Bengal and Lissamine Green test – doctors perform this test to check for dry spots on the surface of the eyes.

  • Salivary Flow Test – This will measure the amount of saliva that is produced over a certain period.

  • Salivary Gland Biopsy – Confirms that the salivary glands have been infected with an inflammatory cell.

Unfortunately, there is no cure for Sjorgren’s syndrome, which is why the treatments available focus on the managing the symptoms. Treatments include, lubricating the eyes with artificial tears, using artificial saliva, mouth rinses, nasal sprays, vaginal lubricants, skin moisturizers, corticosteroids, non-steroidal anti-inflammatory medications to control pain, and immunosuppressive medications to manage an overactive immune system. It is vital that the condition be diagnosed while it is still in its early stages. If the disease develops, there is a possibility of it affecting other internal organs, causing major complications.

Some of the most common complications are vision problems, dental cavities, and yeast infections. Dryness of the eyes results in light sensitivity and corneal ulcers. Aside from helping people swallow and digest food, saliva also helps protect the teeth. Without enough saliva, the teeth become prone to cavities and other disorders, such as yeast infections in the mouth.

To treat the symptoms of Sjogren's syndrome, doctors will prescribe a variety of medications that will help to increase tear and saliva production. These medications include pilocarpine and cevimeline. If the condition is associated with arthritis, the doctor will also likely to prescribe NSAIDs to manage the pain. Finally, the doctor will prescribe a drug that is usually used to treat malaria, called Hydroxychloroquine. This drug suppresses the immune system, which makes it helpful in treating the condition.

If your eyes are greatly affected, you may need to undergo minor surgery to seal the tear ducts to prevent tears from draining from your eyes. Surgery may include plugging the ducts with collagen or silicone plugs. The doctor may also opt for a more permanent solution, which is to seal the tear ducts using a laser.

If your body responds to the treatment prescribed by the doctor, it’s likely that you’ll also need to make a few lifestyle changes to continually cope with the condition. These changes include eating a healthy diet and quitting smoking. Smoke from cigarettes irritate the eyes and can cause havoc on dry eyes. You will also need to apply moisturizers, artificial tears, and artificial saliva on a regular basis to prevent your skin, eyes, and mouth from drying.

References:

  • Sjogren's Syndrome Foundation: "About Sjogren's Syndrome."
  • American College of Rheumatology: "Sjogren's Syndrome," "Methotrexate."
  • National Institute of Arthritis and Musculoskeletal and Skin Diseases: "Questions and Answers about Sjogren's Syndrome."
  • NHS: "Treating Sjogren's Syndrome."
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