Sjogren syndrome

Overview – Sjogren’s syndrome is an autoimmune disease (body’s immune system attacks healthy cells) characterized by diminished lacrimal and salivary gland function resulting in dry eyes and dry mouth.

The exact cause of Sjogren’s syndrome is not known but appears to be a combination of certain genes and triggering mechanisms such as infection.

The immune system targets the lacrimal and salivary glands mainly but can damage other parts such as thyroid, kidney, joints, lungs, skin, nerves.

 

Symptoms

  • Dry eyes – the sensation of feeling gritty as if there’s sand in the eyes.
  • Dry mouth – This can cause difficulty swallowing food especially dry food such as crackers.
  • Some people may have joint pain, joint swelling, dry skin and skin rashes, dry cough, vaginal dryness.

 

Complications

  • Dental caries and oral infections including candidiasis (yeast infection)
  • Chronic esophagitis
  • Weight loss
  • Lymphoma
  • Blurred vision and corneal damage
  • Pneumonia
  • Bronchitis
  • Hepatitis
  • Kidney dysfunction

 

Diagnosis

  • The diagnosis of Sjogren’s syndrome is made in the presence of clinical symptoms and laboratory features that exclude other causes of ocular and/or oral dryness.
  • Diagnostic testing includes an eye examination, blood tests. Some patients may require salivary gland biopsy, and/or imaging studies.

 

Lifestyle management

  • Artificial tears, eye lubricant may help relieve the discomfort of the dry eyes.
  • Maintain oral hygiene to prevent infections. Brush your teeth and floss after every meal.
  • Increase your fluid intake particularly water throughout the day. Avoid drinking alcohol, coffee, or acidic beverages.
  • Follow a healthy diet and limit sweets as sweets can increase the risk of dental caries.
  • Talk to your doctor about trying artificial saliva products. They come as a spray or lozenge and will help keep your mouth moist.
  • Schedule regular dental appointments.
  • Do not smoke. In addition to its inherent risks, it worsens dry mouth and dry eye symptoms and augments the risk of dental caries and infections.
  • Use nasal saline spray if you have a dry stuffy nose.
  • Vaginal moisturizers and lubricants can be used if you have vaginal dryness.
  • Certain medications can worsen the symptoms of Sjogren’s syndrome. These include antihistamines (cold and allergy medications), antiparkinson, opioids, inhaled bronchodilators, antiemetics, certain heartburn medications, muscle relaxants, antipsychotics. Talk to your doctor about your condition before being prescribed any of these medications.
  • Increasing the indoor humidity and reducing your exposure to blowing air can help with dryness.
  • If you are planning a pregnancy talk to your doctor about how Sjogren’s syndrome may affect the unborn baby.
  • After the diagnosis and prior to the institution of immunosuppressive therapies make sure you talk to your doctor to receive appropriate immunizations.

 

Medical management

  • For moderate to severe dry eye, drops such as cyclosporine or lifitegrast may be recommended.
  • Drugs such as pilocarpine and cevimeline can increase the production of saliva, and sometimes tears.
  • Non-steroidal anti-inflammatory medications are prescribed if you have arthritis.
  • Antifungal medications are used if there is a yeast infection.
  • Methotrexate, hydroxychloroquine are other medications used in the treatment of Sjogren’s syndrome.
  • Surgery is an option for severe dry eyes.

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