Sjögren’s Syndrome What is it?

Sjögren's syndrome is a chronic autoimmune disease characterized by the abnormal production of extra antibodies in the form of white blood cells which attack the moisture-producing glands in the body, causing dry eyes (inflammation of the glands that produce tears (lacrimal glands) which leads to decreased water production for tears and eye dryness. It also causes dry mouth with inflammation of the glands that produce the saliva in the mouth (salivary glands, including the parotid glands). These symptoms are not associated with other auto-immune diseases. However, Sjogren's syndrome is referred to as a secondary syndrome when patients have other auto-immune diseases, such as rheumatoid arthritis, systemic lupus, Erythematosus or scleroderma, which happens about 50% of the time. I had lupus for several years before I was blessed with this disease. As always, I wanted to understand the disease and immediately ordered "The New Sjogren's Sundrome Handbook" by Dr, Wallace (the best author on autoimmune disease in my humble opinion).

The cause remains unknown, but it does tend to run in families with auto-immune diseases, thyroid disease or juvenile diabetes. About 90% of patients are female, over 4,000,000 suffer from Sjögren’s syndrome, yet it is basically unknown to most people. Often it goes undiagnosed; however, the symptoms may be minor or debilitating. All instances of Sjögren’s syndrome are systemic, affecting the entire body. Sjögren’s can cause joint pain or inflammation (arthritis), Raynaud's phenomenon, lung inflammation, lymph-node enlargement, kidney, nerve, and muscle disease. Other common diseases associated with Sjögren syndrome is autoimmune thyroiditis, detecting by thyroid blood tests, heartburn and difficulty swallowing can result from esophageal reflux disease and it may rarely cause liver problems. As the symptoms of Sjögren’s syndrome mimic other conditions and diseases, on average it takes 7 years to get a diagnosis.

Treatment for the eyes is important. Dry eyes have a gritty feeling and dryness leads to eye irritation which can cause eye infections and serious abrasion of the dome of the eye (cornea). Restasis is often prescribed for the eyes to increase tear production, most doctors also recommend using eye drops at least 5 times a day, plus a get lubricant in bed at night. Sometimes physicians will insert plugs made of silicone or other material into the openings that normally drain tears which allows the patient to retain tears on the ocular surface for a longer period of time. There is evidence that taking Omega 3 by mouth may improve dry eye symptoms. Essential fatty acids are also found in flaxseed oil and fish oil supplements. Clinical trials are now being conducted. I take all those as I figure it may help and you don’t have to worry about side effects.

Treatment for dry mouth is equally important. Mouth dryness is uncomfortable, and it can lead to swallowing difficulties, dental decay, gum disease, mouth sores and swelling, stones and infection of the parotid gland inside the cheeks. Dry lips are also a problem. Seeing your dentist for regular cleaning and evaluation is very important. Brushing your teeth frequently with a product like Biotine toothpaste and be sure to floss daily. There is also a Biotene mouth moisturizer available for use at night. Sipping water frequently throughout the day and using sugarless mints and gum help. There are two medications that may be prescribed: pilocarpine (Salagen) and cevimeline (Evoxas). Sometimes, Plaquenil is used and for serious cases prednisone, Imunan and Cytoxan have been used. I personally tried the pilocarpine which seemed to give me some relief until I had a serious allergic reaction to it after a couple of days. I am not using any of the other treatments at this time, except low dose prednisone which is more for the lupus problems. It is possible to get thrush (a yeast infection) in your mouth from the dryness and I can only say I now know why babies who get thrush cry so much. It is thoroughly miserable, but there is a medication, Diflucan, which is best treatment in my opinion. It us also recommended that you use a saline spray for you nose to moisten those mucous membranes.

If you have any of these symptoms, I suggest you write down all the problems, and then see your physicians, an eye doctor and a dentist are good choices. They can do a biopsy in your mouth to prove you have the disease but I think if you have the symptoms of dry eyes, nose and mouth you can be fairly certain you are dealing with Sjögren’s syndrome