Sjogren's Syndrome

Sjogren’s syndrome, also known as “Sicca syndrome,” is a systemic autoimmune disease in which immune cells attack and destroy the exocrine glands that produce tears and saliva. Nine out of ten Sjogren’s patients are women and the average age of onset is after menopause in women, although Sjogren’s occurs in all age groups in both women and men. It is estimated to affect as many as 4 million people in the United States along, making it the second most common rheumatic disease.

Sjogren’s syndrome can exist as a disorder in its own right or may develop years after the onset of an associated rheumatic disorder, such as rheumatoid arthritis, systemic lupus erythematosus, scleroderma, primary biliary cirrhosis, etc.

Symptoms of Sjogren’s syndrome is a generalized dryness, typically including xerostomia (dry mouth), rheumatoid arthritis, and keratoconjunctivitis sicca (dry eyes), part of what are known as sicca symptoms. In addition, Sjogren’s syndrome may cause skin, nose, and vaginal dryness, and may affect other organs of the body, including the kidneys, blood vessels, lungs, liver, pancreas, peripheral nervous system, and brain.

Diagnosing Sjogren’s syndrome is complicated by the range of symptoms a patient may manifest, and the similarity between symptoms of Sjogren’s syndrome and those of other conditions. Nevertheless, the combination of several tests can lead to a diagnosis of Sjogren’s syndrome. Blood tests can be done to determine if a patient has high levels of antibodies that are indicative of the condition, such as anti-nuclear antibody (ANA) and rheumatic factor, which are associated with autoimmune diseases.

There is no cure for Sjogren’s syndrome, but it can be treated and controlled. The goals of treatment are to decrease discomfort and reduce the harmful effects of dryness. The type of treatment prescribed will be tailored to each patient’s symptoms and needs. The following are some of the main methods of treatment for Sjogren’s syndrome:

Good Oral Hygiene — Good mouth care may not prevent a dry mouth, but it helps prevent infection and cavities. Toothpastes and oral gels are available for people with dry mouth symptoms. These products contain low doses of peroxide. These products also may have antibacterial action to reduce the severity of dental cavities over a long period of time.

Increasing Eye Moisture — Dry eyes are mainly treated with the use of artificial tears, and a wide range of products are available. Artificial tears must be used regularly and more often in dry environmental conditions such as on airplanes, in air-conditioned buildings, and on windy days. While artificial tears are helpful, they often do not last long enough. Thicker preparations are available that last longer. These often are used at bedtime because they sometimes cause blurry vision. Eye drops containing cyclosporine (Restasis) treat inflammation in the glands around the eyes and may help to increase tear production. Surgery to slow the disappearance of tears by blocking or sealing the tear ducts is another treatment option for more severe cases when artificial tears are not sufficient.

Medications — Drugs that tend to deplete body fluids should be avoided. Mild pain-relieving medications including acetaminophen (Tylenol) or Motrin or Aleve can reduce muscle or joint pain. Two prescription drugs, Salagen and Evoxac, stimulate saliva production and may relieve the dry mouth symptoms. In some patients, the anti-rheumatic drug Plaquenil has been beneficial in decreasing pain and salivary gland swelling.

For patients with generalized symptoms, particularly when the disease affects internal organs (including the gastrointestinal system, kidneys, brain, or spinal cord), high doses of immunosuppressive drugs may be necessary. These include medicines such as prednisone and, rarely, chemotherapy-type medications such as methotrexate.

Some people may experience only the mild symptoms of dry eyes and mouth, while others have symptoms of severe disease. Many patients are able to treat problems symptomatically. Others are forced to cope with blurred vision, constant eye discomfort, recurrent mouth infections, swollen parotid glands, hoarseness, and difficulty swallowing and eating.