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Sjogren's Disease

What is Sjogren's Disease?

 

Sjogren's disease is an autoimmune connective tissue disease which results in dryness of the mucous membranes and can affect swallowing, digestion, the mouth and the eyes. The symptoms of dryness can be quite debilitating for many people.

What causes Sjogren's disease?

We don't know exactly what causes Sjogren's disease. It is known that there are immune antibodies associated with the condition but how exactly they are involved in the process of causing the disease is not known. Nor is it know what causes these antibodies to form.

What are the symptoms of Sjogren's disease?

Sjogrens' disease usually causes dryness of the mucous membranes in the body.

Typically this includes the eyes, the mouth and the digestive tract. At times women may also experience a dry vagina. Not all areas are dry, sometimes, only the eyes, or only the mouth can be affected.

People can find it hard to speak, to chew and to digest food because of these dryness symptoms.

Eyes can be very dry itchy and scratchy and uncomfortable.

 

Many people tend to find the dry mouth more of an issue than the dry eyes which are more easily managed with eye drops. Its more difficult to manage a dry mouth than dry eyes, and dental cavities can occur as a result of longstanding dry mouth.

 

Many people can also get reflux which can worsen this issue.

The salivary glands can become inflamed and enlarged from time to time as well. The enlargement is typically painless, but uncomfortable due to the size.

Sometimes Sjogren's disease can be associated with other symptoms of more widespread autoimmune disease.

  • People can get generalised aches and pains fatigue which is very common

  • Sometimes people can develop Rheumatoid Arthritis.

  • About 50% of people get aches in the joints.

 

Fatigue is actually the most common symptom of Sjogren's disease!

Sjogren's disease can rarely affect other organs such as the lungs, heart and the nervous system.

Very rarely a type of lymphoma called a MALT lymphoma can develop most usually in the Parotid glands, which are the largest salivary glands.

How do we diagnose Sjogren's disease?

Sjogren's disease is diagnosed on the basis of clinical findings: Dry eyes and mouth, and enlarged salivary glands are classical features, particularly in combination with autoimmune antibodies.

Blood tests are done for immune markers such as ANA, ENA, and RF. Immunoglobulins are checked as Sjogren's disease can be associated with hypergammaglobulinemia ( ie high levels of immune globulins).

Other blood investigations are done looking at the immune system, red cells, and white cells, the liver kidneys. Radiological investigations may be ordered depending on your symptoms.

Sometimes your Rheumatologist may do a test called 'Schirmer's test' to see how much tears is produced by your eyes to confirm dry eyes, but usually symptoms are enough to make this diagnosis.

Rarely a salivary gland biopsy may be done to confirm a diagnosis if it is in question, particularly if the immune antibodies are negative.

How is Sjogren's disease treated?

The treatment of Sjogren's disease depends on which symptoms are experienced.

 

Dry eyes and mouth are usually managed symptomatically with appropriate gels, drops and mouth hygiene. There is no strong evidence for any medication reversing these symptoms.

Treating dry eyes involves appropriate eye drops. Some drops work better for some people so its important to find out which ones work best for you.

Treating a dry mouth involves the use of gels and mouth washes such as Biotene gel, artificial saliva, and avoiding medications that can worsen dry mouth such as:

  • Certain anti-depressants,

  • Diuretics

  • Antihistamines.

This all needs to be reviewed with your Rheumatologist and your GP.

Its important to avoid mouth breathing if you have a dry mouth and to treat reflux if it is present to improve symptoms and also lessen negative impact on oral symptoms.

If Sjogren's disease causes systemic autoimmune issues such as Vasculitis or Rheumatoid Arthritis or involves the lungs your Rheumatologist is likely to recommend DMARD therapy to treat these symptoms.

  • Common DMARDs used to treat fatigue, myalgias, arthralgias and frank Rheumatoid Arthritis are Plaquenil and Methotrexate.

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