Scottsdale Ear, Nose & Throat 8752 E. Via De Commercio, Ste. 1 Scottsdale, AZ 85258 Phone (480) 684-1080 FAX (480) 684-1081
WHAT IS SJOGREN’S SYNDROME? Sjogren’s (SHOW-grens) Syndrome is an autoimmune disease that causes dry eyes and a dry mouth. An autoimmune disease is a disease in which the immune systems turns against itself. Your immune system is your body’s natural defense against antigens, which are substances that your body regards as foreign. Bacteria and viruses are examples of antigens. The immune system fights off antigens by activating certain white blood cells and producing antibodies, which are special types of blood protein. These cells and antibodies then attack antigens and render them harmless. Occasionally the immune system does not function properly and loses the ability to distinguish between its own body cells and antigens. Instead of fighting antigens, the immune system mistakenly fights the body’s own cells. This is referred to as an autoimmune response (auto means self, and this is a response directed against the body’s own cells. Sjogren’s Syndrome can occur in two forms; primary and secondary. Primary Sjogren’s Syndrome occurs by itself and is not associated with other disease. Secondary Sjogren’s Syndrome occurs with rheumatic disease such as rheumatoid arthritis, systemic lupus erythematosus (lupus), polymyositis and some forms of scleroderma. Rheumatic disease are conditions that affect joints, bones, muscles, skin and sometimes other organs. Sjogren’s Syndrome can affect people of any race and any age, although it is relatively rare in people under age 20. Ninety percent of the people affected are women. The tendency to develop Sjogren’s Syndrome increases if someone in your family has had the condition. It is estimated that Sjogren’s syndrome affects more than one million people in the US. WHAT HAPPENS IN SJOGREN’S SYNDROME? In Sjogren’s Syndrome, a type of white blood cell called a lymphocyte invades moistureproducing glands, such as tear and salivary glands in the head and Bartholin’s glands in the vagina. Lymphocytes can damage these glands and prevent them from producing moisture. Sjogren’s Syndrome can also cause problems in other parts of the body. These problems can include joint inflammation as well as inflammation in parts of the lungs, kidneys, liver, nerves thyroid gland and brain.
Areas more commonly affected by Sjogren’s Syndrome: Eyes, Mouth and Throat, Salivary Glands, Thyroid, Muscles, Joints Areas less commonly affected by Sjogren’s Syndrome: Central Nervous System, Lymph Nodes, Lungs, Skin, Stomach, Kidneys, Liver, Vagina
WHAT ARE THE SYMPTOMS OF SJOGREN’S SYNDROME? Sjogren’s syndrome affects every differently. You may not have every symptom listed in this section. The symptoms may vary from mild at times to severe at others. Symptoms include: Dry mouth - the mouth normally contains saliva, which aids chewing and swallowing. People with Sjogren’s syndrome produce much less saliva. This makes chewing, swallowing and speaking difficult. It also can decrease your sense of taste. Dry eyes - your eyes may feel dry, “gritty” or “sandy”. They may bum and look red. Excess mucus may accumulate at the comers of your eyes while you sleep. Your eyes may be more sensitive to sunlight. If not properly treated, Sjogren’s syndrome can lead to dry spots on the eyes and corneal ulcers (ulcers on the clear covering of your eyeball). On rare occasional this can cause of loss of vision. Remember, however, that not every person with dry mouth or dry eyes has Sjogren’s syndrome. Dry mouth or dry eyes can occur because of the aging process. Dryness can be a symptom of other diseases. Dryness also can be a side effect of such medications as diuretics (water pills), antihistamines or certain high blood pressure medications. Swollen salivary glands - three pairs of major glands produce saliva. These glands are located under your tongue, in your cheeks in front of your ears, and under the back of your mouth. They may feel or look swollen. Occasionally they may become tender and be accompanied by a fever. Swollen glands develop in about half of the people with Sjogren’s syndrome. You have a pair of parotid, sublingual and submandibular glands, one on each side of your jaw. In Sjogren’s syndrome both glands can become swollen at the same time, but often only one is affected. Although it’s possible for all six glands to be swollen at the same time, this generally does not happen. Dental caries - cavities - this is a common problem that becomes worse with dry mouth. Saliva contains antibacterial enzymes that fight bacteria and defend against dental caries. When there is less saliva, you produce fewer antibacterial enzymes. Consequently your teeth may develop cavities more easily, particularly at your gum line. Oral yeast infection - oral yeast infection (candidiasis - can-di-DYfi-ah-sis) is a condition that produces redness and burning in the lining of the mouth of many people with dry mouth. It is caused by an excess of a common yeast, Candida (CAN-di-dah), which usually is present in the mouth in small quantities. Dry nose, throat and lungs - dryness may make your throat feel dry and tickly. You may have a dry cough, hoarseness, a decreased sense of smell and nosebleeds. Dryness can also lead to pneumonia, bronchitis and ear problems. Dryness of the vagina - Sjogren’s Syndrome can cause vaginal irritation and make intercourse painful for women. Fatigue - fatigue is a common symptom of Sjogren’s Syndrome. It can develop either from the disease itself or as a result of the physical and emotional stress of having a chronic illness.
Scottsdale Ear, Nose & Throat 8752 E. Via De Commercio, Ste. 1 Scottsdale, AZ 85258 | Phone (480) 725-3753 | Fax (480) 684-1081
Other problems - other problems can include inflamed, achy joints; muscle weakness; dry skin; rashes; constipation; inflamed nerves; feelings of numbness and tingling; and swollen lymph nodes. (In rare situations, lymph gland swelling can result in a type of cancer called lymphoma.) These are reasons why medical exams and continued follow-up are important.
WHAT CAUSES SJOGREN’S SYNDROME? The cause of the condition is not known. There is some evidence that heredity, viral infections and hormones may contribute to Sjogren’s syndrome. ‘
HOW IS SJOGREN’S SYNDROME DIAGNOSED? Your doctor’s diagnosis may be based on several sources of information. These include: Your medical history: Your doctor will examine your medical records and ask you to describe your symptoms. Your physical examination: Your doctor will look or feel for other signs, such as: - changes in your eyes, mouth and/or salivary glands - enlargement of lymph nodes in your neck ‘ - tenderness in your muscles - inflammation in your joints Chest x-ray results: Your doctor may want you to get a chest x-ray in order to determine if any changes have occurred in your lungs. Laboratory tests: Your doctor also may have you undergo various lab tests. These include: - Blood tests - tests for specific blood markers can help in diagnosing Sjogren’s Syndrome. However, not everyone with Sjogren’s has these markers, and not everyone with these markers has Sjogren’s syndrome. Schirmer test: This test helps determine how dry your eyes are. It involves placing a small piece of filter paper beneath your lower eyelid to measure the amount of tears your eyes produce. Slit-lamp examination: This is a more accurate way to find out if your eyes are dry. In this test, the doctor puts a drop of dye into your eye and examines the eye with a special instrument called a slit lamp. The dye will stain the dry or eroded areas of your eye. An ophthalmic (eye) specialist usually conducts this kind of test. Lip biopsy: In this test, the doctor removes a few minor salivary glands from inside your lip. The glands are examined under a microscope. Their appearance determines if salivary changes you are experiencing are the same ones that occur in Sjogren’s Syndrome. Salivary function tests: These tests measure the actual amount of saliva you produce and help determine how dry your mouth is. Urine tests: These tests may be done to check your kidney function.
Scottsdale Ear, Nose & Throat 8752 E. Via De Commercio, Ste. 1 Scottsdale, AZ 85258 | Phone (480) 725-3753 | Fax (480) 684-1081
A NOTE ABOUT PREGNANCY Pregnancy may present special problems for the developing fetus in women with Sjogren’s syndrome. Your doctor may check you for certain antibodies (blood proteins) that may help identify potential problems. If you are a woman who has one of the rheumatic diseases associated with secondary Sjogren’s syndrome especially lupus - and you have experienced kidney problems and/or high blood pressure, be sure to see your doctor. If you do become pregnant, you and your doctor can work out the best treatment plan. HOW IS SJOGREN’S SYNDROME TREATED? As yet, there is no cure for Sjogren’s syndrome. But proper treatment can help relieve symptoms so that you can life a comfortable and productive life. One of the main goals of treatment is to relieve discomfort and lessen or prevent the effects of the dryness. Since Sjogren’s syndrome affects everyone differently, your treatment plan needs to be based upon your specific needs. Following are some things that can help you cope with the symptoms. For systemic problems: - Since Sjogren’s Syndrome is a systemic disorder, which means that it can affect various internal organs and body parts, several different medications can be used to treat it. Aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) can help reduce joint pain and stiffness, as well as muscle aches. Recent studies have shown that hydroxy-chloroquine (Plaquenil) can help relieve joint pain, rashes and fatigue in some people. If you have serious complications, your doctor may recommend stronger medicines, such as steroids (cortisone) or medications that may alter or modify your immune system response. - Exercise also can help treat systemic problems by keeping joints and muscles flexible. Walking, swimming and range-of-motion exercises are well suited for people with Sjogren’s Syndrome. For dry mouth - Sip water throughout the day as needed. - Use sugar-free gum or candies to stimulate saliva production. - seek treatment for oral yeast infection, candidiasis, from your dentist or physician. Your mouth will feel better afterward. However, candidiasis is a condition that can reoccur, which means that you may need additional treatment. - try saliva substitutes or mouth-coating gels. They are particularly useful at night and are available without a prescription. To prevent dental caries (cavities) - have frequent dental checkups. - ask your dentist to recommend fluoride-containing products, particularly for dry mouth. - brush and floss your teeth effectively and regularly, especially after meals. - eliminate sugary foods and drinks between meals. . For dry eyes- use artificial tears to help relieve the discomfort of dry eyes. You may wish to use preservative-free products if you apply the drops more than four times per day. - try lubricating eye ointments at night and small, long-acting pellets during the day. - your doctor may recommend a procedure called punctual occlusion. This is a simple operation that prevents tears from draining out of your eyes and into your nose. This procedure can help retain tears so your eyes can benefit from nature moisture. Scottsdale Ear, Nose & Throat 8752 E. Via De Commercio, Ste. 1 Scottsdale, AZ 85258 | Phone (480) 725-3753 | Fax (480) 684-1081
For dry skin - use moisturizing lotions for sensitive skin. - avoid drafts from air conditioners, heaters and radiators whenever possible. - avoid detergents, deodorant soaps and excessively hot water. - use a humidifier whenever possible. For vaginal dryness - use lubricants made specifically to help vaginal dryness. Don’t use petroleum jelly.
CHECKUPS ARE IMPORTANT! Members of your health-care team may include your family doctor, a rheumatologist (an arthritis specialist), an eye specialist and your dentist. Since Sjogren’s Syndrome can affect many parts of your body, regular checkups can help detect and prevent future problems. THE FUTURE Sjogren’s Syndrome is generally not life-threatening. The outlook for people with this condition is usually good. Dryness, however, may last for the rest of your life. By using artificial moisture and preventing dental caries (cavities), you can help prevent serious problems. If you have Sjogren’s Syndrome and a rheumatic disease, make sure you follow your doctor’s complete treatment program.
Scottsdale Ear, Nose & Throat 8752 E. Via De Commercio, Ste. 1 Scottsdale, AZ 85258 | Phone (480) 725-3753 | Fax (480) 684-1081
