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Sjogren's syndrome is a disorder of the immune system and it is often characterized by its two most common symptoms — dry eyes and a dry mouth.
Most people have never heard about Sjogren's but is it important to know that it's a disease that often accompanies other autoimmune disorders — rheumatoid arthritis, lupus and other which are marked by inflammation of connective tissues. Every patient should know that, in Sjogren's syndrome, immune system attacks healthy tissue-in this case- the mucous membranes and moisture-secreting glands of eyes and mouth. All this is resulting in decreased production of tears and saliva and can lead to problems from difficulty swallowing to dental cavities to light-sensitive eyes to corneal ulcers. Sjogren's syndrome can also result in damage to tissues of lungs, kidneys and liver. Sjogren's syndrome that involves the gland inflammation (resulting in dryness of the eyes and mouth, etc.), but not associated with a connective tissue disease, is referred to as primary Sjogren's syndrome. Secondary Sjogren's syndrome involves not only gland inflammation, but is associated with a connective tissue disease, such as rheumatoid arthritis, systemic lupus erythematosus, or scleroderma. Unfortunately- there's no cure for Sjogren's syndrome, but treatments can relieve many of the symptoms.

Incidence of the condition

Sjogren's syndrome affects 1-4 million people in the United States. Although you can develop Sjogren's syndrome at any age, most people are older than 40 at diagnosis. The condition is 9 times as likely to occur in women as in men and the disease affects predominantly middle-aged women, in the peri- or post-menopausal period. However, it can be seen in both sexes and all ages. Although many people still haven’t heard about this condition- it is considered to be quite common since in addition to the primary syndrome, 30% of patients with rheumatoid arthritis, systemic lupus erythematosus and systemic sclerosis suffer secondary Sjögren’s syndrome. It is also proven that 2 to 5 % of people aged 60 and above have primary Sjögren’s syndrome.

Signs and symptoms of Sjogren’s syndrome

Bad thing with describing the characteristic symptoms of Sjogren's syndrome as well with diagnosis- is the fact that the signs and symptoms are similar to those caused by other diseases and can vary from person to person. Not only that -the side effects of a number of medications can mimic some signs and symptoms of Sjogren's syndrome. Typical signs and symptoms of Sjogren's include:
  • Difficulty swallowing or chewing
  • Change in sense of taste
  • Dry eyes
  • Dry mouth
  • Dental cavities
  • Fatigue
  • Fever
  • Hoarseness
  • Oral yeast infections, such as candidiasis
  • Dry cough that doesn't produce sputum
  • Joint pain, swelling and stiffness
  • Irritation and mild bleeding in your nose
  • Enlarged parotid glands
  • Skin rashes or dry skin
  • Vaginal dryness

Possible causes of Sjogren’s syndrome

Every patient should know that Sjogren's syndrome is an autoimmune disorder which means that body attacks its own cells and tissues. Unfortunately- it's unknown why this happens, but researchers believe that a combination of factors trigger something to go wrong with immune system. These triggers could be:
·         Heredity
·         Hormones
·         viral or bacterial infection
·         nervous system disorder
In the case of Sjogren's syndrome, white blood cells called lymphocytes target, attack and damage your moisture-producing glands. These cells can also damage other organs, including lungs, kidneys and liver.

Risk factors for developing Sjogren’s syndrome

Unfortunately- although anyone can develop Sjogren's syndrome, it typically occurs in people with one or more known risk factors. These include:
  • Rheumatic disease
It's common for people who have Sjogren's syndrome to also have a rheumatic disease, such as rheumatoid arthritis, lupus, scleroderma or poliomyelitis. It is proven that this place you in high risk for developing this syndrome!
  • Being female
It is already mentioned that women are 9 times as likely as men are to have Sjogren's syndrome.
  • Being a certain age
Sjogren's syndrome is usually diagnosed in people older than 40.
  • Having a family history of Sjogren's
Sjogren's syndrome sometimes runs in families although some specific gene which is responsible for the condition still isn't found!

Diagnosis of Sjogren’s syndrome

  • Patient’s history
To diagnose Sjogren's syndrome, every doctor should first ask for a history of symptoms, including how long the patient has them. Doctor may ask about diet, including the types and quantities of liquids that patient drink in a day.  
  • Blood tests
Every patient should know that doctor may order blood tests to check blood counts and sedimentation rate. The main purpose of these tests is of course- to check for autoantibodies. Checking blood count allows doctor know the proportion of the various types of blood cells in a given volume of your blood. Autoantibodies can play a role in the inflammatory response, which can damage tissues and organs.
  • Tear test
Because the condition affects ability to produce tears- doctor can measure the dryness of patient’s eyes with one test called- the Schirmer tear test, in which a small piece of filter paper is placed under lower eyelid to measure tears. An ophthalmologist may also examine eyes with a slit-lamp after placing a drop of liquid containing a dye in eye.  
  • Imaging
Not too many people have heard about this test, but it is important to know that, to check on the condition of salivary glands, doctor often order a special X-ray called a sialogram. It detects dye that is injected into parotid glands, located behind jaw and in front of ears. What's good about test- it reveals the flow of saliva into mouth. The fact is also that doctor may perform a parotid gland flow test to determine the amount of saliva that patient produce over time.  
  • Biopsy
Doctor may also recommend to do a lip biopsy to detect the presence of clusters of inflammatory cells, which can indicate Sjogren's syndrome. Although patient are often scared to do this test- it is very easy- a small sliver of tissue is removed from salivary glands located in your lip and examined under a microscope.
  • Urine sample
Urine sample that can be analyzed in the laboratory to determine whether Sjogren's syndrome has affected kidneys could be extremely beneficial!

Possible complications if left untreated

Although there are many possible complications of Sjogren's syndrome – most of them are more annoying than serious. But even some serious can develop. Common complications of Sjogren's syndrome include:
  • Difficulty swallowing
  • Dental cavities
  • Vision problems
 
Less common complications include:
  • Inflammation of organs such as lungs, kidneys or liver
These inflammations can cause pneumonia, bronchitis or other problems in lungs and may lead to problems with kidney function.
  • Heart problems for babies born to mothers with Sjogren's syndrome
When a patient is planning to become pregnant, she should talk with doctor about being tested for certain autoantibodies that may be present in blood because they have been associated with a neonatal lupus syndrome.
  • Cancer of the lymph nodes (lymphoma)
  • Peripheral nervous system disorders
Most common symptoms are numbness, tingling and burning. 

Medications

  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
This group of medications help relieve both pain and inflammation. The most commonly used is Aspirin! They should always be taken with food.  
  • Corticosteroids
Most people already know that these medications reduce inflammation and may slow joint damage. In the short term, corticosteroids can make you feel dramatically better. Possible side effects may include easy bruising, thinning of bones, cataracts, weight gain, a round face, diabetes and high blood pressure.
  • Hydroxychloroquine (Plaquenil)
This antimalarial drug may be useful if you have inflamed joints, as with rheumatoid arthritis.  
  • Pilocarpine (Salagen)
Medication called Pilocarpine should be prescribed if patient has dry-mouth symptoms caused by Sjogren's syndrome.
  • Cevimeline (Evoxac)
Most people have already heard about this medication which is also used to relieve symptoms of a dry mouth. It works by causing certain mouth glands to produce more saliva. Common side effects may include excessive sweating, nausea, and a runny or stuffy nose.  
  • Cyclosporine
  • Immunosuppressants
These medications, such as Cyclophosphamide (Cytoxan), methotrexate (Rheumatrex), mycophenolate (CellCept) and Azathioprine (Imuran), suppress the immune system.  

Surgery

Most patients already know that there is one way to relieve dry eyes - a minor surgical procedure to seal the tear ducts that drain tears from your eyes. Collagen or silicone plugs are inserted into the ducts for a temporary closure.  

Prognosis

Unfortunately- Sjögren’s syndrome remains fundamentally an incurable disease, since no therapeutic method has been identified that may alter the course of the disease. However, the treatment of dry eyes is largely symptomatic and includes artificial tears and lubricant ointments. Occasionally, patients may require surgical punctual occlusions to block tear drainage.  
 

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