Arthritis is an inflammatory disease that affects the joints, leading to joint pain and stiffness. However, arthritis has also been known to affect other regions of the body including the heart, eyes and even the mouth.
Patients with autoimmune arthritis, such as those with rheumatoid arthritis, lupus and vasculitis, are more likely to develop Sjögren's syndrome, a disease characterized by dry eyes and dry mouth. There are two subtypes of Sjögren's syndrome:
- Primary Sjögren's syndrome (in which the condition develops on its own for unknown causes)
- Secondary Sjögren's syndrome (which develops secondary to other disorders, including arthritis)
What is Sjögren's syndrome?
Sjögren's syndrome is an autoimmune disease. Normally, the immune system protects us from foreign pathogens. However, in the cause of autoimmune disease, the immune system goes haywire and starts to attacks the body’s healthy cells and healthy tissue instead. In the cause of autoimmune arthritis, such as rheumatoid arthritis, the immune system attacks the joints of the body. However, in the case of Sjögren's syndrome, the immune system attacks the cells of the glands that produce moisture in your mouth and eyes. Hence, both these diseases are characterized by inflammation, which is a hallmark of autoimmune disease.
Symptoms of Sjögren's syndrome
Sjögren's syndrome affects the eyes, mouth, throat and airways. These are the symptoms of primary and secondary Sjögren's syndrome:
- Fatigue or tiredness
- Brain fog
- Joint pain
- Muscle pain
- Nerve pain
- Difficulty tasting
- Difficult swallowing
- Dental issues
- Problems speaking
- Vaginal dryness (for women)
- Skin rash
- Gastrointestinal issues
- Liver, kidney, pancreas, lung inflammation
- Infertility or early menopause
- Loss of appetite
Secondary Sjogren’s syndrome is often accompanied by:
- Rheumatoid arthritis
- Primary biliary cholangitis
Diagnosis of Sjögren's syndrome
Primary Sjögren's syndrome
Secondary Sjögren's syndrome
Secondary Sjögren's syndrome is diagnosed in patients that have previously received a diagnosis of a different autoimmune disease (including rheumatoid arthritis or lupus). A diagnosis of Secondary Sjögren's syndrome is bestowed to autoimmune disease patients when they develop key Sjögren's syndrome symptoms such as dryness in their eyes and mouth.
Sometimes, there are other disease that can mimic Sjögren's syndrome such as use of certain medications that you may be taking including tricyclic antidepressants, antihistamines, and radiation treatment. These can cause extreme dry eyes and mouth but it is not Sjögren's syndrome.
Treatment for Sjögren's syndrome
Unfortunately, similar to arthritis, there is no cure for Sjögren's syndrome. However, there are treatments for the disease that can help keep it under control. The goal of treatment is to diminish any feelings discomfort and the harmful effect that dryness has. Talk to your doctor who will tailor the treatment regimen to your needs.
These are the four ways in which you can treat Sjögren's syndrome.
1. Ensure your teeth and mouth are healthy by maintaining good oral hygiene
While having good oral hygiene may not prevent the development of dry mouth, it can reduce the incidence of infection and cavities. Furthermore, there are toothpastes and other products that are available specifically for patients that have dry mouth as toothpastes can often be drying and these ones contain less of the compound that causes dryness.
2. Keep your eyes well hydrated
Generally, dry eyes can be treated using artificial tears, for which there are lots of products available. These are commonly administered in conditions that cause dryness, such as on airplanes. While artificial tears can be beneficial, they often don’t last as long. Thicker preparation of artificial tears can last longer. You should use them at bedtime so that you can avoid blurry vision in the morning. Furthermore, using eye drops that contain cyclosporine can help treat inflammation that is around the eyes and can help increase production of tears.
3. Stimulate lubrication of the eyes
These are small plugs that are put into your tear duct by your doctor in order to induce or keep lubrication of your eyes. The process usually only takes a few minutes in the exam chair. In extreme cases, you can undergo surgery to slow the reduction of tears by sealing the tear ducts with cautery.
4. Be careful which medications you take
It is important to avoid drugs that are associated with depletion of body fluids. There are two prescription drugs, Evoxac and Salagen, that help induce saliva production and relieve dry mouth. In a subset of patients, Plaquenil has been shown to reduce pain and swelling of salivary gland.
While there is a small chance you may develop Sjögren's syndrome if you have arthritis, there are ways to manage both conditions. Importantly, if you feel symptoms of dry eyes and dry mouth, go to your doctor and describe your symptoms. It is important to get treatment as quickly as possible before the drying has significant negative effects.