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With Sjogren’s syndrome, changes occur in the immune system. This is the body’s defense against disease. The problem is that the immune system lacks the usual controls.

This causes white blood cells to invade glands in the body that produce moisture, such as the tear and salivary glands. Commonly the Bartholins glands in the vagina are also affected. This can destroy the glands and cause them to stop producing moisture at all. Sjogren’s syndrome can also cause problems in other parts of the body, including the joints, lungs, muscles, kidneys, nerves, thyroid gland, liver, pancreas, stomach, and brain. In addition, Sjogren's syndrome may cause skin, nose, and vaginal dryness and may affect other organs of the body.

What is Sjogren's syndrome?

Sjogren’s syndrome classically features a combination of dry eyes, dry mouth, and another disease of the connective tissues, most commonly rheumatoid arthritis. Sjogren’s syndrome is an autoimmune disease, characterized by the abnormal production of extra antibodies in the blood directed against various tissues of the body. This particular autoimmune illness is there because of inflammation in the glands of the body. Inflammation of the glands that produce tears, which are lacrimal glands, leads to decreased water production for tears, and consequently eye dryness. Inflammation of the glands that produce saliva in the mouth, or salivary glands, including the parotid glands, leads to mouth dryness.
Sjogren’s syndrome that involves the gland inflammation, but is 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 also connective tissue disease, such as rheumatoid arthritis, systemic lupus erythematosus, or scleroderma. Sjogren’s syndrome is a chronic and lifelong disorder.

What causes Sjogren’s syndrome?

While the exact cause of Sjogren's syndrome is not clear, there is a growing scientific support for genetic factors. The illness sometimes occurs in other family members and is more common in families that have members with other autoimmune illnesses, such as systemic lupus erythematosus, autoimmune thyroid disease, or juvenile diabetes. It is interesting that 90% of Sjogren’s syndrome patients are female.

What are symptoms of Sjogren’s syndrome?

Symptoms of Sjogren’s syndrome can involve the glands but there are also possible affects of the illness involving other organs of the body. These are known as extra-glandular manifestations of Sjogren’s syndrome.

Dry mouth is a common symptom of Sjogren’s. The mouth normally contains saliva, which aids chewing and swallowing but in people with Sjogren’s syndrome, the amount of saliva is reduced. This problem makes chewing, swallowing, and speaking difficult and it may cause a decreased sense of taste.

Dry eyes is an annoying symptom because eyes may feel dry, gritty, or sandy, they may burn and look red. A thick substance may accumulate in the inner corner of the patient’s eyes during sleep. Eyes may be more sensitive to sunlight and if not properly treated, Sjogren’s syndrome can lead to ulcers of the cornea. (Cornea is the clear covering of the eyeball.) On rare occasions, this can even cause blindness.

Salivary glands
are located under the tongue, in the cheeks in front of ears, and in the back of the mouth. They may feel swollen and tender, and this may occur along with a fever. This affects about one-half of the people with the Sjogren’s disorder.

Dental cavities are a common problem that results from a dry mouth. Saliva fights bacteria and defends against cavities, and because you have decreased saliva, your teeth may develop cavities more easily.

Dry nose, throat, and lungs are common symptoms as well. Patient may have a dry cough, hoarseness, a decreased sense of smell, and nosebleeds. Sjogren’s syndrome can also lead to pneumonia, bronchitis, and ear problems.

Dryness of the vagina can cause painful intercourse.

Fatigue is a common complaint, where patient may get easily exhausted and feel tired and worn out.

Other problems also occur, because Sjogren’s syndrome can affect other parts of the body such as blood vessels, the nervous system, muscles, skin, and other organs. This can lead to muscle weakness, confusion and memory problems, dry skin, and feelings of numbness and tingling, but some patients develop cancer of the lymph tissue as well.

Sjogren’s syndrome diagnosis

Diagnosing Sjogren’s syndrome involves detecting the features of dryness of the eyes and mouth, where the tests for dryness should perform by a general practitioner in his office. He should perform it by testing the eye’s ability to wet a small testing paper strip placed under the eyelid. This is the famous Schirmer’s test.

An ophthalmologist can perform more sophisticated eye testing. Salivary glands can become larger and harden, or become tender, so a doctor could detect inflammation by radiological salivary scans. In addition, the doctor is able to measure a diminished ability of the salivary glands to produce saliva with salivary flow testing. The diagnosis could get strong support with the abnormal findings of a biopsy of salivary gland tissue, a common choice for samples is the glands of the lower lip in the diagnosis of Sjogren’s syndrome. It is easy to perform the lower lip salivary gland biopsy procedure under local anesthesia. The surgeon makes a tiny incision on the inner part of the lower lip to expose and remove a sample of the tiny salivary glands within.

Patients with Sjogren’s syndrome typically produce a myriad of extra antibodies against a variety of body tissues called auto-anti-bodies. These can be detected through blood testing and include antinuclear antibodies, present in nearly all patients. Typical antibodies are present in most, but not all patients. These are SS-A and SS-B antibodies, rheumatoid factor, thyroid antibodies, and others. Low red blood count known as anemia and abnormal blood testing for inflammation are present as well.

Sjogren’s syndrome treatment

The treatment of patients with Sjogren’s syndrome is directed toward the particular areas of the body that are involved, and the most common complications, such as infection. Unfortunately, there is no cure for Sjogren’s syndrome, although its complications and symptoms can be solved. For example, a patient could relieve dryness of the eyes by using artificial tears, eye lubricant ointments at night, and minimizing the use of hair dryers. When dryness becomes more significant, the ophthalmologist can plug the tear duct closed so that tears cover the eye longer then in normal conditions. Cyclosporin eyedrops as Restasis, are recently approved medicated drops that can reduce the inflammation of the tear glands improving their function. Signs of conjunctivitis, such as pus or excessive redness or pain, should only be evaluated by a doctor.

In case of dry mouth, problematic symptoms can be relieved by drinking plenty of fluids, humidifying air, and using dental care to avoid dental decay. The glands can be stimulated to produce saliva by sucking on sugarless lemon drops or glycerin swabs, whatever the patient finds is better. Additional treatment for the dry mouth symptom are prescription medications as saliva stimulants. Those medications are pilocarpine as Salagen, and cevimeline as Evoxac. People with certain heart diseases, asthma or glaucoma should avoid these medications.

Artificial saliva preparations can ease many of the problems associated with dry mouth as one of Sjogren’s syndrome symptom. Many of these types of agents are available as over-the-counter products, including toothpaste, gum, and mouthwash such as Biotene. Some patients used vitamin E oil with some success in treating this symptom of the Sjogren’s syndrome. You should treat infections of the mouth and teeth as early as possible in order to avoid more severe complications due to mouth dryness. Diligent dental care is very important as part of Sjogren’s syndrome treatment. Salt water as saline nasal sprays can help dryness in the passages of the nose, while you should consider vaginal lubricant for sexual intercourse if you are a woman with Sjogren’s syndrome. Hydroxychloroquine or Plaquenil has been helpful for some manifestations of Sjogren’s syndrome as well. Serious complications, such as vasculitis, can require immune suppression medications, including cortisone or azathioprine as Imuran, or cyclophosphamide as Cytoxan. Infections, which can complicate Sjogren’s syndrome, should receive treatment with appropriate antibiotics.

A rare complication of Sjogren’s syndrome is cancer of the lymph glands called lymphoma, which should receive independent treatment.