Sjogren’s syndrome

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Sjogren's syndrome is a disorder commonly seen in women over the age of 40 where eyes and mouth become extremely dry. Famous tennis player Venus Williams is suffering with this disorder. 

[caption id="attachment_8681" align="alignleft" width="146" caption="Tennis Player Venus Williams is suffering from Sjogren's syndrome"]Sjogren's syndrome[/caption]

Sjogren’s syndrome, pronounced as SHOWgrin’s syndrome, is an autoimmune disorder seen mostly in women. Common symptoms are dryness of the eyes and mouth.  An autoimmune disorder is one where the body produces antibodies as it mistakenly thinks its own cells as outsiders. Hence, it is the immune system that malfunctions in any autoimmune condition.

Causes of Sjogren’s syndrome

  1. 90% of sufferers are female. It is generally seen in women over the age of 40, but there is no age bar.
  2. It is sometimes associated with connective tissue disorders like rheumatoid arthritis or lupus.
  3. Research points to an inherited cause as many members of a family may have this syndrome or another autoimmune disorder.
  4. It is suspected that a trigger in the form of an infection by a particular bacterium or virus may cause this condition.

Symptoms of Sjogren’s syndrome

In Sjogren’s syndrome the glands are the target organs, namely the lacrimal gland which produces tears from eyes and the salivary glands which secrete saliva.

Symptoms include:

Dry eyes – There is a feeling of itching, burning or a gritty sensation in the eyes as if sand has entered the eyes. Dry eyes can further lead to eye irritation, abrasion of the cornea and eye infections. Dry eyes are referred to as xerophthalmia.

Dry mouth – The mouth feels unusually dry as if it is full of cotton; medically termed as xerostomia.

Other parts of the body that may be affected are joints, thyroid, skin, lungs, liver, kidneys and nerves.

Dry skin, autoimmune thyroiditis or a persistent dry cough are other potential problems.

Diagnosis of Sjogren’s syndrome

Most people consult a family physician, a dentist or an ophthalmologist for symptoms like dry mouth and eyes. If your doctor suspects Sjogren’s syndrome, you may be referred to a rheumatologist (a specialist in rheumatology and autoimmune disorders).

Investigating Sjogren’s syndrome

  1. Blood tests are done to check the level of antibodies in the body and to detect any infection. If one is suffering from Sjogren’s syndrome C- reactive protein (CRP) and erythrocyte sedimentation rate (ESR) may be high and Sjogren’s syndrome A and B antibodies (SS-A and SS-B) along with rheumatoid factor and thyroid antibodies may be seen.
  2. Imaging tests: A sialogram is an X-ray taken after injecting a dye into the parotid gland to check how much saliva is being produced. Salivary gland inflammation can be detected by special radiologic scans called salivary scans.
  3. Another test to measure quantity of saliva is to spit every minute for fifteen minutes and then check how much saliva is collected.
  4. Biopsy: A small piece of tissue from the inner lip gives an idea of salivary gland located within the lip tissue. The procedure is done under local anaesthesia.
  5. Chest X-ray: To check for lung inflammation, an X-ray of the chest is required.

Treatment of Sjogren’s syndrome

  1. Dry eye can be treated by using artificial tear drops a couple of times a day or more if required. They are completely safe for long term use. Medicated eyedrops containing cyclosporine are useful as they reduce inflammation of the tear glands. Lubricating ointments can be used at the bedtime. The tear duct can be closed surgically (punctual occlusion) or by using laser or silicon or collagen implants so that tears remain in the eye for longer. Adding flaxseed to the diet may improve the symptoms. One must always wear protective sunglasses when going outdoors.
  2. Dry mouth can be treated by regular drinking of fluids, humidifying the air and good dental care. Pilocarpine and cevimeline can be used to stimulate saliva production but cannot be used if the person has asthma or a heart problem. Sucking on lemon drops or hard candy can stimulate flow of saliva. Dental check-up should be done every six months. Regular brushing and flossing is essential to maintain oral hygiene. Use an antiseptic mouthwash if required.
  3. Warm water compress can be applied on the lower cheek when the largest gland called parotid gland is infected.
  4. To treat muscle fatigue and joint pains, hydroxychloroquine can be tried.
  5. A vaginal lubricant can be used before sexual intercourse if vaginal dryness makes sex painful.
  6. Nasal passages can be kept moist using saline nasal sprays.
  7. If skin dryness occurs, avoid bathing with hot water and use a good moisturiser after bath.
  8. In serious cases, medications that suppress the immune system should be given.

Complications due to Sjogren’s syndrome

  • Fungal infections are common, especially in the mouth.
  • Dental caries is a definite problem.

Written by Dr Nisreen Nakhoda, General Physician

Photograph via

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