Introduction:
Between 400,000 and 3.1 million adults have Sjögren’s syndrome. This condition can affect people of any age, but symptoms usually appear between the ages of 45 and 55. It affects ten times as many women as men.
Definition:
Sjogren’s syndrome is an autoimmune disease that causes your immune system to attack the glands that make tears and saliva. This causes a dry mouth and dry eyes.
Types:
- Primary: Sjögren’s syndrome occurs in people with no other rheumatic disease.
- Secondary: Sjögren’s occurs in people who have another rheumatologic disease, most often systemic lupus erythematosus and rheumatoid arthritis.
Pathogenesis:
The cause of Sjögren’s syndrome is still ambiguous.
The decrease in tears and saliva seen in Sjögren’s syndrome occurs when the glands that produce these fluids are damaged by inflammation.
Genetic, viral, and immune factors are suspected as causes for this disease.
Symptoms:
-Irritation, a gritty feeling, or painful burning in the eyes.
-Dry mouth (or difficulty eating dry foods) and swelling of the glands around the face and neck.
-Swallowing difficulty and symptoms of acid reflux are also common.
-Dryness in the nasal passages, throat, vagina, and skin.
Diagnosis:
Diagnosis requires a thorough questioning of the patient, physical examination, and blood tests.
- Specific tests can detect any decrease in tear or saliva production.
But, dry eyes and mouth can be caused by many other conditions or medications. Further investigation is necessary in these cases.
- Blood tests can determine the presence of antibodies (immune system proteins that help destroy foreign invaders) typical of the disease. Typical antibodies include anti-nuclear antibodies (ANA), anti-SSA and SSB antibodies, or rheumatoid factor, but these are not always present.
- Biopsies of saliva glands can help to make a diagnosis.
Treatment:
Treating Sjögren’s syndrome is aimed at relieving symptoms of dry eyes and mouth and preventing and treating long-term complications.
- Dry eyes usually respond to artificial tears applied regularly during the day or to gels applied at night.
- Water, chewing gum, or saliva substitutes help relieve dry mouth. Some medications that stimulate saliva flow can also be helpful.
- Humidifiers and nasal saline irrigation could help improve nasal dryness.
- Medications that reduce gastric acid (such as proton-pump inhibitors and H2 blockers) may lessen symptoms of acid reflux.
Complications:
Most of the complications of Sjögren’s syndrome occur because of decreased tears and saliva.
- Dry eyes increase the risk for infections around the eye and can lead to damage to the cornea.
- A dry mouth can increase the risk of dental decay, gingivitis, oral yeast infections that may cause pain and burning. Some patients have episodes of painful swelling in the saliva glands around the face.
Complications can also affect the rest of the body:
- Pain and stiffness in the joints with mild swelling may occur in some patients, even in those without rheumatoid arthritis or lupus.
- Rashes on the arms and legs can be caused by an inflammation in small blood vessels (vasculitis) and inflammation in the lungs, liver, and kidney.
- Numbness, tingling, and weakness.
In a small number of people, Sjögren’s syndrome may be associated with lymphoma, a cancer of the lymph glands.
Conclusion
Sjögren’s syndrome is manageable. Patients can live normal lives after making small changes.
Dealing with disease mostly means dealing with dry eyes and mouth.
Patients should see their physician regularly for general and dental health check-ups to prevent complications.
