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Sjögren’s Syndrome

With April being Sjögren’s Syndrome Awareness Month, More Than Lupus deemed it pertinent to convey information on this illness, its relationship to lupus, and what everyone should know about this incurable syndrome.



Below are some of the things everyone should be aware of if they have been diagnosed with this illness or suspect they may be living it.


Sjögren’s syndrome (pronounced show-grins) is an autoimmune disease that primarily affects women over the age of 40; however, Sjögren’s can impact women or men of all ages, as well as all racial and ethnic groups. Millions suffer from Sjögren’s in the United States, making it one of the most common autoimmune disorders in America.


In Sjögren’s, the immune system (the body’s natural defense system) attacks the moisture-producing glands in the body. This process can destroy these glands causing painfully dry eyes and mouth. Sjögren’s can also present as dryness of the skin, vagina, and nose. Moreover, it can affect the kidneys, lungs, blood vessels, gastrointestinal tract, liver, pancreas, and central nervous system.


The Lupus and Sjögren’s Connection

When Sjögren’s syndrome occurs by itself, it is classified as primary Sjögren’s. If Sjogren’s occurs when a patient already has been diagnosed with another connective tissue or autoimmune disease such a lupus or rheumatoid arthritis, it is classified as Secondary Sjögren’s.


One thing that has been increasing clear is that autoimmune conditions like lupus and Sjögren’s like to “party together.” It is not uncommon to develop more than one lupus “overlap” disease. However, the challenge is differentiating between what symptoms are caused by lupus and what are caused from Sjögren’s. For instance, both lupus and primary Sjögren’s syndrome may cause rashes, arthritis, and kidney disease. Both diseases can cause a positive ANA or antinuclear antibody, SSA-SSB antigens, and similar genetic variants present in the blood.


Diagnosis

If you suspect you are suffering from Sjögren’s, reach out to a medical professional. Your doctor will want to conduct a thorough medical history and physical exam. If you are under the care of a Primary Care Physician, he or she most likely will refer you to a rheumatologist.

A rheumatologist is a doctor who specializes in diagnosing and treating rheumatic diseases. A rheumatic disease is an illness, condition, or disorder that involves pain and inflammation in the tissues of the body.


If you are already under the care of a rheumatologist, he or she will most likely test certain markers in your blood. The tests below are used to detect antibodies associated with Sjögren’s syndrome:

  • Rheumatoid Factor (RF)

  • Antinuclear Antibodies (ANA)

  • Sjögren’s Syndrome-associated antigens A and B (SSA and SSB) also known as (RO and LA)

If these tests lean towards a diagnosis, your doctor may also have you see a ophthalmologist. This is a type of eye doctor that specializes in the study and treatment of diseases of the eye. An ophthalmologist will also perform a thorough examination looking for these symptoms:

  • Very dry eyes

  • Burning or stinging in the eyes

  • Blurry vision

  • Being very sensitive to light

  • Blepharitis(inflamed eyelid margins)

In addition, he or she may perform what’s called a Schirmer's test. This is when the tip of a small strip of paper is inserted under the eyelid to measure the amount of tears are produced over a 5 minute time period. A dye test may be used as well to color your tears and allow your doctor to see how quickly your tears dry up. Also, an ophthalmologist may press on the tiny glands in your eyelids. These are called meibomian ("my-BOH-me-un") glands, and they produce oil for your tears. (Yes, your tears are made up of oil AND water). There are about 25 to 40 meibomian glands in the upper eyelid and 20 to 30 in the lower eyelid. If your meibomian glands are swollen and blocked, they may not produce tears. Enlarged pictures may be taken of your meibomian glands to enable the doctor to see exactly where the blockages are and the extent of the dysfunction.


Treatment:

Treatment for Sjögren’s syndrome depends entirely on what parts of the body are affected. For instance, if your meibomian glands are affected, a minor procedure to seal the tear ducts that drain tears from your eyes (punctal occlusion) might help relieve your dry eyes.

Many people are able to manage the dry eyes by using artificial tear drops. But, some people need prescription medications.


Some medications include:

  • Eye drops such as cyclosporine (Restasis) or lifitegrast (Xiidra)

  • Drugs such as pilocarpine (Salagen) and cevimeline (Evoxac) can increase the production of saliva, and sometimes tears.

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) or other arthritis medications if you also have inflammation in other parts of the body.

  • Hydroxychloroquine (Plaquenil), is often helpful in treating Sjogren's syndrome. Drugs that suppress the immune system, such as methotrexate (Trexall), also might be prescribed.

If you are looking for some things you can do to be proactive with your Sjögren’s syndrome, consider these self-care measures:


For dry mouth:

  • Don't smoke.

  • Increase your fluid intake.

  • Stimulate saliva flow by chewing sugarless gum or sugar-free candy.

  • Try artificial saliva. Saliva replacement products lubricant your mouth.These products come as a spray or lozenge.

  • Use nasal saline spray if you experience a dry nose as well. It will help with breathing through your nose and not your mouth, which only makes your mouth more dry.

For dry eyes:

  • Use artificial tears, or an eye lubricant.

  • Increase humidity and try to reduce your exposure to air directly in your eyes or mouth like from a fan or air conditioner.

  • Try warm compresses.

  • Try taking Omega-3 supplements.

For oral health:

  • Dry mouth increases your risk of dental cavities and tooth loss. To help prevent those types of problems:

  • Brush your teeth and floss after every meal (dry mouth increases cavity risk and tooth loss).

  • Schedule regular dental appointments.

  • Use daily topical fluoride treatments and antimicrobial mouthwashes.

  • Try a mineral paste on your teeth like MI Paste Plus.

For other areas of dryness:

  • For dry skin: avoid hot water when you bathe and shower. Regularly apply moisturizer and use rubber gloves when doing dishes or house cleaning.

  • For vaginal dryness: use moisturizers and lubricants.

Conclusion:

While there is no known cure for Sjögren’s syndrome, many of the symptoms can be treated with simple corrective measures. For more information and support, please visit these websites:


Sjögren’s Syndrome Foundation

The American College of Rheumatology

The Arthritis Foundation

The Lupus Foundation of America



Article By:

Kelli Roseta


**All resources provided by this blog are for informational purposes only, not to replace the advice of a medical professional. Kelli encourages you to always contact your medical provider with any specific questions or concerns regarding your illness. All intellectual property and content on this site and in this blog is owned by morethanlupus.com. This includes materials protected by copyright, trademark, or patent laws. Copyright, More Than Lupus 2019.


Sources:

https://www.aao.org/eye-health/diseases/sjogren-syndrome-diagnosis

https://www.mayoclinic.org/diseases-conditions/sjogrens-syndrome/diagnosis-treatment/drc-20353221

https://www.sjogrens.org/

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