Sjogren’s Ailment

Overview

Women area unit ninefold a lot of probably than men to develop Sjögren’s syndrome, achronic, incurable disorder in whichimmune system cells attack and destroy the glands that manufacture wet. Sjögren’s (pronounced “show-grins”) can occur at any age, but a woman is at higher risk for developing the condition after menopause.

The Sjögren’s Syndrome Foundation estimates that four million Americans suffer from this disorder; many go undiagnosed.

The syndrome, named when Swedish specialist Henrik Sjögren, is an autoimmune disorder—a disorder in which your immune system attacks your body’s healthy tissues. Ordinarily, the immune system produces antibodies and cells that target such destructive material as viruses and bacteria. In the case of Sjögren’s and alternative response diseases, the system produces autoreactive cells and autoantibodies, which turn against the part of the body they should protect.

Types of Sjogren Syndrome: Primary and Secondary
Sjögren’s syndrome might occur alone (referred to as primary Sjögren’s syndrome), or it’s going to be related to alternative autoimmune/rheumatic diseases, such as rheumatoid arthritis, lupus, polymyositis and scleroderma. When Sjögren’s occurs with another autoimmune disease it is called secondary Sjögren’s syndrome.

Symptoms of Sjogren Syndrome

Common Symptoms

The hallmark symptoms of Sjögren’s area unit dry eyes and dryness. The disorder might also cause skin, nose and canal condition, and it can affect other organs of the body as well, including your skin, lungs, gastrointestinal tract, liver, pancreas, kidneys,thyroid, joints, muscles, blood, blood vessels, brain, spinal cord and peripheral nerves.

Inadequate tear production may result in eye irritation and a sense of getting grit or sand in your eyes. The lack of saliva generally causes dry mouth (xerostomia); this can lead to difficulties with speech and swallowing food, extensive tooth decay, tooth loss, oral sores and fungal infections in the mouth. If dryness is difficult at midnight, it will cause sleep issues through a cycle of augmented fluid intake and augmented excretion. The salivary glands may enlarge to produce visible swelling, particularly below the ears at the angle of the jaw; this swelling may be confused with mumps.

Another problem is that the quality of the saliva that is produced is not as good, predisposing you to problems related to oral bacteria. Saliva is that the main protecting issue for the higher epithelial duct tract––the mouth, pharynx and esophagus. Salivary proteins facilitate stop tooth decay; repair wounds or ulcers within the soft tissue layer tissues; kill bacterium, certain fungi and some viruses; and permit proper swallowing of food. Saliva also facilitates your ability to taste and to speak. All of those functions are often littered with Sjögren’s.

Impact of Sjogren Syndrome on Salivary Glands
Salivary glands are a prime target of Sjögren’s. They are composed of two parts, the acinar region or secretory end piece and the ductal region. Acinar cells are the site of fluid secretion, and they are responsible for making and secreting more than 85 percent of the proteins involved in producing saliva. Ductal cells cannot secrete fluid. In Sjögren’s, autoreactive lymphocytes (a type of white blood cell) infiltrate and destroy the glandular tissue.

Severe Symptoms
In severe cases, Sjögren’s can damage vital organs. Symptoms vary, as this is a disease of many manifestations. The symptoms might level out, worsen or go into remission (disappear for a while). Some folks expertise solely the gentle symptoms of dry eyes and mouth, while others experience cycles of good health followed by severe disease. Many patients area unit able to treat issues symptomatically, but others must cope with blurred vision, constant eye discomfort, recurrent mouth infections, swollen parotid glands (the salivary glands near the ears), hoarseness, difficulty in swallowing and eating, bronchitis and other pulmonary disorders, debilitating fatigue and joint pain. Also, there is a slightly elevated risk of lymphoma in people with Sjögren’s.

Risks for Pregnant Women with Sjogren Syndrome
An antibody to the supermolecule SS-A/Ro, found in girls with Sjögren’s syndrome, will terribly seldom be related to inborn atrioventricular block and babe lupus in newborn babies. If you have Sjögren’s syndrome and plan to become pregnant, see your health care professional about testing for this marker and deciding what to do if the marker is present.

Diagnosis

No single gene, microorganism or hormone is known to cause Sjögren’s syndrome. As a result, diagnosis is often difficult. Its symptoms can mimic those of other diseases, and no two people with Sjögren’s syndrome have exactly the same set of symptoms or medical history. Moreover, individual symptoms may be reported to different health care professionals—such as dry mouth to the dentist or dry eyes to an optometrist—so the condition often goes undiagnosed. In fact, the average time from the onset of Sjögren’s symptoms to diagnosis is over six years.

Once Sjögren’s is suspected, an in depth history and physical communication, blood tests for autoantibodies, tests to see the degree of dry eye and mouth, and typically duct gland biopsies, can point to the presence of Sjögren’s.

Symptoms can include:

• Dry mouth. If you have Sjögren’s syndrome, you produce far less saliva than normal. This makes manduction, swallowing and speaking difficult, and it may diminish your sense of taste as well as produce halitosis, or bad breath.
• Dry eyes. Your eyes could feel dry and gritty—they may burn and switch red and be extre ME ly sensitive to daylight. A thick substance could accumulate within the inner corner of your eyes whereas you sleep. If not properly treated, Sjögren’s syndro me can so metimes lead to ulcers of the cornea. On rare occasions, this can cause loss of vision.
• Swollen salivary glands. Two sets of major salivary glands produce saliva. They are under your tongue and in the cheeks in front of your ears. They may feel swollen and tender.
• Saliva fights bacteria and defends against cavities. If you have Sjögren’s syndrome, your saliva will be decreased, and your teeth may develop cavities more easily.
• Dry nose, throat and lungs. Your throat feels dry and tickly, and you may have a dry cough, hoarseness, a decreased sense of smell and nosebleeds. Sjögren’s can also lead to pneumonia, bronchitis and ear problems.
• Vaginal dryness. Because Sjögren’s can affect the me chanisms for secreting vaginal fluids, you may find sexual penetration difficult.
• Fatigue. Sjögren’s may cause you to tire more easily or feel an underlying fatigue. Fatigue is also frequently a symptom of other autoimmune disorders, such as rheumatoid arthritis or lupus.
• Joint pain. If the immune system attack spreads to the joints, move me nt of fingers or other joints can become difficult or painful. Joint involvement may indicate you have another autoimmune disorder, such as rheumatoid arthritis or lupus.
• Other problems. Sjögren’s syndrome will have an effect on alternative elements of the body, such as blood vessels, the nervous system, muscles, skin and other organs. This can cause muscle weakness, confusion and me mory problems, dry skin and feelings of numbness and tingling. Sjögren’s syndrome can also affect the liver and spleen. People with Sjögren’s also have a slightly increased risk of developing lymphoma (cancer of the lymphocytes). Although this is unusual, it is another reason why medical exams and continued follow-up are critical.

With such a broad array of symptoms, in varying severity from patient to patient, diagnosis can be difficult. You and your health care professional may go through several steps before confirming the diagnosis of Sjögren’s syndrome.

• Medical history and physical examination. Your health care skilled can most likely raise you to explain your symptoms. He or she will then look for other signs of Sjögren’s, such as red, itchy eyes; swollen salivary glands; a dry, cracked tongue; and enlarged salivary glands in your neck. You’ll also want to discuss what me dications you are taking—both prescription and over-the-counter, because many medications can cause dryness of the mouth and eyes.
• Blood tests. Antinuclear antibodies ( ANA ), a group of antibodies that react against normal components of a cell nucleus , may be found in patients with Sjögren’s syndrome, as well as the antibodies SS-A (or Ro) and SS-B (or La). However, not everyone with Sjögren’s has these markers, and not everyone with these markers has Sjögren’s syndrome.
• Schirmer test. This helps determine how dry your eyes are. It involves putting atiny low piece of paper beneath your lower protective fold to live tear production.
• Rose Bengal and Lissamine Green and sodium fluorescein. These dyes are used to detect dry spots on the surface of the eye.
• Salivary gland biopsy. In this check, the health care professional removes a few minor salivary glands, usually from inside your lower lip. The tissue is examined under a microscope. The appearance of the tissue helps verify if you’ve got Sjögren’s syndrome.
• Salivary function tests. To measure the number of spittle you turn out over a particular time, your health care skilled could order tests like a secretion scintigraphy, that involves injection of a radioactive isotope, or a sialography, an x-ray of the salivary-duct system that shows how much saliva flows into your mouth. He or she may also order a spit test, during which you spit into a test tube every minute for 15 minutes, to measure your saliva production.
• Urine tests. These may be done to test your kidney function.
• Chest x-ray. This can help detect inflammation in the lungs.

Treatment

There is no cure for Sjögren’s syndrome, and no treatment has yet been found to restore physiological glandular secretions. This means that treatment primarily addresses the symptoms and is meant to alleviate your discomfort and reduce the consequences of condition. Put another way, you can generally learn to manage your condition, but the root problems will remain. You may be referred to a rheumatologist for treatment.

Sjögren’s syndrome can affect various parts of your body, so regular checkups can help detect and prevent future problems. And if you have secondary Sjögren’s syndrome—that is, if the disorder is associated with another autoimmune condition—be sure to follow treat me nts for that condition.

Since Sjögren’s syndrome affects everybody otherwise, your treatment set up are going to be supported your specific desires. But generally, moisture-replacement therapies could ease the symptoms of condition. In some cases, your health care skilled could suggest an easy procedure that blocks tear emptying from your eyes.

Dry eyes reply to the utilization of artificial tears or to medicine stimulation of tear production. Dry mouth are often alleviated by potable, chew sugar-free gum or mistreatment artificial spittle or spittle stimulants (such as alkaloid and cevimeline). Wearing protecting eyewear, like specs, or using a humidifier to keep moisture in the air can be helpful.

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, may be used to treat musculoskeletal symptoms. If you have got severe complications, your health care skilled could bring down corticosteroids and/or immunological disorder medication.

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, may be used to treat musculoskeletal symptoms. If you have severe complications, your health care professional may prescribe corticosteroids and/or immunosuppressive drugs.

Here’s an overview of some of the most commonly used medications:

• NSAIDs can suppress inflammation and reduce pain. Sjögren’s patients ar usually prescribed NSAIDs for joint pain, muscle ache, fever and fatigue. However, NSAIDs offer no improvement within the secretion or tear flow.
• Corticosteroids could also be used if you have got viscus involvement, that is rare. If you have secondary Sjögren’s syndrome, you may already be on corticosteroids––especially if the primary condition is lupus or rheumatoid arthritis. The aspect effects are often vital, therefore you and your health care skilled got to monitor each the effectiveness and attainable aspect effects of the medication.
• Hydroxychloroquine (Plaquenil), an antimalarial drug, is sometime used to relieve swelling, stiffness and pain. It may also have a limited effect on the glandular symptoms, the hallmark of the disease.
• Immunomodulating agents ar sometimes utilized in response diseases like Sjögren’s. These medications act very slowly, so they don’t bring about immediate relief. As with corticosteroids, these immunomodulating agents are generally used when there is internal organ involvement. These agents can include:
  • Methotrexate (Trexall) is a folic-acid inhibitor generally used to treat rheumatoid arthritis and may be prescribed in rare cases for Sjögren’s patients with internal organ involvement.
  • Cyclophosphamide (Cytoxan) is significantly less assailable than amethopterin and is reserved for the foremost serious organ involvement. Other medication used for severe organ involvement embrace mycophenolate (CellCept) and medication (Azasan, Imuran).
  • Antifungal drugs, such as nystatin (Bio-Statin) may be used to treat oral candidiasis (a common fungal infection).
  • Pilocarpine (Salagen) and cevimeline (Evoxac) tablets may be used to increase salivary flow. Evoxac, however, should not be used for those with a number of other conditions, including asthma and acute angle glaucoma. Higher doses of both of these medications may have significant side effects including flushing, sweating, nausea, vomiting and diarrhea, among others.
• Saliva substitutes such as Oasis Mouth Moisturizing Spray, Mouth Kote spray and Biotene mouth spray and gel, can be used to replace oral secretions.
• Artificial tears or eyedrops can help relieve the discomfort of dry eyes. You probably want to use preservative-free products, especially if you apply the drops frequently. These products include Tears Naturale Free and Bion Tears. (Note: Some over-the-counter eyedrops contain vasoconstrictors and can cause further drying.)
• Cyclophosphamide (Cytoxan) is significantly less assailable than amethopterin and is reserved for the foremost serious organ involvement.
• Hydroxypropyl cellulose (Lacrisert), a small dissolvable cellulose pellet that fit into your lower eyelid, may also be helpful in the treatment of dry eyes. Lacrisert is also only available by prescription.

Prevention

Sadly, there’s no known way to prevent the onset of Sjögren’s syndrome. However, the symptoms are often treatable, and you can develop strategies for keeping some symptoms at bay.

Early diagnosis and intervention may slow the progress of Sjögren’s syndrome and prevent complications. All too typically, the condition goes undiagnosed and symptoms continue to worsen. Since Sjögren’s syndrome can affect many parts of the body, regular checkups can help detect and prevent problems. You and your health care skilled ought to meet oftentimes to debate your treatment strategy to stay the condition from worsening.

A healthy diet is an element of taking care of yourself beneath any circumstances, and it’s doubly important if you have Sjögren’s. You should most likely avoid alcoholic and caffeinated beverages as a result of they will be dehydrating. Spicy and acidic food will irritate your mouth, and sugary food can promote tooth decay.

Of course, get lots of rest and avoid tobacco and (when possible) stress. Mild exercise, such as walking or swimming, can help keep joints and muscles flexible. Exercise may also protect against further joint damage. Warm compresses or heating pads can help ease joint or gland pain.

Keeping your mouth moist is important. Artificial moisture can help. Methylcellulose swabs or spray might facilitate alleviate mouth waterlessness and lower your risk of ulcers. Sipping sugar-free fluids throughout the day might facilitate, too, further as sugar-free gum or candies, that stimulate secretion production. Use artificial tears or eyedrops to relieve the discomfort of dry eyes. Medications such as Salagen and Evoxac may improve saliva production, and eyedrops containing cyclosporine A (Restasis) may improve tear production.

Practicing good oral hygiene is essential. Frequent dental checkups, fluoride and mouth rinses, regular brushing with antibacterial toothpastes and flossing are more important for Sjögren’s patients, since you are at a higher risk for tooth decay.

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Here are other coping strategies that can help moderate your symptoms.

• Don’t smoke; avoid tobacco smoke and other air irritants.
• Use self-adhesive stamps and envelopes.
• Don’t direct hair dryers toward your eyes.
• Wear glasses on windy days and goggles when swimming.
• Coat your lips with petroleum-based lubricants to prevent drying. (Many lipsticks can also provide this protection.)
• Keep your home humidity between 30 percent and 50 percent. You may want to use a humidifier year-round. Some experts advise using a cool-mist, ultrasonic humidifier; be sure to clean it daily.
• Avoid rubbing your eyes.
• If you have nasal and airway dryness, consider using a soft cervical collar while you sleep to help prevent your mouth from opening, thus preventing the dryness that mouth breathing causes.
• Avoid abrasive detergents, soaps and, in some cases, dryer sheets.
• Consider soft contact lenses rather than the traditional hard ones. Many patients with Sjögren’s are unable to wear contact lenses.
• Avoid prolonged hot showers or baths.
• Talk to your health care professional about discontinuing your use of decongestants and antihistamines because they dry your mouth and nasal areas.
• Use sunscreen.
• Apply lotions or other lubricants to still-damp skin right after you bathe or shower.
• Frequent small sips of water—or sucking on ice chips—can help keep your lips and gastrointestinal tract hydrated.
• Avoid drafts from air conditioners, heaters and radiators, when possible.
• If you have vaginal dryness, use lubricants made specifically for that purpose.

Finally, experts stress the importance of mental and emotional health. Joining a self-help or support group can help you cope emotionally, as well as teach you new strategies for managing your disease.

Facts to Know

1. Women are nine times more likely than men to develop Sjögren’s (pronounced “show-grins”) syndrome, a chronic, incurable disorder in which immune system cells attack and destroy the glands that produce tears and saliva. Sjögren’s can occur at any age, but women are at higher risk after menopause.
2. The hallmark symptoms of Sjögren’s square measure dry eyes and xerostomia. The disorder may also cause skin, nose and vaginal dryness, and, in rare cases, affect other organs of the body as well, including your kidneys, blood vessels, lungs, liver, pancreas and brain
3. The Sjögren’s Syndrome Foundation estimates that four million Americans suffer from this disorder; many go undiagnosed.
4. The syndrome, named after Swedish ophthalmologist Henrik Sjögren, is an autoimmune disorder, which means that your immune system attacks your body’s healthy tissues. Ordinarily, the immune system produces antibodies that target such destructive material as viruses and bacteria. In the case of Sjögren’s and alternative response diseases, autoantibodies—antibodies turned against the self—are produced.
5. Sjögren’s syndrome may occur alone (primary Sjögren’s syndrome), or it may be a symptom of other autoimmune/rheumatic diseases, such as rheumatoid arthritis, lupus, polymyositis and some forms of scleroderma (secondary Sjögren’s syndrome).
6. A blood marker often found in women with Sjögren’s syndrome can, very rarely, be associated with heart problems or neonatal lupus in newborn babies. If you have Sjögren’s syndrome and plan to become pregnant, see your health care professional about testing for this marker and deciding what to do if the marker is present.
7. There is no cure for Sjögren’s syndrome, and no treatment has yet been found to restore total glandular secretions. This means that treatment addresses the symptoms only and is designed to relieve your discomfort and lessen the effects of dryness. Put another way, you can generally learn to manage your condition, but the root problems will remain.
8. Much about Sjögren’s is still unknown. Certain genes seem to put people at a higher risk for the disorder, but scientists think some sort of a trigger—such as a virus or bacteria—is also necessary to bring it on. Unfortunately, there’s no way to prevent the onset of Sjögren’s syndrome. However, the symptoms are often treatable, and you can develop strategies for keeping some symptoms at bay.
9. A healthy diet is part of taking care of yourself under any circumstances, and it’s doubly important if you have Sjögren’s. You should probably avoid alcoholic and caffeinated beverages because they are dehydrating. Spicy and acidic food can also irritate your mouth, and sugary food can promote tooth decay.
10. Since Sjögren’s syndrome affects everybody otherwise, your treatment plan will be based on your specific needs. In general, moisture-replacement therapies could ease the symptoms of status. In some cases, your health care skilled could advocate a straightforward operation that blocks tear evacuation from your eye.

Key Q&A

1. Who gets Sjögren’s syndrome? Am I at risk?Who gets Sjögren’s syndrome? Am I at risk?Women are nine times more likely to develop Sjögren’s syndrome than men, and the disorder occurs sometimes in connection with another autoimmune disease, such as rheumatoid arthritis, lupus or scleroderma. Women are at higher risk for developing Sjögren’s after menopause. And the disorder sometimes runs in families. Other than those, there are not any clear risk factors for predicting UN agency can get Sjögren’s.
2. How can I prevent the disease?Researchers haven’t found any special dietary tips or style modifications which will obviate the onset of Sjögren’s. The best which will be done is to diagnose the sickness as early as doable and begin aggressive treatment to do to forestall worsening of symptoms.
3. Why is Sjögren’s called an autoimmune disease?Ordinarily, the immune system produces antibodies that target such destructive material as viruses and bacteria. In the case of Sjögren’s and different reaction diseases, autoantibodies—antibodies that flip against the a part of the body they ought to protect—are made. With Sjögren’s, immune-system cells attack and destroy the glands that turn out tears and spittle.
4. What are the symptoms of Sjögren’s?The hallmark symptoms of Sjögren’s ar dry eyes and xerostomia. The disorder may also include skin, nose and vaginal dryness, as well as swollen salivary glands, joint pain and fatigue.
5. I have dry mouth and dry eyes. Do I really need to see a health care professional, or can I just use artificial tears and sip water?Early diagnosis and a systematic treatment plan are essential for slowing the disease’s progress. Sjögren’s syndrome will have an effect on different components of the body, like blood vessels, the nervous system, muscles, skin and other organs. This can cause muscle weakness, confusion and memory issues, dry skin and feelings of numbness and tingling. When Sjögren’s syndrome affects other organs, there is a greater chance for developing cancer of the lymph tissue. Although this is unusual, it is another reason why medical exams and continued follow-up are critical.
6. How is Sjögren’s syndrome diagnosed?Once Sjögren’s is suspected, blood tests for autoantibodies, tests to determine the degree of dry eye and mouth and sometimes salivary gland biopsies can point to the presence of Sjögren’s.
7. Is it safe to get pregnant if I have Sjögren’s?A blood marker often found in women with Sjögren’s syndrome can, very rarely, be associated with heart problems or neonatal lupus in newborn babies. If you have Sjögren’s syndrome and plan to become pregnant, see your health care professional about testing for this marker and deciding what to do if the marker is present.
8. What treatments are available for Sjögren’s?Artificial tears, which are sold under many brand names, combat dry eyes, and saliva substitutes (such as Oasis Mouth Moisturizing Spray, Mouth Kote spray and Biotene mouth spray and gel) combat dry mouth. If you need to use artificial tears more than four times a day, it is best to use preservative-free drops because preservatives can irritate dry eyes. Talk to your health care skilled before exploitation any of those merchandise. Cyclosporine A (Restasis) eyedrops decrease inflammation and are also used to increase tear production. Unlike artificial tears, these are available only by prescription. Over-the-counter lubricating merchandise also are out there to handle epithelial duct, skin and nasal dryness. Pilocarpine (Salagen) or cevimeline (Evoxac) tablets could also be prescribed to extend secretion flow. If symptoms include joint pain, muscle ache, fever and fatigue, nonsteroidal anti-inflammatory drugs such as aspirin or ibuprofen may be prescribed or recommended. In a case of organ involvement, your health care skilled could advocate a lot of aggressive treatments, like corticosteroids and/or immunomodulating agents.