Sjogren’s Syndrome

DISCLAIMER: The following information is a summary about Sjogren’s syndrome treatment as well as some general information about this medical condition. This is in no way meant to replace professional medical advice. If you feel sick or think you may have Sjogren’s syndrome you should always visit a doctor and have them assist you.

Overview

Sjogren’s syndrome is an immune system disorder that is identified by the two most common symptoms: dry mouth and dry eyes. 

Sjogren’s syndrome also coincides with immune system disorders like lupus and rheumatoid arthritis. In Sjogren’s syndrome, the moisture-secreting glands and the mucous membranes of your mouth and eyes are usually affected first. This results in decreased saliva and tears. 

Though you can develop Sjogren’s syndrome at any age, most people get diagnosed when they’re over 40. The condition is more common in women, but anyone of any gender can develop Sjogren’s syndrome. Sjogren’s syndrome treatment focuses on relieving symptoms. 

Symptoms

The two main symptoms of Sjogren’s syndrome are: 

  • Dry mouth. Your mouth may feel like it’s full of cotton which could make it difficult to speak or swallow. 
  • Dry eyes. Your eyes could burn, itch, or feel gritty as if sand is in them. 

Some people with Sjogren’s syndrome will also experience one or more of the following: 

  • Skin rashes or dry skin
  • Joint pain, swelling and stiffness
  • Persistent dry cough
  • Prolonged fatigue
  • Swollen salivary glands — particularly the set located behind your jaw and in front of your ears
  • Vaginal dryness

Complications

The most commonly occurring complications from Sjogren’s syndrome involve your eyes and mouth. 

  • Yeast infections. People who have Sjogren’s syndrome are more likely to develop oral thrush which is a yeast infection in the mouth.
  • Vision problems. Dry eyes can result in light sensitivity, corneal damage, and blurred vision. 
  • Dental cavities. Because saliva helps to protect the teeth from bacteria that cause cavities, if you have Sjogren’s syndrome you will be more prone to developing cavities due to the dry mouth. 

Less common complications could affect: 

  • Lymph nodes. A small percentage of those with Sjogren’s syndrome develop lymphoma (cancer of the lymph nodes). 
  • Lungs, kidneys, or liver. Inflammation can cause bronchitis; pneumonia or other lung issues; lead to cirrhosis or hepatitis in your liver, or lead to problems with kidney function.
  • Nerves. You could develop tingling, numbness, or burning in your feet and hands. 

Causes

Sjogren’s syndrome is an autoimmune disorder where your immune system will mistakenly attack your body’s tissues and cells. 

Scientists aren’t entirely sure why some people develop Sjogren’s syndrome. There are certain genes that put people at a higher risk of the disorder, but it does appear that a triggering mechanism (like infection with a particular virus or bacteria strain) is also necessary to develop Sjogren’s syndrome. 

In Sjogren’s syndrome, your immune system targets the glands that make tears and saliva first. However, it can also cause damage to other parts of the body including: 

  • Thyroid
  • Liver
  • Joints
  • Nerves
  • Lungs
  • Kidneys
  • Skin

Diagnosis

Because the signs and symptoms of Sjogren’s syndrome vary widely from person to person and are similar to those caused by other diseases, it can be difficult to diagnose. Side effects from various medications also mimic some of the signs and symptoms of Sjogren’s syndrome. 

Tests can help with ruling out other conditions and can also help to pinpoint a diagnosis of Sjogren’s syndrome. 

Blood tests

Your doctor may request blood tests that check for: 

  • Presence of antibodies common in Sjogren’s syndrome
  • Indications of problems with the kidneys and liver
  • Evidence of inflammatory conditions
  • Levels of different types of blood cells

Eye tests

Your doctor can measure the dryness of the eyes with a test called a Schirmer tear test. In this test, a small piece of filter paper is placed under the lower eyelids to measure tear production. 

A doctor that specializes in the treatment of eye disorders may also examine the surface of your eyes using a slit lamp which is a magnifying device. 

Imaging

There are certain imaging tests that can check your salivary gland function: 

  • Salivary Scintigraphy. This nuclear medicine test involves the injection of a radioactive isotope into a vein. This isotope is then tracked over an hour to see how long it takes to reach your salivary glands. 
  • Sialogram. This is a special X-ray that detects dye that is injected into the salivary glands in front of your ears. This procedure shows how much saliva is secreted into your mouth.

Biopsy

Your doctor could also do a lip biopsy to detect the presence of inflammatory cell clusters which can indicate Sjogren’s syndrome. For this test, a sliver of tissue gets removed from the salivary glands in your lip and then is examined under a microscope. 

Treatment

Sjogren’s syndrome treatment will depend on the parts of the body that are affected. Many people manage the dry eye and mouth symptoms by drinking more water and using over-the-counter eyedrops. Some individuals may need prescription medications or surgical procedures as Sjogren’s syndrome treatment. 

Medications

Depending on the symptoms you have, your doctor might suggest medications for Sjogren’s syndrome treatment that: 

  • Decrease eye inflammation. There are prescription eyedrops like Restasis or Xiidra that may be recommended for Sjogren’s syndrome treatment if you have moderate to severe dry eyes. 
  • Increase production of saliva. Drugs like Salagen (pilocarpine) and Evoxac (cevimeline) can increase the production of saliva and sometimes tears. 
  • Address specific complications. If you develop arthritis symptoms, your Sjogren’s syndrome treatment may benefit from nonsteroidal anti-inflammatory drugs or other arthritis medications.
  • Treat systemwide symptoms. Plaquenil (hydroxychloroquine), a medication which is designed to treat malaria is helpful in Sjogren’s syndrome treatment. You may also be prescribed a drug such as Trexall (methotrexate) that suppresses the immune system. 

Surgery

Punctal occlusion is a minor procedure used in Sjogren’s syndrome treatment. It seals the tear ducts that drain tears from your eyes. Silicone or Collagen plugs are inserted into the ducts to help preserve your tears.