A guide to Sjogren’s syndrome, an autoimmune disease that causes certain parts of the body to malfunction.
Sjogren’s syndrome is an autoimmune disease where the patient’s tear ducts (lachrymal) and salivary glands stop working. Like all autoimmune diseases, it is the result of the body’s immune system failing to recognise the body’s tissues as its own. This causes the body’s natural defences against invading organisms to suddenly begin to attack healthy tissue.
Sjogren’s syndrome can either occur on its own (primary Sjogren’s syndrome) or coexist with another autoimmune disease (secondary Sjogren’s syndrome), such as rheumatoid arthritis, scleroderma or lupus.
Signs and Symptoms
In Sjogren’s syndrome, the body first targets the moisture-secreting glands of your eyes and mouth. Once attacked, these exocrine glands (glands that secrete substances through a duct) stop working properly, causing some of the disease’s hallmark symptoms such as dry eyes (keratoconjunctivitis sicca) and dry mouth (xerostomia).
Patients with dry eyes may experience a burning, itchy or gritty sensation. Dry eyes can lead to light sensitivity, blurred vision and corneal ulcers. In cases of dry mouth, your mouth may feel like it’s full of cotton,making it difficult for you to speak or swallow. You may have to drink water very often throughout the day.
Other symptoms of Sjogren’s syndrome are:
- Swollen salivary glands
- Persistent dry cough
- Swelling and inflammation of joints
Unfortunately, there is no known means of curing the disease or even preventing its occurrence. The number of factors associated with the progression of the disease makes it difficult to understand both its causal mechanism as well as the possible risk factors.
Current medical knowledge suggests that a patient must first be genetically predisposed to the disease and, secondly, be struck by a specific type of virus or strain of bacteria. The presence of the virus in the patient’s body starts an overreaction of various immune cells, which in turn causes the body’s immune system to start attacking itself.
Although you can develop Sjogren’s syndrome at any age, most people are above 40 at the time of diagnosis. For reasons unknown to modern science, Sjogren’s syndrome is more common among women. However, this tendency is not unique to Sjogren’s syndrome; autoimmune diseases in general tend to affect more females than males. Hormonal issues such as the presence of oestrogen in women could be a factor. Exposure to mutagens — a physical or chemical substance that causes a genetic mutation — could also increase one’s risk of developing Sjogren’s syndrome.
The most common complications of Sjogren’s syndrome involve the eyes and the mouth.
- Dental Cavities
As saliva protects the teeth from cavity-causing bacteria, a dry mouth puts you at greater risk of developing cavities.
- Yeast Infections
Sjogren’s syndrome sufferers tend to be prone to oral thrush, a yeast infection of the mouth.
- Vision Issues
Dry eyes can lead to light sensitivity, blurred vision and corneal ulcers.
Although less common, the disease can have an impact on:
- Lungs or Kidneys Inflammation may cause conditions called interstitial lung disease or interstitial nephritis.
- Lymph Nodes A small number of people with Sjogren’s syndrome will develop cancer of the lymph nodes (lymphoma).
- Nerves Numbness, tingling and burning in your hands and feet (peripheral neuropathy) may occur. Rarely, the spinal cord may be inflamed or the brain may be affected.
Diagnosis and Treatment
It can be tricky to diagnose Sjogren’s syndrome because the signs and symptoms vary from person to person and can be similar to those caused by other diseases. Your doctor may carry out blood tests to check for antibodies (common in Sjogren’s syndrome) as well as inflammation. An inner lip biopsy may be done to check for clusters of inflammatory cells, which can indicate the presence of the disease.
Although there is no cure, a lot can be done to manage the symptoms. Some of these include non-prescription medications, such as artificial tears. There are also eye gels you can use. The feeling of a persistently dry mouth, in turn, can be assuaged through the use of certain mouthwashes, gels and toothpaste. Sucking on sugar-free sweets, eating more fibrous foods and frequent sips of water can stimulate saliva flow. For dry eyes, people find using a humidifier or vapouriser at night helpful. These can also help with your dry mouth or nose. For a dry nose, try a nasal saline or gel. If dry skin is a problem, use warm water — not hot — when you shower, and apply moisturiser frequently.
Depending on the severity of your symptoms, your doctor may suggest medications that:
- Boost Saliva Production
There are drugs that can increase the output of saliva and sometimes tears. These may have side effects like sweating, abdominal pain, flushing and more urination.
- Alleviate Specific Complications
If you develop symptoms of arthritis, your rheumatologist may prescribe nonsteroidal anti-inflammatory drugs or other arthritis medications. Prescription eye drops may be required if over-the-counter drops don’t work too well. Yeast infections in the mouth can be successfully addressed with antifungal medications.
- Address Systemwide Symptoms
Drugs that suppress the immune system may be prescribed — usually only when the illness is severe and affects major organs. These drugs, known as immunosuppressants, may weaken the patient’s immune system, making it more likely that he/she will get infections.
To relieve dry eyes, you may consider undergoing a minor surgical procedure to seal the tear ducts that drain tears from your eyes (punctal occlusion). Collagen or silicone plugs are inserted into the ducts for a temporary closure. Collagen plugs eventually dissolve, but silicone plugs stay in place until they fall out or are removed. Alternatively, your doctor may use a laser to permanently seal your tear ducts.
Everyone’s experience of the disease is different. Learning that you have a lifelong disease is worrying. However, you can take heart in the knowledge that most people with Sjogren’s syndrome are able to stay healthy and lead normal lives.