Sjögren’s disease is a chronic, autoimmune disease. Sjögren’s presents with dry eyes and dry mouth. Inflammation of the tear ducts and saliva glands cause dryness and irritation. Other common symptoms include joint and muscle pain, fatigue, and rashes. Less commonly, it can affect internal organs such as the lungs, gastrointestinal tract, kidneys, and nervous system. Sjögren’s affects women about 10 times more often than men and usually occurs between 45 and 55. Symptoms can range, but patients can often lead a normal life. Rarely, it can cause complications like an increased risk of lymphoma, a type of cancer.
Signs/Symptoms
Dry eyes and dry mouth are common symptoms of Sjögren’s. The eyes may turn red, burn, or feel gritty like sand in your eyes. It may be hard to eat dry foods or swallow because of lack of saliva. Glands of the neck or face may swell up. Other symptoms include dryness of skin, vagina, nasal passages and throat; heartburn; joint and muscle pains; fatigue; and rashes. Because of chronic dryness, patients may be at risk for eye infections or cornea damage, tooth decay or gum disease, and vaginal yeast infections.
Diagnosing Sjögren’s includes a physical exam, blood tests and sometimes a biopsy. An eye exam by the ophthalmologist may be necessary to evaluate dry eyes. A rheumatologist can do blood tests for anti-nuclear antibodies (ANA), anti-SSA (Ro) and SSB (La) antibodies, and rheumatoid factor (RF), or obtain a salivary gland biopsy to make a diagnosis.
Treatments
Treatments for Sjögren’s relieve symptoms of dryness and prevent problems like infections or dental disease. Treatments for dry eyes include artificial tears or eye gels; eye drops such as Restasis to increase tear production. For dry mouth, sips of water or chewing gum may help, but some patients need prescription drugs like pilocarpine (Salagen) or cevimeline (Evoxac) to increase saliva production. Patients with reflux may use proton-pump inhibitors or H2 blockers. Depending on the symptoms and organ system involved, some people with Sjögren’s may need Hydroxychloroquine, corticosteroids Methotrexate, Imuran, Cellcept, rituxan or Cytoxan in life threatening cases.
Management
Dry mouth :
modifying the environment, increasing fluid, omega 3 free fatty acid intake. Reduce caffeine intake, smoking, alcohol intake. Limit time at the computer, turn off ceiling fans, eliminating anti-histamines, decongestant.
fluoridated toothpaste, mouthwash, professional dental cleaning. Avoiding sucrose, fructose, potato chips, carbonated beverages.
Sugar-free gums will help increase salivary flow. Oral wetting agents like omega-3 free fatty acids, flaxseed oil in water, olive oil in water will help with symptoms of oral dryness. Other commercial products to relieve xerostomia symptoms include MouthKote, Biotene mouthwash. Skin dryness improves with lotions and creams that has urea/lactate.
Dry eyes:
regular ophthalmology visits for dry eyes, avoiding artificial tears that contain polyvinyl alcohol or vasoconstrictors like Visine. Preservative free artificial tears like refresh, Thera tears, sooth systane are generally less Irritating and help with dry eyes. Lubricant ointments like refresh p.m, Lacri-Lube help with dryness during the night. Humidifiers will help with dry eyes dry mouth.