Sjögren's causes painful and irritating dryness of the eyes as well as other symptoms.
Sjögren's can develop at any age. However, the majority of patients are diagnosed after the age of 40 years. Females constitute 90 percent of patients, but men and children are also affected.
Until recently, the condition was known as Sjögren's syndrome. It is now more commonly referred to as Sjögren's.
Sjögren's affects an estimated 0.1 to 4 percent of people in the United States (U.S.).
- Sjögren's is an autoimmune disorder that affects moisture-producing glands.
- The condition affects 0.1 to 4 percent of people in the U.S., and 90 percent of people with Sjögren's are women.
- It causes the eyes and mouth to dry out, and can also lead to tooth decay, recurring oral thrush, and a persistent dry cough.
- Sjögren's affects multiple systems and can be difficult to diagnosis. However, blood tests, ophthalmological testing, and measuring the salivary flow rate can identify the condition.
- Prescribed eye drops, artificial tears, and moisture chamber spectacles can help to relieve dry eyes.
- Other medications can help to stimulate the flow of saliva. Sucking on ice cubes and chewing sugar-free gum are other ways to lubricate the mouth.
What is Sjögren's?
Sjogren's is caused by white blood cells mistakenly attacking moisture-producing glands.
In Sjögren's, white blood cells attack saliva glands, tear glands, and other tissues.
This leads to a dry mouth and eyes due to the decrease in the body's tear and saliva production. It can also cause skin, nose, upper respiratory, and vaginal dryness.
Doctors classify Sjögren's as either primary or secondary. Primary Sjögren's does not develop as the result of another condition, whereas secondary Sjögren's will co-occur with another condition, such as lupus. However, the symptoms of primary and secondary Sjogren's are similar, and both can be severe.
The reason for the targeting of moisture-producing glands is not clearly known and requires further research.
Sjögren's is a serious condition, but timely treatment can mean that complications are less likely to develop, and tissue damage is less likely to occur. Once treated, an individual can usually manage the condition well.
The most common symptom associated with Sjögren's is the inability to produce moisture for the eyes and dry mouth.
Females may also report vaginal dryness.
Other symptoms can include:
- tooth decay, and eventual loss of teeth
- persistent dry cough
- problems chewing and swallowing
- hoarse voice
- difficulty speaking
- swollen salivary glands
- recurring oral thrush, a fungal infection in the mouth
The signs and symptoms associated with dry eyes include:
- a sensation in one or both eyes similar to the irritation caused by foreign material, such as sand or gravel
- tired-looking and heavy eyes
- an itchy sensation
- discharge of mucus from the eyes
- photophobia, or sensitivity to light
- stinging or burning eyes
- swollen and irritated eyelids
- blurred vision
Smoking, air travel, overhead fans, and air-conditioned or windy environments can exacerbate symptoms.
In some cases, the patient's immune system attacks other parts of the body, causing the following signs and symptoms:
- general tiredness
- brain fog
- aching muscles
- inflammation of joints, as well as stiffness and pain
- peripheral neuropathy, or numbness and occasional pain in the arms or legs
- lung disease
- Raynaud's phenomenon, in which the hands feel painful, cold and numb
- vasculitis, where the blood vessels become inflamed
Sjögren's comes with serious complications if left untreated, including:
- an increased risk of lymphoma and multiple myeloma
- oral yeast infections
- dental cavities
- vision problems
- inflammation leading to bronchitis, pneumonia, and other lung problems
- kidney function problems
- autoimmune hepatitis or cirrhosis in the liver
- giving birth to a baby with heart problems or lupus
- peripheral neuropathy
- interstitial cystitis of the bladder
It is important to seek treatment for Sjögren's as early as possible to prevent these.
The causes of Sjögren's remain largely unknown.
Studies have indicated that a viral or bacterial infection may trigger the disease, but that the underlying cause is primarily genetic and environmental. The nervous system and the endocrine, or hormone-producing, system have also been implicated in the onset of Sjögren's.
An environmental factor may change the immune system and cause immune problems later on, such as infection with hepatitis C or the Epstein-Barr virus.
As the majority of people who develop Sjögren's are female, doctors still believe that estrogen, a female hormone, plays an important role.
The menopause is the most common time for a diagnosis of Sjögren's to be made. Some studies theorize that estrogen protects against Sjögren's, and falling levels of the hormone may alter immune function and trigger the condition.
As Sjögren's signs and symptoms are similar to some other health conditions, it can sometimes be hard to diagnose. The patient may be seeing various health professionals, perhaps a dentist for dry mouth and tooth decay, a gynecologist for vaginal dryness, and an ophthalmologist for dry eyes.
Some medications can also cause symptoms similar to those in Sjögren's.
The criteria for a definitive diagnosis are as follows:
- the need to apply eye drops containing tears more than 3 times a day
- a constant feeling of irritation in the eyes
- persistent dry eyes and mouth for over 3 months
- swelling in the salivary glands between the jaw and ears, known as the parotid glands
- a frequent need to drink when trying to swallow food
- evidence of dry eye in ophthalmological test results
- measuring salivary flow rates
- SSA or SSB autoantibodies in blood
- a lip biopsy showing focal lymphocytic inflammation
Sjögren's presents in different ways for different people. A doctor may order some further tests, including:
Blood tests: Sjögren's triggers the presence of special antibodies in the blood. As these antibodies only show up in about 60 to 70 percent of people with Sjögren's, a negative result does not mean the syndrome can be ruled out. This frequently causes confusion in initial diagnosis.
Ophthalmological tests: An ophthalmologist can carry out the Rose Bengal, Lissamine green, and Schirmer eye tests. Dyes and blotting paper are used to expose dry areas on the eye.
Salivary flow rate: The doctor measures the weight of saliva produced in a cup over 5 minutes. If insufficient saliva was produced, it is one of the indicators of Sjögren's.
Sialogram: A dye is injected into the parotid glands. An X-ray is then taken to determine how much saliva flows into the patient's mouth.
Salivary scintigraphy: A radioactive isotope is injected and tracked with imaging to measure salivary gland function.
Chest X-ray or CT-scan: This determines the presence of inflammation in the lungs, which can be caused by Sjögren's.
Skin biopsy with nerve fiber stain: This determines the presence of Small Fiber Neuropathy (SFN).
Urine testing: Urine is sampled and tested to determine whether the kidneys have been affected.
Eye drops and artificial tears are effective methods of managing dry eyes.
Sjögren's treatment aims to lubricate the affected areas and prevent the onset of complications.
Treatment options include:
- Medications to stimulate saliva flow: These include pilocarpine and cevimeline. They have a short-term impact, limited to a few hours only, so several doses a day are usually required.
- Artificial saliva: Saliva substitutes and mouth-coating gels can relieve dryness of the mouth. They are available as sprays, pre-treated swabs, and liquids. These can be important at night, as the mouth becomes dryer during sleep.
- Artificial tears: Artificial tears can help to lubricate the eyes, and are available over-the-counter (OTC). Prescription options are available that reduce the need for artificial tears, such as cyclosporine ophthalmic emulsion and hydroxypropyl cellulose pellets.
- Prescription eye drops: These include cyclosporine and lifitegrast.
- Moisture chamber spectacles: These are special glasses that keep out irritants and retain moisture.
- Prescription expectorants and throat medications: In cases of respiratory dryness, drugs such as those used to stimulate saliva flow, as well as linseed extract, sorbitol, xylitol, or malic acid, can moisturize the area.
- Nonsteroidal anti-inflammatory drugs (NSAIDs): Anti-inflammatory drugs such as aspirin, naproxen, and ibuprofen can provide relief for people with Sjögren's who are experiencing joint pain.
- Disease-modifying antirheumatic drugs (DMARDs): In cases where the joint pain is accompanied by fatigue and rashes, DMARDs may relieve symptoms. Examples include hydroxychloroquine or methotrexate. If Sjögren's seems to be affecting the muscles, nerves, lungs, or kidneys, stronger DMARDs or corticosteroids may be prescribed.
- Antifungal medication: If oral yeast infections are occurring, medication may be prescribed to combat the fungus.
- Vaginal lubricants: For vaginal dryness, water-based vaginal lubricants can provide a solution, especially during sexual intercourse.
- Punctual occlusion: When all conservative treatment options have been exhausted, this surgical option seals the tear ducts with small plugs to reduce the drainage of tears from the eye. This keeps the eye moist for longer. Temporary silicone plugs are likely to be used until the procedure is confirmed successful.
- Autologous eye serum: In severe cases of eye dryness, eye drops can be made from the person's blood serum.
Here are some easy ways to keep the mouth lubricated.
- consuming more liquids.
- sucking on ice cubes
- rinsing the mouth regularly to prevent infection and soothe the area
- maintaining excellent oral and dental hygiene
- quitting smoking, as smoke irritates the mouth and speeds up the evaporation of saliva
- chewing sugar-free gum, which stimulates the production of saliva
- applying coconut oil to the dry areas, as it is both moisturizing and anti-microbial
There is no cure for Sjögren's. However, by successfully managing the dryness of the affected regions and treating any affected organs, a person with the condition can maintain a good quality of life.