By Daniel O’Leary, ACI Blog Coordinator & Volunteer
Sjogren’s is a systemic autoimmune disease, meaning it affects the whole body. Some people living with this disease experience minimal discomfort, while others suffer excruciating symptoms that significantly affects their quality of life. Sjogren’s can occur on its own, but many patients suffer from this disease in the presence of other autoimmune diseases.
It is estimated that there are four million Americans living with this autoimmune disease. There is an estimated 2.5 million people in the US currently undiagnosed with this disease. It takes about 2.8 years to receive a proper diagnosis of Sjogren’s.
9 out of 10 patients are women.
The average age of Sjogren’s onset is 40 years old, but disease can occur at any point in one’s lifetime.
Symptoms of Sjogren’s vary among patients but they can include:
- Dry eyes
- Corneal ulcerations
- Dry nose
- Nosebleeds
- Dry mouth
- Mouth sours
- Change in taste of smell
- Dry or peeling lips
- Swollen, painful salivary glands
- Difficulty swallowing
- Heartburn
- Interstitial lung disease
- Recurring bronchitis
- Respiratory issues
- Gastroparesis
- Abnormal liver function
- Irritable bowels
- Joint/muscle pain
- Fatigue
- Vasculitis
- Brain fog
- Skin sensitivity
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Patients with Sjogren’s often notice irritation or painful burning in their eyes. Dryness is common in the nasal passages, skin, throat, and vagina.
Primary Sjogren’s occurs in patients with no other history of rheumatic disease. Secondary Sjogren’s, on the other hand, occurs in patients with other rheumatic autoimmune diseases, including lupus or rheumatoid arthritis.
Most Sjogren’s complications are the result of decreased tear and saliva production. Patients suffering from dry eyes tend to be at an increased risk for eye infections, as well as corneal damage. Dry mouth can increase the chance of developing dental decay, oral yeast infections, or gum inflammation. Complications can occur in other parts of the body as well. Rashes may form on the legs and arms, due to inflammation in small blood vessels; inflammation in the lungs, kidneys, and liver can also occur.
Sjogren’s is difficult to diagnose, as its symptoms can mimic various things like menopause, drug side effects, or medical conditions. Due to the complexity of disease, symptoms may be treated individually as one’s healthcare provider does not recognize a systemic disease is occurring.
70% of Sjogren’s patients are positive for SS-A and 40% for SS-B; these are marker antibodies for the disease.
Because this syndrome is an autoimmune disease, people have abnormal proteins circulating throughout their body. This suggests the the immune system is attacking its own healthy tissue. The significant decrease to both saliva and tear production is the result of inflammation that damages the the glands that produce these bodily fluids.
Eye tests, such as the Schirmer test, is used to measure tear production in patients. Dental tests, such as a salivary flow test, measures the amount of saliva produced over time. Sjogren’s patients should schedule regular check-ups with their dental providers to avoid tooth decay and loss that can result from this condition.
Sjogren’s is often managed with a combination of prescription medications, over-the-counter products, and lifestyle management adjustments. Most patients will require medication at some point to help control disease and limit complications.
NSAIDs are often a first-line therapy to treat Sjogren’s. They are used to reduce inflammation levels, which are often elevated in patients. NSAIDs include over-the-counter drugs such as aspirin or ibuprofen. Corticosteroids, such as prednisone, can be pretty successful in aiding in severe symptoms of Sjogren’s or during a flare-up.
Disease-modifying anti-rheumatic drugs modify the way the immune system operates, regulating the abnormal immune response associated with autoimmune conditions like Sjogren’s. Hydroxychloroquine is often prescribed for both initial and long-term therapy in Sjogren’s treatment. For severe cases of disease, biologic therapies may be considered, including Cytoxan and Rituxan.
Over-the-counter treatments exist for both dry mouth and dry eye issues associated with Sjogren’s. Dry eyes can be treated with artificial tears applied throughout the day or to certain gels used at night. In severe cases, blocking the tear ducts can be beneficial. Inflammation-reducing eye drops, such as cyclosporine, can be used to increase tear production. Likewise, dry mouth can be relieved by using saliva substitutes or taking prescription medications that stimulate saliva flow. Humidifiers or saline irrigation can be used to help patients suffering from nasal dryness.
Adjusting to life with an autoimmune conditions like Sjogren’s can be challenging. Finding coping strategies that work for you is important, as this disease can affect each person differently.
It is important to be your own advocate. No one knows your body better and no one feels the pain and symptoms you are feeling. It is important that your healthcare provider listens and works with you to find the best treatment plan. The Autoimmune Community Institute is here for you.
Sources:
https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Sjogrens-Syndrome
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