Rheumatic Disease & Sjogren's Syndrome.

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Author: Terry OBrien

Article source: http://www.articledeshboard.com/. Used with author's permission.

Dr Henrik Sjogren first described Sjogren's syndrome hence its name, Sjogrens is a chronic autoimmune disorder in which immune cells attack and destroy the glands that produce tears and saliva. The hallmark symptoms of the disorder are dry mouth and dry eyes. Sjogren's syndrome can occur in two ways: primary and secondary. Both forms affect roughly an equal number of people.

Primary Sjogren's syndrome occurs by itself and is not associated with other diseases.

Secondary Sjogren's syndrome occurs with rheumatic diseases such as rheumatoid arthritis, systemic lupus erythematosus (lupus), polymyositis and some forms of scleroderma. Rheumatic diseases are conditions that affect joints, bones, muscles, skin, and sometimes other organs.

Sjogren's syndrome is generally not life-threatening. The outlook for people with this condition is usually good. Dryness, however, may last for the rest of your life. By using artificial moisture and practicing good oral hygiene, you can help prevent serious problems.

Sjogren's syndrome can affect people of any race and any age. However it usually affects women more than Men.

A certain blood marker often found in women with Sjogren's syndrome can, very rarely, be associated with heart problems in newborn babies. If you're a woman with Sjogren's syndrome who is planning to become pregnant, see your GP about testing for this marker. If it is present, ask your GP whether pregnancy is advisable. If you do become pregnant, you and your GP can work out the best plan to manage the situation.

Symptoms

Sjogren's syndrome affects everyone differently. You may not have every symptom listed here, and you may have only minor problems with those you do have. The symptoms may seem worse at some times than at others.
In people with no other health problems, the most common early symptom is the onset of severe dry mouth and eyes.

In people with rheumatoid arthritis or related conditions, dry eyes and mouth develop more slowly. In this case, Sjogren's may be difficult to diagnose.

Symptoms may include:
Dry mouth
The mouth normally contains saliva, which aids chewing and swallowing. In people with Sjogren's syndrome, the amount of saliva is much less. This makes chewing, swallowing, and speaking difficult. It may also cause a decreased sense of taste.

Dry eyes
Your eyes may feel dry, "gritty," or "sandy." They may burn and look red. A thick substance may accumulate in the inner corner of your eyes while you sleep. Your eyes may be more sensitive to sunlight. If not properly treated, Sjogren's syndrome can lead to ulcers of the cornea (the clear covering of the eyeball). On rare occasions, this can cause blindness.

Swollen salivary glands
There are three set of glands that produce saliva. They're located under your tongue, in the cheeks in front of your ears, and in the back of your mouth. They may feel swollen and tender (see figure 2). This may occur along with a fever. This affects about one-half of people with the disorder.

Dental cavities
This is a common problem that results from a dry mouth. Saliva fights bacteria and defends against cavities. Because you have decreased saliva, your teeth may develop cavities more easily.

Dry nose, throat, and lungs
This may make your throat feel dry and tickly. You may have a dry cough, hoarseness, a decreased sense of smell, and nosebleeds. It can also lead to pneumonia, bronchitis, and ear problems.

Dryness of the vagina
This can cause painful intercourse for women with Sjogren's syndrome.

Fatigue
Fatigue is a common complaint. You may get easily exhausted and feel tired and worn out.

Other problems
Sjogren's syndrome can affect other parts of the body, such as blood vessels, the nervous system, muscles, skin, and other organs. This can lead to muscle weakness, confusion and memory problems, dry skin, and feelings of numbness and tingling.

Sjogren's syndrome can also affect the liver and pancreas. When it does, there is a greater chance for developing cancer of the lymph tissue. Although this is unusual, it is one reason why medical exams and continued follow-up are important.

Diagnosis
Your GP may do several things to find out if you have Sjogren's syndrome. Some of the tests you may undergo include:

Physical examination
Your GP will ask you to describe your symptoms, and will look for other symptoms, such as red, itchy eyes; swollen salivary glands; a dry, cracked tongue; and enlarged lymph glands in your neck.

Blood tests
Tests for specific blood markers can determine if you have Sjogren's syndrome. However, not everyone with Sjogren's has these markers.

Diagnostic tests
Schirmer test
This helps determine how dry your eyes may be. It involves placing a small piece of filter paper under the lower eyelid to measure the amount of tears your eyes produce.

Slit-lamp examination
This is a more accurate way to find out if your eyes are dry. In this test, the GP puts a drop of dye into your eye and examines the eye with a special instrument called a slit lamp. The dye will stain dry or eroded areas of the eye. This test is often done by an ophthalmologist (eye GP}.

Lip biopsy
In this test, the GP removes a few salivary glands from inside your lip. The tissue is examined under a microscope. The appearance of the tissue helps determine if you have Sjogren's syndrome.

Salivary function tests
These measure the actual amount of saliva you produce, to help determine if you have Sjogren's.

Urine tests
These may be done to test your kidney function.

Chest X-ray
This can help detect changes in your lungs.

Treatment
Unfortunately as yet, there is no cure for Sjogren's syndrome. However, proper treatment can help relieve symptoms so you can live a comfortable and productive life.
The main goal of treatment is to relieve discomfort and lessen the effects of the dryness. Since Sjogren's syndrome affects everyone differently, your treatment plan will be based on your specific needs.
See your family GP and your dentist regularly. Since Sjogren's syndrome can affect many parts of the body, regular checkups can help detect and prevent future problems. You may also need regular check ups with an arthritis specialist) and an eye specialist. If you have Sjogren's syndrome and a rheumatic disease, make sure you follow your GP's complete treatment program.

Self-management
Your treatment may include different ways to relieve your symptoms, such as those listed below. If you have arthritis or another condition, you will also want to follow specific treatment for that condition.

For dry mouth:
Sip fluids throughout the day.
Use sugar-free gum or candies to stimulate saliva production.
Try saliva substitutes or mouth coating products. They may be useful in some people, and are available without a prescription.

To prevent dental cavities:
Have frequent dental checkups.
Use mouth rinses that contain fluoride.
Brush and floss your teeth regularly.
Use sugar-free products.

For dry eyes:
Use artificial tears or eye drops to help relieve the discomfort of dry eyes. Use preservative-free products, if you apply the drops more than four times per day.
Try lubricating ointments or small, long-acting pellets for overnight or long-lasting relief.
Your ophthalmologist may recommend a simple operation that blocks tear drainage from your eye.

For dry skin:
Use moisturizing lotions for sensitive skin.
Avoid drafts from air conditioners, heaters, and radiators, when
possible.
Use a humidifier in your house and at work.

For vaginal dryness:
Use lubricants made specifically to help vaginal dryness. Do not use petroleum jelly.

Exercise and therapy
Mild exercise, such as walking or swimming, can help keep joints and muscles flexible. Exercise may also protect against further joint damage.

Medications
Aspirin and nonsteroidal anti- inflammatory drugs (NSAIDs) help reduce joint swelling and stiffness, as well as muscle aches.
If you have serious complications, your GP may recommend stronger medicines.

If you feel that you would like further information on Sjogren's Syndrome visit The Sjogen's Syndrome Foundation at (sjogrens.org)

Terry O'Brien
Back Trouble UK.

Terry has worked in General Medicine for over 30 years, starting out as a Medical Officer in HM Forces, serving just over 15 years. Links: www.backtrouble.co.uk www.backdoctor.org.uk