Sjogren’s Syndrome

Definition

Sjogren’s syndrome is an autoimmune disease where the immune system mistakenly starts producing antibodies against its own body cells leading to various symptoms. The main symptoms of Sjogren’s syndrome are dry eyes due to reduced tear production and dry mouth because of reduced saliva production. Although Sjogren’s syndrome can attack at anyone at any age group, most of the patients are females and the onset is usually after menopause.

Often symptoms of Sjogren’s syndrome occur alone or it may appear following other autoimmune diseases like rheumatoid arthritis, systemic lupus erythematosus or scleroderma. In most patients, over-the-counter tear supplements and frequent sips of water is sufficient to ease the symptoms. However, in severe cases drugs may be prescribe or in some instances surgery is needed.

Symptoms

The two most common symptoms of Sjogren’s syndrome includes :

  • Dry eye due to reduced amount of tear production leading to burning, itchy or gritty sensation as if there is foreign object in the eye.
  • Dry mouth due to reduced saliva production leading to difficulty speaking or swallowing.

Some times Sjogren’s syndrome may lead to :

  • Joint pain, swelling and stiffness with restricted joint movement.
  • Swollen glands especially of the salivary glands in front of the ear and behind the jaw.
  • Skin rashes.
  • Dryness of the skin.
  • Fatigue.
  • Persistent dry cough.
  • Convulsions,
  • Tingling and numbness of the lower limbs due to peripheral neuropathy.
  • Visual difficulty like blurring of vision.
  • Ulcers on the cornea.
  • Intolerance to light due to damage to the optic nerve.
  • Impaired kidney function due to involvement of the kidney.
  • Dental problem because the antibacterial action of saliva is absent.
  • Increased chance of developing oral thrush.
  • Rarely cancer of lymph nodes (lymphoma).

Causes

The immune system produce antibodies directed against foreign proteins that it encounters. This is one of the important actions for defending the body. However, in some cases the immune system mistakenly start producing antibody against self proteins leading to organ damage or even destruction. This condition is known as an autoimmune disease.

Sjogren’s syndrome is an autoimmune disease that wrongly attacks the body cells especially the tear glands of the eyes and salivary glands of the mouth. The exact factors that activate the immune system is not yet known but viral infection like HTLV-1, EBV, HIV and hepatitis C may be responsible. Children of mothers suffering from Sjogren’s syndrome are more at risk of developing heart disease and neonatal lupus.

Risk factors

  • Women especially beyond 40 years and after menopause are more at risk of developing the disease, however, men and children may also suffer from the disease.
  • Patients with rheumatic disease like rheumatoid arthritis and systemic lupus erythematosus are more likely to develop the symptoms of Sjogren’s syndrome.

Treatment

Over-the-counter tear supplements and frequent sipping of water helps many patients to combat the two principal symptoms, however, drugs are required in serious cases. Commonly prescribed drugs are pilocarpine, cevimeline to increase saliva production, painkillers , anti-inflammatory drugs to treat associated joint problem and hydroxychloroquine, methotrexate or cyclosporine to suppress the immune system. Low dose corticosteroids may be taken for prolonged periods. Surgery may be required to manage severe eye symptoms.

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