Sjögren's Syndrome

Sjogren’s Syndrome – Chronic Autoimmune Disorder

Sjogren’s syndrome is a chronic autoimmune disorder in which a person’s immune system attacks glands that secrete fluid like the tear and saliva glands. The white blood cells attack moisture-producing glands which make it difficult for the body to produce saliva and tears. Certain glands could tend to get inflamed thereby reducing the production of tears and saliva causing the main symptoms of Sjogren’s syndrome which are dry mouth and dry eyes.

Its effect could be widespread. Sjogren’s syndrome is an autoimmune condition, wherein instead of protecting the body from illness and infection, the immune system reacts abnormally and attacks the healthy cells and tissues. The immune system attacks the other secretory glands in the body, besides the tear and saliva glands.The cause of this disorder is not known, though researchers are of the opinion that it is triggered by a combination of genetic, environment and probably hormonal factors. Some people are prone to be more vulnerable to this ailment when they are born and certain events like an infection could trigger the problems with their immune system.

Primary SS/Secondary SS

Sjogren being a systemic disease could affect the entire body and is not localized to one area and its symptoms could remain steady or worsen or go into remission. Some may experience a mild discomfort and have a normal life while others could suffer from debilitating symptoms which could severely affect their daily routine activities. Diagnosing the condition in its initial stage with timely treatment could help to prevent serious complications and lead to improvement of the disease.

At times this disorder occurs alone while at other times it could occur in the presence of another autoimmune connective tissue disease like rheumatoid arthritis, lupus, or scleroderma that are often linked with Sjogren’s. Whenever one or more autoimmune disorders take place simultaneously, they are known as overlap diseases and when it occurs alone, Sjogren’s syndrome is called primary Sjogren’s syndrome (Primary SS). When it tends to occur with another connective tissue disease it is said to be secondary Sjogren’s syndrome (Secondary SS).

Signs & Symptoms 

Those suffering from secondary Sjogren’s have a milder condition though they could deal with symptoms of the co-existing or overlap disease, the most common condition taking place with secondary Sjogren’s is rheumatoid arthritis. Signs and symptoms of this condition may differ from person to person, from extreme fatigue and joint pain to dysfunction in main organs like the kidneys, circulatory system, lungs, gastrointestinal system, liver, pancreas and the central nervous system where the most pronounced symptoms are dry eyes, dry mouth and throat.

Common oral symptom is xerostomia or dryness of the mouth – burning or cracking of the tongue, need for lubrication while speaking, cracked or peeling lips, intensified dental decay – cavities or root decay, painful swelling of salivary glands. There is no treatment for Sjogren’s syndrome but treating this condition could help to reduce the symptoms. Dry eyes and mouth could usually help with the aid of artificial saliva and tears. It is essential to maintain good eye and mouth hygiene since the risk of developing the infection could be greater. Maintenance of good hygiene of eyes and mouth could help to avert the problem like corneal ulcers as well as tooth decay.

Other Symptoms

Symptoms which may develop in the throat and nose include difficulty in swallowing, limited ability in taste and/or smell coughing and dry nose. The most prominent symptom around the eyes is a sandy or gritty sensation together with limited potential to produce tears, constant itching, redness and burning, decrease in mucus leading to coughing with irritation in the throat, photosensitivity, and difficulty in swallowing with irritation in the stomach.

In rare cases, Sjogren’s could cause symptoms outside the glands, like skin rash, gastrointestinal problems or inflammation of the liver, pancreas, kidneys or lungs and these symptoms are seen in 1/3 of people with primary Sjogren’s though rarely with secondary Sjogren’s. The extra glandular symptoms include muscle pain, joint pain, low-grade fevers and increased fatigue.There is a possibility that some of these symptoms and signs could be associated with lung, kidney, and or vasculitis (inflammation of blood vessels) involvement. There is also the possibility of experiencing lymphomas – tumours of the lymph glands, which tend to develop in 6% of cases with primary Sjogren’s.

Test 

Just in the case of lupus, there is no single definite test for Sjogren’s and diagnosis usually takes place when a person with a diagnosed autoimmune disease tends to experience extreme dryness of the mouth and eyes. The diagnosis involves a complete medical history together with a physical examination of the individual. It takes around 4-7 years to receive a diagnosis since the disease is usually mild and the first signs of dryness in the mucous membrane could be present for years before the disease is eventually diagnosed. The test carried out to confirm the diagnosis includes:

Schirmir’s Test: where a piece of paper is placed at the corner of the eye to determine the degree of wetting over a period of 5 minutes.

Salivary Gland Flow Rate Test: determines if there is a decrease in the production of saliva.

Rose-Bengal Staining Test: test determines the cornea is inflamed or not.

Biopsy: the lip or the parotid gland which is the gland producing saliva could be biopsied to determine the diagnosis