SJÖGREN’S SYNDROME

TYPES

Sjögren’s syndrome can be classified into two main types: primary Sjögren’s syndrome and secondary Sjögren’s syndrome.

1. Primary Sjögren’s Syndrome: This is the most common form of Sjögren’s syndrome and occurs when the condition develops on its own, without any other underlying autoimmune diseases. In primary Sjögren’s syndrome, the immune system mistakenly attacks the body’s own exocrine glands, leading to dryness of the eyes and mouth, as well as other systemic symptoms.

2. Secondary Sjögren’s Syndrome: Secondary Sjögren’s syndrome occurs in conjunction with another autoimmune disorder, such as rheumatoid arthritis, lupus, or scleroderma. In these cases, the symptoms of Sjögren’s syndrome often overlap with those of the primary autoimmune condition. Secondary Sjögren’s syndrome tends to have more systemic manifestations and may involve more severe organ involvement.

It’s worth noting that Sjögren’s syndrome can also be further categorized based on the extent of systemic involvement and severity of symptoms. This classification is known as the European League Against Rheumatism (EULAR) Sjögren’s syndrome disease activity index. It helps to assess the activity of the disease and guide treatment decisions.

Differentiating between primary and secondary Sjögren’s syndrome is important as it may have implications for treatment and management. However, regardless of the type, both primary and secondary Sjögren’s syndrome require regular monitoring, symptom management, and appropriate medical care to maintain quality of life and prevent complications.

SYMPTOMS

Sjögren’s syndrome can present with a wide range of symptoms that can vary in severity and may affect different parts of the body. The most common symptoms of Sjögren’s syndrome include:

1. Dry eyes (xerophthalmia): This is one of the hallmark symptoms of Sjögren’s syndrome. It can cause a gritty or sandy sensation in the eyes, redness, and blurred vision.

2. Dry mouth (xerostomia): Another common symptom is a persistent feeling of dryness in the mouth. This can result in difficulty speaking, swallowing, or tasting food. It may also lead to an increased risk of dental cavities and gum disease.

3. Fatigue: Many individuals with Sjögren’s syndrome experience chronic fatigue, which can significantly impact daily activities and quality of life.

4. Joint pain and swelling: Joint pain, stiffness, and swelling, similar to that experienced in rheumatoid arthritis, can occur in individuals with Sjögren’s syndrome.

5. Dry skin and rashes: Dryness can extend beyond the eyes and mouth, leading to dry skin that may become itchy or prone to rashes.

6. Dry nose and throat: Nasal dryness can cause a stuffy or runny nose, frequent nosebleeds, and a sore throat.

7. Vaginal dryness: Women with Sjögren’s syndrome may experience vaginal dryness, which can lead to discomfort during sexual intercourse.

8. Swollen salivary glands: In some cases, the salivary glands may become enlarged and tender.

9. Digestive problems: Sjögren’s syndrome can affect the digestive system, causing symptoms such as abdominal pain, bloating, and difficulty swallowing.

DIAGNOSIS

Diagnosing Sjögren’s syndrome can be challenging as its symptoms can overlap with other conditions. A healthcare professional, often a rheumatologist or an ophthalmologist, will typically assess your medical history, perform a physical examination, and order specific tests to aid in the diagnosis. Here are some common diagnostic tools used for Sjögren’s syndrome:

1. Blood tests: Blood tests can help detect certain antibodies commonly associated with Sjögren’s syndrome, such as anti-SSA (Ro) and anti-SSB (La) antibodies. These tests are not definitive but can support the diagnosis.

2. Schirmer’s test: This is a simple eye test that measures tear production. Special paper strips are placed inside the lower eyelid to measure the amount of tears produced over a specific time period.

3. Salivary gland imaging: Imaging tests, such as a salivary gland scintigraphy or ultrasound, can be performed to evaluate the function and structure of the salivary glands.

4. Salivary flow rate test: This test measures the amount of saliva produced over a specified period, typically using a small device that collects saliva.

5. Lip biopsy: In some cases, a minor lip biopsy may be performed to examine the salivary glands for signs of inflammation and characteristic changes seen in Sjögren’s syndrome.

TREATMENT

The treatment of Sjögren’s syndrome aims to manage symptoms, prevent complications, and improve quality of life. The specific treatment plan will depend on the individual’s symptoms, the severity of the disease, and any other underlying conditions. Here are some common treatment approaches for Sjögren’s syndrome:

1. Symptomatic Relief:

– Artificial tears and eye lubricants can help relieve dry eyes.

– Saliva substitutes, oral rinses, and frequent sips of water can help manage dry mouth symptoms.

– Over-the-counter moisturizers and lip balms can help alleviate dry skin and chapped lips.

2. Medications:

– Nonsteroidal anti-inflammatory drugs (NSAIDs) can be used to manage joint pain and inflammation.

– Immunosuppressive medications, such as hydroxychloroquine or methotrexate, may be prescribed for more severe symptoms or systemic involvement.

– Prescription eye drops containing cyclosporine or lifitegrast can be used to reduce inflammation and increase tear production.

3. Dental Care:

– Regular dental visits and good oral hygiene practices are essential to prevent dental decay and gum disease.

– Use of fluoride treatments or mouth rinses may be recommended to promote oral health.

4. Moisture Management:

– Using a humidifier in the bedroom or living areas can help alleviate dryness in the air and reduce symptoms.

– Avoiding dry environments, excessive heat, and exposure to smoke or irritants can also be beneficial.

5. Other Therapies:

– For individuals with severe dryness or complications, certain procedures like punctal occlusion (plugging the tear ducts) or salivary gland duct rerouting may be considered.

– Physical therapy and occupational therapy can assist with joint mobility and daily activities.