Sjogren’s syndrome: symptoms and treatment

Sjogren's syndrome: symptoms and treatment

Sjögren’s syndrome (Sjögren’s disease) is an autoimmune disease. This means that the immune system, which is supposed to protect us from germs like bacteria and viruses, attacks the cells of our own body. Sjögren’s syndrome affects the eye’s tear glands and the mouth’s salivary glands, among other things. These glands ensure adequate tear and saliva production and thus also help to prevent tooth decay and eye injuries. However, if the salivary glands are attacked by your immune cells, the saliva becomes viscous, and your mouth feels dry. If the tear glands are also affected, the eyeballs are no longer sufficiently moistened, and the eyes dry. Sjogren’s syndrome can also affect the joints and cause pain. Read here which symptoms are associated with the autoimmune disease and how the treatment is carried out.

Symptoms: How does Sjogren’s syndrome manifest itself?

Sjögren’s syndrome mainly affects women and can cause many different symptoms. However, the most common are dry mouth, also known as xerostomia, and dry eyes, also known as xerophthalmia. The combination of these two symptoms is also known as sicca syndrome.

In addition, other parts of the body can also be affected by Sjögren’s syndrome, which can manifest itself through the following symptoms:

  • Joints: inflammation (arthritis)
  • Hands and feet: Raynaud’s syndrome on fingers and toes (sequence of paling, turning blue and finally reddening of the affected areas, usually caused by cold or psychological stress)
  • Stomach complaints: heartburnnauseastomach pain, stomach inflammation (gastritis)
  • Intestines: flatulencediarrhoeaconstipation
  • Lungs: pneumonia
  • Kidneys: inflammation of the kidneys
  • Vessels: vascular inflammation (vasculitis), minor bleeding
  • Skin changes: dry skin, recurrent wheal formation, skin ulcers
  • Nervous system: spinal cord inflammation

Sjögren’s syndrome can also manifest itself through non-specific symptoms, such as:

  • faster fatigue
  • slight fever
  • Muscle aches
  • joint pain

The disease can occur in phases. This means that the symptoms worsen or reappear during the flare-up.

 

Suspected Sjogren’s syndrome: where to find medical help?

Rheumatologists usually carry out the diagnosis and treatment of Sjögren’s syndrome. Sjögren’s syndrome is one of the connective tissue diseases, also called collagenosis, which belongs to the areas of rheumatology.

Diagnosis: How is Sjögren’s syndrome diagnosed?

If those affected consult a medical professional about their symptoms, they will first ask them about the duration of the symptoms. These should be available for at least three months before further tests occur.

 

Investigation of a possible Sjogren’s syndrome

Further diagnostics initially include “measuring” the symptoms. The following tests are carried out:

  • unstimulated salivation
  • Schirmer test
  • Lissamine green or fluorescein stain

During the unstimulated saliva test, the person to be examined sits down with their head bent, first swallows their saliva and then either lets their saliva drip into a cup or spits it out for 15 minutes. The amount of saliva collected in this way can then be measured. A salivary flow of fewer than 0.1 millilitres per minute is typical of Sjögren’s syndrome.

The Schirmer test measures tear flow. A filter paper is hung between the lower limb and the eyeball. The filter paper is now soaked with the tears produced. After five minutes, the filter paper is removed again, and the length of the moist portion of the filter paper can be measured. A wetted section length of less than 5 mm may indicate Sjogren’s syndrome.

The cornea and tear film condition can also be assessed using fluorescein or lissamine green staining. The eye is sprinkled with the dye. With lissamine green staining, bumps and defects in the cornea and conjunctiva of the eye can be seen with the naked eye. If fluorescein is used, the examiner can assess the cornea and conjunctiva using a slit lamp equipped with colour filters.

Laboratory tests in Sjogren’s syndrome

Sjögren’s syndrome is an autoimmune disease, meaning the immune system attacks its cells. The following tests are available to diagnose this disease:

  • Blood test for autoantibodies (SSA antibodies, anti-Ro)
  • Assessment of the salivary gland tissue under the microscope

The “Sjögren’s syndrome antigen A (Robert) antibodies”, abbreviated SSA(Ro)-AK, are characteristic of Sjögren’s syndrome. They are directed against the cell nucleus of your cells. After a blood draw, the blood is examined in the laboratory for SSA antibodies. If these autoantibodies are found in the blood, this is a clear sign of Sjögren’s syndrome.

In Sjögren’s syndrome, the salivary gland is most commonly attacked by the immune system, which then becomes inflamed. For diagnostic purposes, a small piece of the salivary gland can be cut out under local anaesthesia and examined under a microscope. If there is inflammation of the salivary gland with an accumulation of specific immune cells (lymphocytes) in the sample, this enormously strengthens the suspicion of Sjögren’s syndrome.

Not all of the tests mentioned have to be positive for the diagnosis of Sjögren’s syndrome. However, suppose several of the tests mentioned point to Sjögren’s syndrome. In that case, the diagnosis can be made, with autoantibody detection and a positive microscopic examination being the most important.

What is the cause of Sjogren’s Syndrome?

Possible triggers for Sjögren’s syndrome are the following chronic diseases:

  • rheumatoid arthritis (an inflammatory disease of the joints)
  • Lupus erythematosus (an inflammatory autoimmune disease that affects connective tissue, mucous membranes, joints and kidneys, among other things)
  • systemic scleroderma (an autoimmune rheumatic disease of the skin, joints and internal organs)
  • chronic active hepatitis (inflammation of the liver)

Sjögren’s syndrome is then referred to as secondary Sjögren’s syndrome. In primary Sjögren’s syndrome, no antecedent disease is identified.

 

How is Sjogren’s syndrome treated?

The disease cannot be treated causally; one can only try alleviating symptoms (symptomatic therapy).

Treatment for dry mouth

If the mouth is dry, attempts are made to stimulate the saliva flow. On the one hand, this alleviates the symptoms; on the other hand, it also helps prevent tooth decay. This is because our salivation flushes leftover food and pathogens from our teeth. On the other hand, it contains antibacterial ingredients that can kill germs in the mouth.

The following remedies are used against dry mouth in Sjögren’s syndrome:

  • sugar-free chewing gum and lozenges
  • saliva substitutes
  • Fluoride strengthens teeth and is also an ingredient in toothpaste.
  • The drugs pilocarpine and cevimeline act on the nervous system and stimulate the production of saliva
  • Electrostimulation of the salivary glands

Therapy for dry eyes

Sjogren’s syndrome’s second most common symptom is dry eyes caused by insufficient tear flow. The tear film is essential for cleaning and freeing the eyes from dirt particles and foreign bodies. If insufficient tear fluid is produced, the cornea and conjunctiva are damaged, and pathogens can more easily settle at the defect sites.

There are different options for treating dry eyes:

  • tear substitutes
  • Glasses serve as protection against the wind.
  • Pilocarpine and cevimeline stimulate tear production by acting on the nervous system.
  • Scleral lenses are dimensionally stable, slightly larger than traditional contact lenses, but comfortable. – before their insertion, they are filled with saline solution, which remains in the eye during the wearing period
  • So-called punctum plugs (tear duct closures) close the tear puncta, draining the tears like a stopper.
  • an operation to close the tear punctum (sclerotherapy)

In addition to the mouth and eyes, the immune system can be slowed down with glucocorticoids if internal organs are also affected. This treatment is also called systemic, i.e. affecting the whole body, immunosuppressive therapy.

 

Tips and tricks for those affected

The following simple tips can help you to alleviate the symptoms caused by Sjögren’s syndrome:

  1. Chew sugar-free gum regularly.
  2. Make sure you brush your teeth regularly with toothpaste containing fluoride.
  3. Visit a dental practice regularly and have your teeth professionally cleaned.
  4. Remember to drink frequently.
  5. Avoid sugary drinks as they promote the development of tooth decay.
  6. Avoid air conditioning and ensure good humidity.
  7. Try not to smoke. Cigarette smoke also dries out the mucous membranes of the respiratory tract and can thus promote infections.
  8. Go out into the fresh air often.
  9. In drafts and sunshine, you should wear glasses to prevent corneal defects in the eye.
  10. Use moisturizing washing lotions and avoid bubble baths.
  11. Take care of your mental health and give yourself rest. It can be beneficial to seek contact with other people who are affected and to seek psychological support.

What can you eat with Sjogren’s syndrome?

Those affected by Sjögren’s syndrome should reduce sugar consumption in their diet as much as possible, as this can prevent imminent tooth decay. Likewise, coffee, green and black tea, alcohol and spicy foods should be avoided as they remove water from the body. In addition, sufferers should pay particular attention to drinking enough.

How Dangerous is Sjogren’s Syndrome?

The prognosis of primary Sjögren’s syndrome is good. Life expectancy is comparable to that of non-diseased people. In secondary Sjögren’s syndrome, the prognosis is highly dependent on the concomitant disease. If the internal organs are also affected, pneumonia or chronic kidney inflammation can develop, which can be fatal. Those affected also have a higher risk of developing a malignant tumour of the lymph nodes, non-Hodgkin lymphoma. Life expectancy can be reduced as a result.

 

Inability to work and disability in Sjogren’s syndrome

In principle, the degree of incapacity to work and disability in Sjögren’s syndrome depends on the constellation of symptoms. The syndrome can cover a wide range of symptoms. The individual case must, therefore, be examined when determining the degree of disability using an expert opinion.

Sjogren’s syndrome in pregnancy

So far, it is not known that the symptoms of Sjögren’s syndrome worsen as a result of pregnancy. However, the risk of heart disease and atrioventricular block is slightly increased in the fetus. This risk increases rapidly to 20 per cent in a second pregnancy. If there is a desire to have children, women with Sjögren’s syndrome should, therefore, seek detailed medical advice.

 

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