Over 400,000 Americans are afflicted by Sjogren’s Syndrome, some without even realizing it. It was first identified in 1933 by Dr. Henrik Sjogren, after whom it was named. Though not defined as lethal, it is a serious illness that should not go untreated. Although there have been cases reported in all age groups and in both sexes, nine out ten people suffering from Sjogren’s Syndrome are women in their late forties and older. Because the hallmark symptoms are dry eyes and dry mouth, which can be attributed to other diseases as well, the average amount of time it takes for the disease to be diagnosed is 4.5 years from the onset of the first symptoms. Other accompanying factors such as extreme fatigue, joint pain and being more prone to Lymphoma are symptoms shared by other afflictions as well.
Definition
Sjogren’s Syndrome is an autoimmune disease that primarily destroys the tear and saliva producing glands by attacking them with white blood cells. Sjogren’s is divided into two classifications:
Primary Sjogren’s Syndrome -This classification is applied if the symptoms develop on their own and not as a consequence of another condition.
Secondary Sjogren’s Syndrome – This classification is used if the symptoms develop alongside or as a result of another condition such as rheumatoid arthritis.
Causes
Scientists still aren’t sure what exactly causes Sjogren’s Syndrome and are still researching, however, there are some theories as to how it could be contracted:
- Primary Sjogren’s Syndrome is believed to be caused by genetic and environmental factors. It is assumed that some people are born with the genetic predisposition to contract the disease and others, without the gene, contracted a virus, such as hepatitis C,which made them more viable for the disease. Since most patients diagnosed are women in their late forties, ergo menopausal, it has been theorized that the cause for this immune system malfunction may be triggered by decreasing estrogen levels.
- Secondary Sjogren’s Syndrome may develop as the primary illness, such as rheumatoid arthritis or lupus, becomes more prevalent.
- There has also been research linking vitamin A surplus and Vitamin D deficiency to this condition.
Symptoms
The hallmark symptoms for Sjogren’s Syndrome are chronic dry eyes (keratoconjunctivitissicca) and chronic dry mouth (xerostomia). Other symptoms include vaginal dryness, chronic bronchitis, fatigue and joint pain. It can also cause damage to your thyroid, kidneys, liver, lungs, skin, blood vessels and peripheral nervous system. The symptom’s effects can range anywhere from mild discomfort to severe debilitation.
Diagnosing Sjogren’s Syndrome
Sjogren’s Syndrome is a difficult disease to diagnose because its symptoms are shared with other diseases and because not all the symptoms are present in every patient. That is why it takes an average of 4.5 years before Sjogren’s Syndrome is diagnosed. However, there is a combination of tests that can lead to the syndrome diagnosis. These include:
- Blood tests determining if the levels of anti-nuclear antibody (ANA) and rheumatoid factors (SS) are elevated.
- Ultrasound of the salivary glands
- Measuring the tear production with Shirmer’s test by holding a strip of filter paper inside the lower eye lid for five minutes. It’s then removed and measured, using a ruler. If the strip indicates less than 5 ml, the test result is considered positive for the disease.
- Measuring the saliva production. This entails the patient spitting into a test tube in intervals of one minute for 15 minutes. If less than 1.5 ml is collected the test result is deemed positive for the disease
- Radiological methods using a contrast agent, injected into the parotid duct can also be applied. If widespread puddling of the contrast agent is visible throughout the gland it would be considered a positive diagnose.
Treatment
The treatment options are limited to treating the symptoms of Sjogren’s Syndrome . Since the symptoms are different for each patient, the treatment methods are equally diverse. The treating physician will address the body part that is afflicted and employ the measures he/she sees adequate for the patient. The following techniques are commonly used in efforts to bring the patient some relief:
- Eyes are treated with artificial tears and can, for a short period of time, be treated with eye-drops containing a corticosteroid. Sometimes surgery may be more advantageous. The procedure used is called punctual occlusion and seals the tear ducts. This can be done as a temporary solution, using collagen and silicone plugs to seal the ducts, or with a laser to create a permanent tear duct seal.Sealing the tear ducts keeps the tear fluid in the eye longer. The patient may also be advised to use moisture chamber glasses, similar to goggles. The goggles not only keep the tear fluid from evaporating too quickly, they protect the eye from dust and particles as well.
- The dry mouth is treated by consuming more liquids, mouthwashes with hydrating properties, good dental hygiene and sucking on ice cubes can help as well. Chewing gum produces more saliva too. Meanwhile there is also a good selection of different oral lubricants to choose from. They come in drop form, as a gel, as a spray and as a gum.
- Vaginal Dryness can be treated with lubricants, estrogen creams and hormone replacement therapies
- Joint and muscle pain can be treated with anti-inflammatories such as ibuprofen.
- System wide symptoms may be treated with Hydroxychloroquine, a drug developed to treat malaria, or with immune system suppressants such as methotrexate.
Fact is that, to date, we are not sure what exactly causes the disease and what needs to be done to cure it. Hopefully research in the fields of genetics, virology and bacteriology will soon find the exact cause of this deceptive disease. For now, we can only treat the symptoms of Sjogren’s Syndrome and alleviate the discomfort and pain they may cause.