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“The only thing necessary for these diseases to the triumph is for good people and governments to do nothing.”

   


What is Sjogren's Syndrome?http://my.webmd.com/content/article/44/2945_503.htm?lastselectedguid={5FE84E90-BC77-4056-A91C-9531713CA348}


Sjogren's Syndrome is a chronic disorder that causes insufficient moisture production in certain glands of the body. It occurs when a person's normally protective immune system attacks and destroys moisture-producing glands, including salivary glands and lacrimal (tear-producing) glands. The lungs, bowel and other organs are less often affected.

Sjogren's Syndrome is named after the Swedish eye doctor, Henrik Sjogren, who first described the condition.


Sjogren's Syndrome may cause the following symptoms:

  • Extremely dry eyes causing a feeling of grit or sand in the eyes or a burning redness
  • Extremely dry mouth and throat causing difficulty in chewing and swallowing, decreased sense of taste, difficulty speaking, an increase in dental cavities, and dry cough or hoarseness
  • Enlarged parotid glands (located at the angle of jaw) and sometimes infection of the these glands
  • Excessive fatigue
  • Aches and pains in muscles and joints

Less common features of Sjogren's Syndrome are:

  • Irritation of the nerves in the arms, hands, legs or feet (neuropathy)
  • Thyroid gland abnormalities
  • Skin rashes
  • Memory loss or confusion
  • Numbness or tingling
  • Gastrointestinal problems
  • Inflammation of the lungs, kidneys, liver or pancreas
  • Cancer of the lymphatic tissue (occurs in less than 1 percent of patients)

What causes Sjogren's Syndrome?
Normally, the immune system (the body's defense against invaders) protects the body from infection and foreign substances such as bacteria and viruses.

In autoimmune diseases, such as Sjogren's Syndrome, the immune system triggers an inflammatory response when there are no foreign substances to fight off. This inflammatory response causes the body's white blood cells to attack and destroy certain moisture-producing glands.

The exact cause for the abnormal immune response in Sjogren's Syndrome is unknown. Some theories suggest that a virus or bacteria may alter the immune system, causing it to attack the glands. Certain people may have a genetic or inherited factor that makes them more likely to develop Sjogren's Syndrome.

What are the forms of the disease?
Sjogren's Syndrome occurs in two basic forms: primary Sjogren's Syndrome, the disease by itself and not associated with any other illness; and secondary Sjogren's Syndrome, disease that develops in the presence of another autoimmune disease such as rheumatoid arthritis, systemic lupus erythematosus or vasculitis.

More than 1 million people in the United States have Sjogren's Syndrome. More than 90 percent of people affected by Sjogren's Syndrome are women. The disease can affect people of any race or age.


How is primary Sjogren's Syndrome diagnosed?
The diagnosis of Sjogren's Syndrome is based on several factors, including:

  • Presence of dry eyes and mouth. An ophthalmologist can detect dry eyes by measuring tear production or carefully examining the cornea (clear part of the eye).
  • Certain laboratory tests also suggest that dry eyes and mouth are caused by autoimmune mechanisms. Examples include the presence of autoantibodies in the blood, known as anti-SSA or anti-SSB (also called anti-Ro or anti-La).
  • Biopsy of the inner lip (performed in some cases to prove the diagnosis of primary Sjogren's Syndrome). The biopsy may show inflammation damaging salivary glands.

How is secondary Sjogren's Syndrome diagnosed?
Secondary Sjogren's Syndrome is generally diagnosed when someone with an established autoimmune disease, such as rheumatoid arthritis or systemic lupus erythematosus, develops extreme dryness of the eyes and mouth. This diagnosis only rarely requires a lip biopsy.

Can other problems mimic Sjogren's Syndrome?
Sometimes, the use of certain medications can cause side effects that mimic the symptoms of Sjogren's Syndrome. Medications such as tricyclic antidepressants, antihistamines and radiation treatments to the head and neck, as well as other autoimmune disorders, can also cause severely dry eyes and mouth.

How is Sjogren's Syndrome treated?
There is no cure for Sjogren's Syndrome, but it can be treated and controlled. The goals of treatment are to decrease discomfort and reduce the harmful effects of dryness. The type of treatment prescribed will be tailored to each patient's symptoms and needs. The following are some of the main methods of treatment for Sjogren's Syndrome.

  • Good oral hygiene:
    Good mouth care may not prevent a dry mouth, but it helps prevent infection. Toothpastes and oral gels are available for people with dry mouth symptoms. These products contain low doses of peroxide (high amounts can cause more severe dryness). These products may also have antibacterial action to reduce the severity of dental cavities over a long period of time.
  • Increasing eye moisture:
    Dry eyes are mainly treated with the use of artificial tears, and a wide variety of products are available. Artificial tears must be used regularly and more often in dry environmental conditions such as on airplanes, in air conditioned buildings and on windy days.

While artificial tears are helpful, they often do not last long enough. Thicker preparations are available that last longer. These are often used at bedtime because they sometimes cause blurry vision.

Surgery to slow the disappearance of tears is another treatment option when artificial tears are not sufficient.

  • Medications:
    Medications that tend to deplete body fluids should be avoided. Mild pain-relieving medications (analgesics) including acetaminophen (such as Tylenol) or nonsteroidal antiinflammatory drugs (NSAIDs such as Motrin and Aleve) can reduce muscle or joint pain.

In some patients, the antirheumatic drug hyroxychloroquine has been beneficial in decreasing pain and salivary gland swelling.

For patients with generalized symptoms, particularly when the disease affects internal organs (including the gastrointestinal system, kidneys or nervous system), high doses of immunosuppressive medications may be necessary. These include medicines such as prednisone (a steroid) and, rarely, chemotherapy-type medications.

  • Balance rest and exercise:
    Guided exercise programs can help patients overcome fatigue, maintain flexibility and overcome joint and muscle pain.

You can learn more about Sjogren's Syndrome by contacting the Sjogren's Syndrome Foundation at 800-475-6473 (800-4-SJOGREN).

Copyright ?1999 content, the Cleveland Clinic. The information provided by the Cleveland Clinic is not intended to replace the medical advice of your doctor or health-care provider. Please consult them for advice about a specific medical condition. For additional health information, please contact the Health Information Center at the Cleveland Clinic (216) 444-3771, or toll-free (800) 223-2273 ext. 43771.