What is Sjögren’s syndrome? What are the findings and treatment methods?

Sjögren’s Syndrome is an autoimmune disease that causes dry eyes and dry mouth. In autoimmune diseases, the body’s defense system functions against itself. The immune system is the body’s natural defense against antigens (foreign substances such as bacteria and viruses). Sometimes the immune system does not work properly and it loses its ability to distinguish between body cells and antigens. Instead of fighting antigens, the immune system mistakenly fights its own body cells. This event is considered an autoimmune event.

Sjögren can occur in two forms: primary and secondary. Primary Sjögren Syndrome occurs on its own and is not related to other diseases.

Secondary Sjögren’s Syndrome occurs with some types of inflammatory rheumatic diseases such as Rheumatoid arthritis, Lupus, and Polymyositis.

Sjogren’s Syndrome; Although it is relatively rare in people under the age of 20, it can affect people of all ages and races. 90% of the patients are women. The tendency for Sjogren’s Syndrome to develop increases when someone in the family has an illness.

What happens in Sjögren’s syndrome?

In Sjögren’s Syndrome, a white blood cell called lymphocyte invades glands such as tears and salivary glands and glands in the vagina. Lymphocytes can damage these glands and prevent them from producing secretion. As a result, there is dryness in the mouth, eyes and vagina. Sjogren’s Syndrome can also cause problems in other parts of the body. It can cause inflammation in the lungs, kidneys, liver, nerves, thyroid gland, joints and brain.

 

What are the findings?

Sjögren’s Syndrome affects everyone differently and its symptoms progress in different severity. Common findings are listed below.

Dry mouth

The mouth normally contains saliva and helps chew and swallow. Patients with Sjogren’s Syndrome produce less saliva than normal. This makes it difficult to chew, swallow, and speak. This can also reduce the sense of taste.

Dry eyes

Eyes feel dry, gritty. There may be burning and redness in the eyes. While sleeping, excess mucus (burr) may accumulate around the eye corners. Your eyes may be more sensitive to sunlight. If not treated well, Sjogren’s Syndrome can lead to blind spots in the eyes and corneal ulcers (wound on the outer part of the eyeball). Rarely, this situation can lead to vision loss.

Swollen salivary glands

Three pairs of large glands produce saliva. These are located under the tongue, in front of the ears, under the cheek, and behind the mouth. These glands can be seen or felt swollen. It can be confused with mumps. Sometimes it may become sensitive and may be accompanied by fever. Approximately half of the patients with Sjogren’s Syndrome have swollen glands.

Tooth decay

This is a common problem caused by dry mouth. Saliva contains bactericidal substances (enzymes) that fight bacteria. Thus, it acts as a protective against tooth decay. When saliva decreases, less enzymes are produced. Because of this, tooth decay occurs more easily.

Fungal infection in the mouth

Most people with a dry mouth have burning and redness in the mouth. This complaint is caused by a fungus called Candida that is found in small quantities in the mouth.

Dry nose, throat, and lungs

Dryness; it causes the throat to have a dry and tickling feeling. It may cause dry cough, hoarseness, decreased sense of smell and nosebleeds. Dryness can also lead to pneumonia, bronchitis, and ear problems.

Dryness of the vagina

Sjogren’s Syndrome can cause pain and irritation in the vagina due to dryness. It causes sexual intercourse to be painful for the woman.

Tiredness

It is a common finding of Sjögren’s Syndrome. It may occur due to the disease itself or as a result of the physical and emotional stress of having a chronic disease.

Other problems

Other problems with Sjogren’s Syndrome; inflamed and painful joints, muscle weakness, dry skin, rashes, constipation, numbness due to inflammation in the nerves, tingling and swollen lymph nodes. These show the importance of continuing medical follow-up.

 

What causes Sjögren’s syndrome?

The cause is unknown. There is evidence that genetics, viral infections and hormones are effective.

How is the diagnosis made?

Diagnosis is based on the history of your complaints, physical examination and test results.

History of your complaints

Your doctor will examine the history of your complaints.

Physical Exam

Your doctor will look for changes in your eyes, mouth and / or salivary glands, swelling of the lymph nodes in your neck, tenderness in your muscles, and inflammation in your joints.

Results of chest radiography

Your doctor will order a chest radiograph to determine if there are any changes in your lungs.

Laboratory tests

Your doctor may ask you to have various laboratory tests listed below.

Blood tests

Tests for specific blood findings are helpful in diagnosing Sjogren’s Syndrome. However, not everyone with Sjögren has these symptoms, or not everyone with these symptoms has Sjögren’s syndrome.

Schirmer test

This test helps determine how dry your eyes are. It is performed by placing a small piece of filter paper on the lower eyelid to measure the amount of tears produced.

A note about pregnancy

A woman with Sjögren’s Syndrome may have specific problems with the development of the unborn baby. Your doctor may check some tests (antibodies) to identify potential problems. If you are a woman with one of the rheumatologic diseases associated with secondary Sjögren’s syndrome – especially if you have lung and kidney problems and / or high blood pressure, be sure to see your doctor. If you do become pregnant, you and your doctor will work to determine the best treatment plan.

Slit-lamp review

This is a more accurate way of determining the dryness of your eyes. With this test, the doctor puts a drop of dye into your eye and examines your eyes with a special instrument called a slit-lamp. The paint will paint the dry or damaged areas of your eyes. This is usually done by an ophthalmologist.

Lip biopsy

These tests help measure the actual amount of saliva and determine how dry your mouth is. This is the most accurate test to make a diagnosis.

Urine tests

These tests can be done to check your kidney function.

How is Sjögren’s syndrome treated?
For now, there is no cure for Sjögren’s syndrome. However, certain treatments can relieve the symptoms and help provide a more comfortable and productive life. One of the main goals of the treatment is to increase the comfort of life and to prevent or reduce the effects of dryness. Since Sjogren’s Syndrome affects everyone differently, the treatment plan should be tailored to specific needs. Here are some suggestions to help you deal with complaints.

For systemic problems

Since Sjogren’s Syndrome affects various internal organs and body parts, various treatments can be used. NSAIDs (pain relievers and anti-inflammatories) can be used to relieve joint pain and joint stiffness as well as muscle pain.

Recent studies have shown that Hydroxychloroquine (Quensyl, Plequanyl) helps relieve joint pain, rash and fatigue in some people. If severe tissue damage has occurred due to the disease, your doctor may prescribe cortisone (prednol, deltacortril, ultralan, flantadine) or stronger drugs that change or regulate the immune system response (immunosuppressive).

Exercise can help by keeping your joints and muscles flexible. Walking, swimming and exercises to improve joint movements are very suitable for people with Sjögren syndrome.

For dry mouth

Sip water throughout the day
Use sugar-free gum to stimulate saliva production
Brush your teeth often
Go to treatment for oral fungal infections. Your mouth will be better from now on. Candidiasis can recur, so you may need additional treatments.
Try artificial saliva or mouth-protecting gels. They are partially useful at night
To prevent caries

Visit your dentist often
Ask your dentist to recommend fluoride-containing products, especially for dry mouths.
Brush your teeth regularly and effectively, especially after meals
Avoid sugary foods and drinks between meals
For dry eyes

Use artificial tears to relieve discomfort in dry eyes. If you are going to apply more than 4 drops a day, you can use products without preservatives.
Use lubricating eye ointments at night
Your doctor may recommend a simple operation that prevents tears from draining from your eyes and flowing into your nose. This operation allows tears to accumulate in your eyes and your eyes benefit from natural moisture.
For dry skin

Use moisturizing lotion for sensitive skin
Avoid air conditioners, heaters and radiators as much as possible
Avoid detergents, deodorant soaps and very hot water.
Use moisturizer as much as possible



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