Sjogren’s Syndrome: Diagnosis and Treatment
Sjogren's syndrome is an autoimmune disease in which the body's immune system mistakenly attacks its own moisture producing glands. Sjogren's is one of the most prevalent autoimmune disorders, striking as many as 2-4 million Americans. Nine out of ten patients are women. The average age of onset is late 40's, although Sjogren's occurs in all age groups in both women and men.
The hallmark symptoms are dry eyes and dry mouth. Sjogren's can also cause dryness of the skin, nose and vagina. Sjogren's also may affect other organs, such as the kidney, GI tract, blood vessels, lung, liver, pancreas and the central nervous system. Many patients experience debilitating fatigue and joint pain.
Symptoms can plateau, worsen, or go into remission. While some people experience mild symptoms, others suffer debilitating symptoms that greatly impair their quality of life.
When Sjogren's syndrome occurs alone and no other connective tissue disease is present, it is called "Primary Sjogren's." When Sjogren's syndrome is accompanied by a connective tissue disease, such as rheumatoid arthritis, lupus or scleroderma, it is called "Secondary Sjogren's." The term "secondary" in no way implies that Sjogren's syndrome is less important than the other co-morbid illness. Approximately half of people with Sjogren's have Primary, and the other half have Secondary Sjogren's.
Early diagnosis and treatment are important for preventing complications. Nevertheless, it sometimes takes a Sjogren's patient two years to get this diagnosis. Sjogren's symptoms may mimic other diseases, such as lupus, multiple sclerosis or rheumatoid arthritis. Furthermore, dryness can occur for other reasons, such as side effects of medications like antidepressants or high-blood pressure medication.
Rheumatology is the medical specialty that has primary responsibility for diagnosing and managing Sjogren's syndrome. Ophthalmologists and dentists are also specialists who diagnose symptoms associated with Sjogren's.
Once Sjogren's syndrome is suspected, the rheumatologist will take a medical history and do a series of blood tests to confirm the diagnosis. The rheumatologist will also refer the patient to an ophthalmologist for further tests, and to an oral pathologist for additional procedures.
The following list includes some of the blood tests that the rheumatologist will order:
ANA (Anti-Nuclear Antibody)
ANAs are a group of antibodies that react against normal components of a cell nucleus. They are present in a variety of autoimmune diseases, so the test is not disease specific. About 70% of Sjogren's patients have a positive ANA test result.
SSA and SSB
The antibodies SSA (or RO) and SSB (or LA) are often found in Sjogren's syndrome; 70% of patients are positive for SSA and 40% are positive for SSB.
RF (Rheumatoid Factor)
This antibody test is indicative of a rheumatic disease, but like the ANA test, is not specific to Sjogren's syndrome. In Sjogren's patients, 60-70% have a positive RF.
ESR (Erythrocyte Sedimentation Rate)
This test measures inflammation. An elevated ESR can indicate an inflammatory disorder, including autoimmune and connective tissue diseases, like Sjogren's syndrome.
Immunoglobulins are normal blood proteins. They are usually elevated in Sjogren's. The following are tests that the ophthalmologists will perform to test for dry eye:
This test provides an indication of the volume of tears by magnifying the eye and viewing it in its resting state. The amount of tears is then examined. The dentist or oral pathologist will perform the following tests:
Parotid Gland Flow
This test is a quantitative measure of the amount of saliva produced over a certain period of time.
This test measures salivary gland function by injecting radioactive material into the salivary glands.
This is an X-ray of the salivary-duct system taken after a radiologically sensitive dye is injected.
This test is used to confirm lymphocytic infiltration of the minor salivary glands. An incision of approximately two centimeters is made on the inside surface of the lower lip. Minor salivary glands are removed and examined under the microscope.
While there is no known cure for Sjogren's syndrome, many problems can be treated symptomatically with over-the-counter and prescription medications. Other helpful tips for coping with Sjogren's symptoms are also available from the Sjogren's Syndrome Foundation.
Over-the-counter moisture replacement therapies are available to ease the symptoms of dryness. These include preservative-free artificial tears, artificial saliva, unscented skin lotions, saline nasal sprays and vaginal lubricants. The Sjogren's Syndrome Foundation maintains an updated list of these products. The Foundation also offers tips for daily living in "The New Sjogren's Syndrome Handbook" and in its "Moisture Seekers" newsletter.
Two prescription medications, Salagen® (pilocarpine hydrochloride) and EvoxacTM (cevimeline), are available to treat the dry mouth associated with Sjogren's. Depending on the nature and severity of symptoms, other medications include non-steroidal anti-inflammatory drugs (NSAIDs), steroids and immunosuppressive drugs.
There are also non-medication strategies for dealing with the various symptoms of Sjogren's syndrome. "The New Sjogren's Syndrome Handbook" contains a chapter covering many helpful ideas. The "Moisture Seekers" newsletter is also a great source of helpful hints.
Remember, only a dentist can diagnose your dental problems and offer the right treatment plan for you. If you need a dentist, call us at 1-866-970-0441 to be connected with one today.