SJOGREN’S SYNDROME (SS): is one of over eighty autoimmune disorders and is classified as a connective tissue disorder that targets the exocrine system, specifically the lacrimal (production/drainage of tears) and salivary glands.
- It is a chronic inflammatory disorder
- It is characterized as 1⁰ (if there are only symptoms of SS) or 2⁰ (if SS is associated with other autoimmune connective tissue disorders such as SLE, RA, etc.)
- 50% of people are diagnosed as primary Sjogren’s
- The cause is unknown
- It is more common in women
- It can present at any age, but usually seen over the age of 40
CLASSIC EXOCRINE GLANDS SYMPTOMS:
- Sicca Complex: xerophthalmia (dry eyes) and xerostomia (dry mouth)
- Variable conjunctival injection (redness)
- Reduced visual acuity
- Sensitivity to light
- Keratitis (inflammation of the cornea) and corneal erosions
- Dryness of other mucosal membranes
OTHER SYMPTOMS THAT MAY BE PRESENT:
- Joint pain and swelling
- Prolonged fatigue
- Skin rashes and dry skin
- Persistent dry cough, bronchitis, dyspnea
- Epistaxis (nose bleed)
- Otitis media (middle ear infection)
SYMPTOMS THAT MAY COMPLICATE THE COURSE OF SS:
- Involvement of the kidneys
- Peripheral and cranial neuropathy
- Systemic lymphadenopathy
DIAGNOSIS: may be a drawn out process and is based on patient history of symptoms, physical examination and various test results.
- Ophthalmologic exam: the Schirmer’s filter paper test is used to assess the degree of dryness of the eyes and examination of the eye to check for corneal erosions and keratitis
- Assessment of pathology and function of the salivary glands: biopsy (to determine degree of inflammation utilizing the “focus score”), sialogram and salivary scintigraphy
- Blood work: checking for autoantibodies (SS-A antibodies are found in 50-75% of people with SS and SS-B antibodies are found in 50-60% of people with SS)
TREATMENT: there is no known cure; therefore, treatment is aimed at alleviating the symptoms and complications of the sicca (dryness) complex.
- Antibiotics for infections
- Water soluble lubricants and moisturizing eye drops
- Drugs to increase the production of saliva
- Surgical intervention
- Immunosuppressive agents
PROGNOSIS: symptoms of Sjogren’s Syndrome may stabilize, worsen or go into remission.
ANTIBODY (aka: immunoglobulin): is a protein that is produced by plasma cells of the body’s defense system (aka: the immune system) to detect and neutralize foreign objects that are deemed as harmful to the body.
AUTOIMMUNE: our immune system erroneously starts attacking and destroying healthy body tissue.
FOCUS SCORE: equal or greater than 1 is compatible with Sjogren’s Syndrome
RA: Rheumatoid arthritis
SLE: Systemic Lupus Erythematosus (commonly called Lupus)
SS-A (Ro) antibodies
SS-B (La) antibodies