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Sjogren's Syndrome

Sjogrens Syndrome

Sjogren's syndrome is a systemic autoimmune disease characterized by lymphocytic infiltrates in exocrine organs. It is named after Swedish ophthalmologist Henrik Sjögren.


Presentation

The early symptoms of Sjogren's syndrome can be easily overlooked. The main clinical presentation in adults is xerophthalmia and xerostomia. In children, bilateral swelling of the parotid glands is a common sign. Xerophthalmia and xerostomia are often described in the following way by affected individuals:

In addition to these sicca symptoms, various extraglandular manifestations may develop, including arthralgia, arthritis, myalgia, Raynaud phenomenon, pulmonary disease, gastrointestinal disease, pericarditis, pulmonary hypertension, lymphadenopathy, neuropathy, vasculitis, renal tubular acidosis, xeroderma, purpura, and urticaria. Late complications such as blindness, dental destruction, oral candidiasis, and non-Hodgkin lymphoma may occur [6].

Splenomegaly
  • On admission, she presented with anemia, elevated C-reactive protein levels, anasarca, and hepato-splenomegaly.[ncbi.nlm.nih.gov]
  • […] the significantly elevated risk of NHL. 67 Significant predictors for the development of NHL lymphoma include low complements (C3 and C4), presence of cryoglobulins, low CD4:CD8 ratio, persistence of unilateral or bilateral parotid gland enlargement, splenomegaly[ncbi.nlm.nih.gov]
  • For instance, reports suggest that patients with Felty's syndrome (splenomegaly and granulocytopenia linked to severe, long-standing seropositive RA) are at a more markedly (5- to 10-fold) increased risk ( 17, 24 ).[doi.org]
Fatigue
  • Outcome measures assessed at baseline and after 12 weeks were aerobic capacity, fatigue, ratings of perceived exertion (RPE), anxiety, depression and HRQoL. Nine women in the TG and 10 women in the CG completed the study.[ncbi.nlm.nih.gov]
  • Lewis, a registered nurse, found out at age 31 that her dry eyes, joint pain and extreme fatigue were caused by Sjogren’s syndrome. Ms. Lewis said that fatigue had been the worst part of living with Sjogren’s syndrome.[nytimes.com]
  • […] systemic autoimmune disease that primarily affects the exocrine glands, resulting in dryness of the eyes and mouth due to lymphocytic infiltration of the salivary and lacrimal glands along with arthritis, kidney, liver, and lung involvement, chronic fatigue[ncbi.nlm.nih.gov]
  • Open caused debilitating joint pain, swelling, numbness and fatigue, she told Good Morning America's Elizabeth Vargas today.[abcnews.go.com]
  • Debilitating fatigue and joint pain can seriously impair quality of life. It is one of the most prevalent autoimmune disorders, striking as many as four million Americans. Nine out of ten individuals with Sjögren's syndrome are women.[nationalhealthcouncil.org]
Fever
  • The patient was admitted due to dyspnea, fever, polyarthralgia, and generalized edema.[ncbi.nlm.nih.gov]
  • Primary Entity # Annals of the rheumatic diseases; the official journal. a schema:Periodical, schema:CreativeWork ; library:oclcnum " 1481413 " ; library:placeOfPublication ; # London library:placeOfPublication ; schema:about ; # Rheumatic Fever schema[worldcat.org]
  • Case 1: Female, 7 years old, reporting for 2 years recurrent parotitis, xerophthalmia, xerostomia, polyarthralgia and fever. Immunological tests were positive for antinuclear antibodies, rheumatoid factor, anti-SSA/Ro and anti-SSB/La.[ncbi.nlm.nih.gov]
  • […] syndrome are: Two or more body systems or organs affected At least one system/function/organ affected to a moderate or severe level At least two of the following symptoms: weight loss (when not trying to lose weight), severe fatigue, malaise, chronic fever[disability-benefits-help.org]
  • Then he gradually developed transient slurred speech, progressive confusion, agitation, extremity weakness, and fever.[ncbi.nlm.nih.gov]
Anemia
  • As a result, patients with Sjogren’s syndrome can present with a variety of symptoms These may include: Dry eyes and/or dry mouth Burning and numbness of the extremities Pain with sexual intercourse Anemia or low white blood count Although Sjogren’s syndrome[hopkinssjogrens.org]
  • Patients with the RA and Sjögren’s combination were also more likely to have blood abnormalities, including decreased numbers of platelets (thrombocytopenia) and decreased numbers of red blood cells (anemia).[rheumatoidarthritis.net]
  • Blood tests may reveal elevated erythrocyte sedimentation rate and transaminase levels, anemia, leukopenia, eosinophilia, hypergammaglobulinemia, presence of antinuclear antibodies, anti–alpha-fodrin antibody and rheumatoid factor.[symptoma.com]
  • Laboratory investigations suggested anemia, thrombocytopenia, significantly increased lactic dehydrogenase, schistocytes in peripheral blood smear, and a disintegrin-like metalloproteinase with thrombospondin motif type 1 member 13 (ADAMTS13) activity[ncbi.nlm.nih.gov]
  • On admission, she presented with anemia, elevated C-reactive protein levels, anasarca, and hepato-splenomegaly.[ncbi.nlm.nih.gov]
Weight Loss
  • A 65-year-old woman with Sjögren's syndrome presented with recurrent abdominal distension, constipation, weight loss, orthostatic dizziness, loss of sweating and incomplete emptying of the bladder.[ncbi.nlm.nih.gov]
  • Further history revealed frequent dental caries, xerostomia and recent weight loss.[ncbi.nlm.nih.gov]
  • The criteria for qualifying for disability benefits based on Sjogren’s syndrome are: Two or more body systems or organs affected At least one system/function/organ affected to a moderate or severe level At least two of the following symptoms: weight loss[disability-benefits-help.org]
  • Unexplained weight loss. Itchy skin. Reddened patches on the skin. Many of these can be symptoms of other problems, including Sjögren’s syndrome itself. Nevertheless, it is important to see your doctor if you have any of these symptoms.[niams.nih.gov]
Chronic Fatigue Syndrome
  • That's because the symptoms can overlap or look like those of other conditions, including chronic fatigue syndrome, fibromyalgia, lupus, rheumatoid arthritis, or even multiple sclerosis.[stlouischildrens.org]
  • Komaroff, The Frequency of HLA Class II Antigens in Chronic Fatigue Syndrome, Journal of Chronic Fatigue Syndrome, 11, 4, (33), (2003). Juan-Manuel Anaya, Paula A. Correa, Ruben D.[doi.org]
  • Evidence that abnormalities of central neurohormonal systems are key to understanding fibromyalgia and chronic fatigue syndrome. Rheum Dis Clin N Am. 1966;22:267–84. CrossRef Google Scholar 32. Yu J.[doi.org]
  • fatigue syndrome and fibromyalgia, Psychol Med, 2001 , vol. 31 (pg. 1331 - 45 ) The Author 2007.[doi.org]
Cough
  • Unexplained cough was defined as chronic cough of unknown etiology despite algorithm-based evaluation and treatment.[ncbi.nlm.nih.gov]
  • Chronic dry cough. Thyroid problems. Joint and muscle pain. Vaginal dryness. Numbness and tingling in the arms and legs. Fatigue or feeling very tired. People with dry mouth can easily get mouth infections.[niams.nih.gov]
  • Other symptoms can include joint swelling and pain, vaginal dryness, persistent dry cough and dry skin. It may also spread to other parts of the body such as blood vessels, nerves, lungs, kidneys and digestive system.[coloradoarthritis.com]
  • In 2011, the elder Williams sister was diagnosed with Sjogren's syndrome, an autoimmune disease that dries out the mouth and eyes, and can also sap strength and cause joint and muscle pain, coughing, and limb numbness.[businessinsider.com]
  • […] in the following way by affected individuals: Unable to eat dry foods Tongue sticks on the roof of the mouth Unable to speak for long period Increased cases of dental caries Change in tastes Painful mouth Sandy sensation in the eyes Persistent, dry cough[symptoma.com]
Pneumonia
  • However her stay at hospital was complicated by severe hospital acquired pneumonia to which she succumbed.[ncbi.nlm.nih.gov]
  • A chronic autoimmune disease like Sjögren's syndrome can affect the entire body, causing dry eyes, dry mouth, dry skin, dental decay, joint pain, extreme fatigue, memory loss, pneumonia and abnormal liver function, among other things.[hospitals.jefferson.edu]
  • Drying in the lungs can result in lung infections or pneumonia. There may be a loss of hair on the body.[cedars-sinai.edu]
  • Acute fibrinous and organizing pneumonia (AFOP) is a new histopathological pattern of acute lung injury first described by Beasley et al. in 2002.[ncbi.nlm.nih.gov]
  • Inflammation can cause pneumonia, bronchitis or other problems in your lungs; lead to problems with kidney function; and cause hepatitis or cirrhosis in your liver. Lymph nodes.[mayoclinic.org]
Dry Cough
  • Other symptoms can include joint swelling and pain, vaginal dryness, persistent dry cough and dry skin. It may also spread to other parts of the body such as blood vessels, nerves, lungs, kidneys and digestive system.[coloradoarthritis.com]
  • […] described in the following way by affected individuals: Unable to eat dry foods Tongue sticks on the roof of the mouth Unable to speak for long period Increased cases of dental caries Change in tastes Painful mouth Sandy sensation in the eyes Persistent, dry[symptoma.com]
  • cough Prolonged fatigue Causes Sjogren's syndrome is an autoimmune disorder.[mayoclinic.org]
  • (The most frequent reason, in 80%, was persistent, dry cough periodically waking up patients at night). The chest HRCT scan revealed lung tissue changes in the course of 29% of all examined patients (of 68).[ncbi.nlm.nih.gov]
Hoarseness
  • Others are forced to cope with blurred vision, constant eye discomfort, recurrent mouth infections, swollen parotid glands, hoarseness, and difficulty in swallowing and eating.[ninds.nih.gov]
  • You may have a dry cough, hoarseness, a decreased sense of smell, and nosebleeds. It can also lead to pneumonia, bronchitis, and ear problems. Dryness of the vagina. This can cause painful intercourse. Fatigue. is a common complaint.[healthcentral.com]
  • Protect Your Voice You can develop hoarseness if their vocal cords become inflamed or become irritated from throat dryness or coughing. To prevent further strain on your vocal cords, try not to clear your throat before speaking.[niams.nih.gov]
  • Eye symptoms: Itching eyes Feeling that something is in the eye Mouth and throat symptoms: Difficulty swallowing or eating dry foods Loss of sense of taste Problems speaking Thick or stringy saliva Mouth sores or pain Teeth decay and gum inflammation Hoarseness[nlm.nih.gov]
Chronic Cough
  • Unexplained cough was defined as chronic cough of unknown etiology despite algorithm-based evaluation and treatment.[ncbi.nlm.nih.gov]
  • Other symptoms can include dry skin, vaginal dryness, a chronic cough, numbness in the arms and legs, feeling tired, muscle and joint pains, and thyroid problems.[en.wikipedia.org]
Constipation
  • A 65-year-old woman with Sjögren's syndrome presented with recurrent abdominal distension, constipation, weight loss, orthostatic dizziness, loss of sweating and incomplete emptying of the bladder.[ncbi.nlm.nih.gov]
Xerostomia
  • Despite symptomatic treatment, xerostomia, glossitis, and glossodynia were still present, at times marked, after 12 months when the ANA titer was unchanged.[ncbi.nlm.nih.gov]
  • Sjogren's syndrome(SS) is a chronic autoimmune disease, which damages exocrine glands especially salivary and lacrimal glands, with xerostomia and xerophthalmia as common symptoms. We report a case of a 49-year-old woman presented with pancytopenia.[ncbi.nlm.nih.gov]
  • After eighteen months and two years respectively, the patients were satisfied with function and aesthetics; restorations were comfortable, stable radiographic bone levels were noted and xerostomia was not reported to affect the function anymore.[ncbi.nlm.nih.gov]
  • The main clinical presentation in adults is xerophthalmia and xerostomia. In children, bilateral swelling of the parotid glands is a common sign.[symptoma.com]
  • Dryness affecting the eyes is sometimes referred to as keratoconjunctivitis sicca (KCS, for short) and dryness affecting the mouth is sometimes referred to as xerostomia.[rheumatoidarthritis.net]
Dental Caries
  • Xerophthalmia and xerostomia are often described in the following way by affected individuals: Unable to eat dry foods Tongue sticks on the roof of the mouth Unable to speak for long period Increased cases of dental caries Change in tastes Painful mouth[symptoma.com]
  • Further history revealed frequent dental caries, xerostomia and recent weight loss.[ncbi.nlm.nih.gov]
  • The patient reported dry mouth and physical examination showed multiple dental caries.[ncbi.nlm.nih.gov]
  • Results of this randomized clinical trial did not provide clear evidence to support or refute that quarterly applications of fluoride varnish can prevent development of dental caries in people with Sjögren's syndrome.[ncbi.nlm.nih.gov]
  • The effect of saliva on dental caries. J Am Dent Assoc. 2008; 139 (Suppl):11S–17S. doi: 10.14219/jada.archive.2008.0347. [ PubMed ] [ Cross Ref ] 23. Hurlbutt M, Novy B, Young D. Dental Caries: A pH-mediated disease. CJDH. 2010; 25 (1):9–15. 24.[web.archive.org]
Cracked Lips
  • Using oil or petroleum-based lip balm or lipstick to help dry, cracked lips feel better. Using a saliva substitute prescribed by a doctor to make the mouth feel wet. Using medicine to help your mouth make more saliva.[web.archive.org]
Dry Eyes
  • BACKGROUND: Sjogren's syndrome is the leading cause for aqueous tear-deficiency dry eye.[ncbi.nlm.nih.gov]
  • We describe patients in whom unexplained chronic cough was associated with dry eyes. Focused workup revealed undiagnosed Sjogren's syndrome in 36%.[ncbi.nlm.nih.gov]
  • Its cardinal symptoms include: Dry eyes Dry mouth Dental decay Systemic symptoms of fatigue and joint pain Dry eyes and dry mouth may also be caused by other diseases and certain medications.[hopkinssjogrens.org]
  • She recommends seeing a dry eye specialist, especially one who is familiar with autoimmune disorders.[nytimes.com]
  • After patient developed sicca syndrome with dry eyes and mouth in 2009, her rheumatoid factor titre was elevated (550 IU/mL), erythrocyte sedimentation rate, anti-Sjogrens syndrome-related antigen A (anti-Ro/SSA) and anti-SSB/La: anti-Sjogrens syndrome-related[ncbi.nlm.nih.gov]
Lacrimal Gland Enlargement
  • Definition (CSP) symptom complex of unknown etiology, usually occurring in middle-aged or older women, marked by the triad of keratoconjunctivitis sicca with or without lacrimal gland enlargement, xerostomia with or without salivary gland enlargement,[fpnotebook.com]
  • gland enlargement, xerostomia with or without salivary gland enlargement, and the presence of a connective tissue disease, usually rheumatoid arthritis but sometimes systemic lupus erythematosus, scleroderma, or polymyositis; an abnormal immune response[icd9data.com]
  • Historical information The first clinical description of Sjögren syndrome was by Mikulicz, who described a 42-year-old with bilateral parotid and lacrimal gland enlargement in 1892.[emedicine.com]
Urticaria
  • […] manifestations may develop, including arthralgia, arthritis, myalgia, Raynaud phenomenon, pulmonary disease, gastrointestinal disease, pericarditis, pulmonary hypertension, lymphadenopathy, neuropathy, vasculitis, renal tubular acidosis, xeroderma, purpura, and urticaria[symptoma.com]
  • DH in pediatric patients presents as urticaria, and more commonly purpura involving the soles, palms, and sides of the fingers.[doi.org]
  • Gastrointestinal disease Leukopenia Anemia Lymphadenopathy Neuropathy Vasculitis Renal tubular acidosis Lymphoma About 50% of patients with Sjögren syndrome have cutaneous findings, such as dry skin (xeroderma), palpable and nonpalpable purpura, and/or urticaria[emedicine.com]
Vaginal Dryness
  • Other symptoms can include joint swelling and pain, vaginal dryness, persistent dry cough and dry skin. It may also spread to other parts of the body such as blood vessels, nerves, lungs, kidneys and digestive system.[coloradoarthritis.com]
  • dryness, or persistent bronchitis.[blackdoctor.org]
  • dryness Skin rashes Joint pain, swelling and stiffness Muscle pain Fatigue In some cases, other parts of the body are affected as well.[uvahealth.com]
  • dryness can be treated with lubricants, hormone replacement therapy, and estrogen creams.[symptoma.com]
Paresthesia
  • Peripheral neuropathy: paresthesias, numbness, and/or motor defects of the lower/upper extremities confirmed by electromyography. Sural nerve biopsy showing vasculitis involving vasa nervorum when performed.[doi.org]
  • ) 3 (16.6%) – Non-specific ulcerations 2 (9.1%) 4 (22.2%) 1 (6.7%) Small aphtae 3 (13.6%) 2 (11.1%) 1 (6.7%) Sutton's aphtae 1 (4.5%) – – Geographic tongue – 2 (11.1%) 1 (6.7%) Fissured tongue 1 (4.5%) – – Enlargement of salivary glands 2 (9.1%) – – Paresthesias[ncbi.nlm.nih.gov]

Workup

No single examination is sufficiently sensitive or specific in the diagnosis of the disorder. Blood tests may reveal elevated erythrocyte sedimentation rate and transaminase levels, anemia, leukopenia, eosinophilia, hypergammaglobulinemia, presence of antinuclear antibodies, anti–alpha-fodrin antibody and rheumatoid factor. Rose Bengal test measures the function of the lacrimal glands and Schirmer's test the production of tears.

Radiological procedures such as sialography and scintigraphy or a salivary gland biopsy may be recommended to aid in the diagnosis of Sjogren’s syndrome [7] [8] [9].

Lymphocytic Infiltrate
  • Sjogren's syndrome is a chronic inflammatory disorder characterized by salivary insufficiency and lymphocytic infiltrates in exocrine organs.[symptoma.com]
  • Valve pathology showed nodular calcification and hyaline degeneration, but lymphocyte infiltration was not evident.[ncbi.nlm.nih.gov]
  • Abstract Sjogren's syndrome (SS) is a systemic autoimmune disease that primarily affects the exocrine glands, resulting in dryness of the eyes and mouth due to lymphocytic infiltration of the salivary and lacrimal glands along with arthritis, kidney,[ncbi.nlm.nih.gov]
  • The clinical presentation of SjS is heterogeneous and can vary from sicca symptoms to systemic disease (characterized by peri-epithelial lymphocytic infiltration of the affected tissue or the deposition of the immune complex) and lymphoma.[ncbi.nlm.nih.gov]
  • Sjögren's syndrome is a systemic autoimmune disorder characterized by salivary insufficiency and lymphocytic infiltration of the exocrine glands.[ncbi.nlm.nih.gov]
HLA-DR3
  • We found significantly increased frequency of HLA-DR3 (P less than .001), HLA-DW52a (P less than .001), and HLA-DQA4 (P less than .05), in comparison to normal controls.[ncbi.nlm.nih.gov]
  • Among the 1 SS patients, clinical and laboratory features such as hypergammaglobulinemia, symmetric peripheral neuropathy, and hypothyroidism were significantly associated with HLADR3 ( P .01) but not with HLA‐DR2 ( P .10).[doi.org]
  • It is important to note that the HLA-DQ2 haplotype found in 95 % of celiac patients shares a strong linkage to the HLA-DR3 haplotype associated with AIH [ 52 ].[doi.org]
  • The association of Sjögren syndrome with human leukocyte antigen (HLA)–B8, HLA-Dw3, HLA-DR3, and the DQA1*0501 allele supports the notion of genetic susceptibility. [16] An active area of research involves genetic polymorphisms of cytokine genes, including[emedicine.medscape.com]
HLA-B8
  • The association of Sjögren syndrome with human leukocyte antigen (HLA)–B8, HLA-Dw3, HLA-DR3, and the DQA1*0501 allele supports the notion of genetic susceptibility. [16] An active area of research involves genetic polymorphisms of cytokine genes, including[emedicine.medscape.com]
  • HLA-DQ2 and HLA-B8 are generally found in Caucasian patients, while HLA-DR5 is related to Greek and Israeli patients.[en.wikipedia.org]
  • Pathophysiology A genetic predisposition in SS-associated dry eye disease exists, as is evidenced by the high prevalence of human leukocyte antigen B8 (HLA-B8) haplotype in these patients.[emedicine.com]
HLA-Dw3
  • The association of Sjögren syndrome with human leukocyte antigen (HLA)–B8, HLA-Dw3, HLA-DR3, and the DQA1*0501 allele supports the notion of genetic susceptibility. [16] An active area of research involves genetic polymorphisms of cytokine genes, including[emedicine.medscape.com]

Treatment

Treatment of the disorder is generally symptomatic and supportive. It depends on the manifestations and varies for every patient. Moisturizing treatments, nonsteroidal anti-inflammatory drugs and low-dose glucocorticoids are most commonly used.

Prognosis

The prognosis of primary Sjogren's syndrome is generally good, but for secondary cases, the prognosis is closely related to the associated disease.

Etiology

Sjogren's syndrome exists as a primary or as a secondary disease. The two forms occur in similar frequency. The secondary form of the disease is associated with disorders such as system lupus erythematosus, polyarteritis nodosa, scleroderma, cryoglobulinemia, and systemic sclerosis. Regardless of whether the syndrome is primary or secondary, the parotid glands, the lungs, eyes, the mouth, the nervous systems, and the skin are affected.

The exact etiology of the disease is currently unknown. So far, it has been established that the pathogenesis is multifactorial. Environmental and hormonal factors are thought to trigger inflammation in individuals with a genetic predisposition to the disorder.

Viruses have been poised as being the number one candidates in possible environmental triggers. Some of the viruses that may play a role include HIV, HTLV-1, human hepersvirus 6, Epstein-Barr virus, cytomegalovirus, and hepatitis C virus [3].

Epidemiology

Sjogren's syndrome is ranked as the second most common rheumatologic disorder behind systemic lupus erythematosus. The disorder affects about 0.1% to 4% of the population in the United States. The wide range reflects the lack of a standard diagnosis method [2].

Globally, the disease has shown to remain homogenous among various ethnic groups and environments. The majority of cases occur in individuals above 40 years of age and mainly women are affected [1].

Sex distribution
Age distribution

Pathophysiology

Sjogren's syndrome is a chronic inflammatory disorder characterized by salivary insufficiency and lymphocytic infiltrates in exocrine organs. Even though the mechanism of its pathology has been studied since the discovery, the roles of different populations of immune cells in the pathogenesis remain inconclusive [4] [5].

Prevention

There are no guidelines for prevention of Sjogren's syndrome.

Summary

Sjogren's syndrome is a chronic inflammatory disorder marked by salivary insufficiency and lymphocytic infiltrates in exocrine organs. It is a relatively common disease, although often under-diagnosed.

In 1933, Dr. Henrik Sjögren published an article describing a group of women in a small Swedish town presenting with keratoconjunctivitis, lymphoid infiltrations of the conjunctiva, cornea, lacrimal glands, and parotid glands, a history of arthritis, swelling of the salivary glands, and dryness of the oronasopharynx. Two years later the observation was connected with Mikulicz’s disease and together formed the basis for this syndrome. In 1936, Duke Elder honored Sjögren by naming the disease Sjogren’s syndrome.

The disorder can occur either primary or secondary. Secondary Sjogren's syndrome appears several years after other associated disorders such as scleroderma, rheumatoid arthritis, and primary billiary cirrhosis.

Sjogren's syndrome is common among women above the age of 40 years. The female-to-male ratio is 9:1. There are no geographical differences in the prevalence of Sjogren's syndrome [1].

The disorder is complicated by the fact that there is no sufficiently sensitive or specific test in the diagnosis of Sjogren's syndrome. Moreover, so far there is no known cure for the disease. Symptomatic treatments control the severity of the symptoms associated with the disease.

Patient Information

Once diagnosed with Sjogren's syndrome, the main challenge is not having the disorder, but not knowing what to do next to live positively with it. The good news is that Sjogren’s syndrome does not have to impede your normal lifestyle.

Several remedies are used to treat Sjogren’s syndrome effects. Artificial tears are effective in remedying against dry eye. Tears in normal eyes are drained through tear ducts. Through surgery, these ducts can be sealed with small plugs. Therefore, the little tears formed in the eyes are not drained hence stay for longer. The process is known as punctual occlusion and it is recommended only after the other possible alternatives have failed.

Possible treatments for dry mouth:

  • Consumption of more liquid
  • Suckling of ice cubes that keeps the mouth moist and lubricated
  • Regular rising of the mouth to protect against infections as well as sooth the mouth
  • Maintenance of good oral hygiene to prevent tooth decay and gum diseases
  • Stop smoking for those who smoke as smoking evaporates the mouth as well as causes an irritation
  • Chewing of sugar free gums which stimulates the production of saliva
  • Use of saliva substitutes

Vaginal dryness can be treated with lubricants, hormone replacement therapy, and estrogen creams. Joint and muscle aching can be relieved with non-steroidal anti-inflammation drugs. Systemic corticosteroids or immunosuppressive agents have been used for various extraglandular symptoms, such as vasculitis, lung involvement and kidney involvement.

References

Article

  1. Mavragani CP, Moutsopoulos HM. The geoepidemiology of Sjogren's syndrome. Autoimmunity Reviews 9 2010, A305-A310
  2. Helmick CG, Felson DT, Lawrence RC, et al. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part I. Arthritis Rheum. Jan 2008;58(1):15-25.
  3. Jonsson R, Vogelsang P, Volchenkov R, Espinosa A. The complexity of Sjogren's syndrome: Novel aspects on pathogenesis. Immunol. Lett. 141 2011, 1; 1-9; 9
  4. Voulgarelis M, Tzioufas AG. Pathogenetic mechanisms in the initiation and perpetuation of Sjogren's syndrome. Nature Reviews Rheumatology 6 2010, 529-537.
  5. Nocturne G, Mariette X. Advances in understanding the pathogenesis of primary Sjögren's syndrome. Nature Reviews Rheumatology 9 2013, 544-556.
  6. Tzioufas AG, Voulgarelis M. Update on Sjögren's syndrome autoimmune epithelitis: from classification to increased neoplasias. Best Pract Res Clin Rheumatol. Dec 2007;21(6):989-1010.
  7. Montaño-Loza AJ, Crispín-Acuña JC, Remes-Troche JM, Uribe M. Abnormal hepatic biochemistries and clinical liver disease in patients with primary Sjögren's syndrome. Ann Hepatol. Jul-Sep 2007;6(3):150-5.
  8. Daniels TE. Labial salivary gland biopsy in Sjögren's syndrome. Assessment as a diagnostic criterion in 362 suspected cases. Arthritis Rheum. Feb 1984;27(2):147-56.
  9. García-Carrasco M, Ramos-Casals M, Rosas J, et al. Primary Sjögren syndrome: clinical and immunologic disease patterns in a cohort of 400 patients. Medicine (Baltimore). Jul 2002;81(4):270-80.

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Last updated: 2019-07-11 21:33