sjogren s syndrome
definition
sjogren s (show-grins) syndrome is a disorder of your immune system often defined by its two most common symptoms — dry eyes and a dry mouth.
sjogren s syndrome often accompanies other autoimmune disorders — such as rheumatoid arthritis and lupus. these diseases are marked by inflammation of your connective tissues, and it s common for people with sjogren s syndrome to also have a connective tissue disorder.
in sjogren s syndrome, your immune system attacks healthy tissue. the mucous membranes and moisture-secreting glands of your eyes and mouth are usually affected first, resulting in decreased production of tears and saliva. the disease can damage other tissues as well.
although you can develop sjogren s syndrome at any age, most people are older than 40 at diagnosis. the condition is much more common in women. there s no cure, but treatments can relieve many symptoms
symptoms
sjogren s syndrome can be difficult to diagnose because the signs and symptoms are similar to those caused by other diseases and can vary from person to person. in addition, the side effects of a number of medications can mimic some signs and symptoms of sjogren s syndrome. still, typical signs and symptoms of sjogren s syndrome include:
§ dry eyes
§ dry mouth
§ dental cavities
§ fatigue
§ enlarged parotid glands — one particular set of your salivary glands, located behind your jaw and in front of your ears
§ difficulty swallowing or chewing
§ change in sense of taste
§ hoarseness
§ oral yeast infections, such as candidiasis
§ skin rashes or dry skin
§ vaginal dryness
§ dry cough that doesn t produce sputum
§ joint pain, swelling and stiffness
causes
sjogren s syndrome is an autoimmune disorder. this means that your body attacks its own cells and tissues.
it s unknown why this happens, but researchers believe that a combination of factors causes something to go wrong with your immune system. these factors may be related to heredity, hormones, a viral or bacterial infection, or your nervous system.
in the case of sjogren s syndrome, white blood cells lymphocytes mistakenly target, attack and damage your moisture-producing glands. they can also damage other organs, including lungs, kidneys and liver.
sjogren s syndrome that results from a rheumatic condition is classified as secondary sjogren s syndrome. primary sjogren s syndrome occurs by itself.
risk factors
although anyone can develop sjogren s syndrome, it typically occurs in people with one or more known risk factors. these include:
§ rheumatic disease. it s common for people who have sjogren s syndrome to also have a rheumatic disease, such as rheumatoid arthritis, lupus, scleroderma or polymyositis.
§ female. women are nine times as likely as men are to have sjogren s syndrome.
§ certain age. sjogren s syndrome is usually diagnosed in people older than 40.
§ a family history of sjogren s. sjogren s syndrome sometimes runs in families
when to seek medical advice
sjogren s syndrome tends to develop slowly. but once symptoms occur, they can lead to complications that require medical attention. if you notice such symptoms as unusually dry eyes or a dry mouth that lasts longer than three months, seek medical advice.
how do you know if your eyes are unusually dry? if the dryness persists or if you frequently feel as if you have grit or sand in your eyes, you re probably experiencing unusually dry eyes. or you may find you re frequently using artificial tears. important signs and symptoms of oral dryness include daily dry mouth or recurrent or persistent swollen salivary glands. if you drink liquids to help swallow dry foods, you may also have an unusually dry mouth.
tests and diagnosis
to diagnose sjogren s syndrome, doctor will likely ask for a history of signs and symptoms, including what they are and how long you ve had them.. doctor may ask about your diet, including the types and quantities of liquids that you drink in a day.
beyond reviewing your medical history, your doctor can use a variety of tests to diagnose sjogren s syndrome:
- blood tests. doctor may order blood tests to check blood count and sedimentation rate ,autoantibodies, proteins formed when your immune system attacks your body s own cells. checking your blood count lets doctor know the proportion of the various types of blood cells in a given volume of your blood. sedimentation rate refers to the speed at which the red blood cells settle to the bottom of a column of blood in a glass tube. certain inflammatory conditions increase the sedimentation rate.
· eye tests. doctor can measure the dryness of your eyes with a test called a schirmer tear test. in this test, a small piece of filter paper is placed under lower eyelid to measure your tears. in another version of the test, a cotton swab is used to stimulate the tear reflex in your nose.
a medical eye doctor (ophthalmologist) may also examine your eyes with a slit lamp after placing a droping of liquid containing a dye in your eye. the dye stains areas of the cornea that have been damaged by the dryness.
· imaging. to check on the condition of your salivary glands, your doctor may order a special x-ray called a sialogram. it detects dye that s injected into your parotid glands, located behind your jaw and in front of your ears. the dye is injected through the opening of a small duct in your mouth. this procedure reveals the flow of saliva into your mouth.
your doctor may also perform a parotid gland flow test to determine the amount of saliva that you produce over time. another imaging test is a salivary scintigraphy, which measures your salivary gland function. your doctor may also order a chest x-ray to check for lung inflammation.
- biopsy. your doctor may also want to do a lip biopsy to detect the presence of clusters of inflammatory cells, which can indicate sjogren s syndrome. for this test, a small sliver of tissue is removed from salivary glands located in your lip and examined under a microscope.
- urine sample. your doctor may want you to provide a urine sample that can be analyzed in the laboratory to determine whether sjogren s syndrome has affected your kidneys.
- slit-lamp exam. your doctor may use magnifying equipment to determine how dry your eye is and whether the outside of your eye is inflamed