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20 August, 2008

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Sjogren's syndrome

Sjogren’s syndrome is a relatively common autoimmune disease that mainly affects the eyes and salivary glands, but can also affect the sweat glands. Immune system cells, called lymphocytes, and antibodies attack the body’s moisture-producing glands (tear, salivary, sweat). The chronic inflammation can eventually destroy the tissues. The disorder progresses slowly, so the typical symptoms of dry eyes and mouth may take years to show. Symptoms can be mild, moderate or severe, and the progression is often unpredictable. Other parts of the body may also be targeted.

Around 0.05 per cent of the population is thought to have Sjogren’s syndrome. Women with the disorder outnumber men by ten to one. There is no cure, but the disorder can be managed. About five per cent of cases develop lymphoma (cancer of the lymph glands).

Symptoms
The symptoms of Sjogren’s syndrome can include:

Insufficient tear production �
Dry, reddened and itchy eyes
Light sensitivity
Dry mouth
Sore and cracked tongue, lips and gums
Swallowing difficulties
A thirst for water while talking
Swollen and tender areas around the ears and below the jaw
Strange taste and smell sensations
Fatigue
Swelling and pain in the joints.

The cause is unknown
No one knows what prompts the immune system to attack the tear and salivary glands. However, the disorder is associated with rheumatoid conditions (such as scleroderma, lupus and rheumatoid arthritis) in around half of all cases. This is known as secondary Sjogren’s syndrome. In the remaining cases, the autoimmune response occurs in isolation. This is known as primary Sjogren’s syndrome. It is believed to have a genetic basis, with an environmental trigger - possibly a virus.

Other areas can be affected
All instances of Sjogren’s syndrome are systemic, therefore affecting the entire body. Sjogren’s syndrome can be mild, moderate or severe, and can progress unpredictably, with some individuals experiencing a remission of symptoms. Common complications include dental decay, skin rashes and an increased susceptibility to thrush infections of the mouth. In some cases, the disorder affects other areas of the body, as well as the eyes and mouth. The mucus membranes of the nose and vagina can dry out, and internal organs (including kidneys, intestines, lungs, heart and liver) may become inflamed. The structures of the circulatory and nervous systems can also be affected.

Diagnosis methods
Early diagnosis and treatment are important for preventing complications. Diagnosis for Sjogren’s syndrome can be difficult, since the symptoms can imitate those of other diseases, including multiple sclerosis and senile glandular atrophy. Dry mouth and eyes can also be the side effects of medications for other problems, such as depression and high blood pressure. Diagnosing Sjogren’s syndrome involves a number of tests, which may include:

Schirmer’s test - special blotting paper held to the eye is used to assess the degree of tear production.
Eye examination - including the use of special dyes.
Biopsy - a small tag of salivary gland tissue is removed (usually from the lip) and examined in a laboratory.
Salivary gland tests - to check the degree of saliva produced.
Blood tests - a series of blood tests may be performed to check the levels of particular immune system cells and immunoglobulins, and for autoantibodies in the blood.

Treatment options
There is no cure for Sjogren’s syndrome, but the disorder can be managed. Treatment options include:

Artificial tears and lubricating ointments for the eyes
Artificial saliva
Mouth rinses and lozenges
Nasal sprays
Vaginal lubricant lotions
Moisturising lotion for the skin
Non-steroidal anti-inflammatory drugs (NSAIDs)
Corticosteroid medications
Immunosuppressive medications.

Management techniques
Other suggestions to manage the symptoms of Sjogren’s syndrome include:

Avoid dry and dusty environments
Avoid air drafts or windy weather
Wear protective glasses when outside in the wind and sun
Exercise regularly
Drink water regularly
Practise good dental hygiene and visit your dentist often.

Where to get help

Your doctor
Rheumatologist
Support groups
Arthritis Victoria Tel. (03) 03 8531 8000

Things to remember

Sjogren’s syndrome is an autoimmune disease that mainly affects the eyes and salivary glands, but can also affect the sweat glands.
Immune system cells attack and destroy the tissue of the tear (lachrymal) and salivary glands.
There is no cure, but the condition can be managed with medications and products, including artificial tears and saliva.

Related topics:

You might also be interested in:
Dry mouth syndrome.
Immune system.
Lupus explained.
Polymyositis.
Rheumatoid arthritis.
Scleroderma affects the skin.

Want to know more?
Go to More information for support groups, related links and references.

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This page has been produced in consultation with, and approved by:

Arthritis Victoria incorporating Osteoporosis Victoria

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