Sjogren's Syndrome - Article from major European Business Magazine  "Focus"

The Sjögren’s Syndrome

This article appeared in a recent edition of the European Business Magazine “Focus” published in German and contains some very useful information in a consise format.

The article is intended to create awareness in the business community and to help employers understand the problems encountered by staff who suffer from the condition  

INGRID MÜLLER, GRADUATE BIOLOGIST

Dry eyes or mouth? In Sjögrens  syndrome, the immune system attacks the tear and salivary glands. The most important thing about course, diagnosis, therapy.

content

1. Life expectancy and course in Sjögren syndrome
2. Frequency and shapes
3. Cause is in the dark
4. Blood count and diagnosis
5. therapy
6. Symptoms first affect the glands

Sjögren Syndrome - what is it? These questions are asked many who come into contact with the complicated term for the first time. The name derives from the Swedish ophthalmologist Henrik Sjögren, who first described the disease in 1933. Another name is Sicca syndrome, derived from "siccus", which means latin "dry".

The Sjögren syndrome doctors are connective tissue diseases called collagenosis. It is also one of the autoimmune diseases in which the immune system falsely attacks and destroys the body's own structures. In Sjögren syndrome, it is initially the salivary glands and lacrimal glands in the eye, later other organs can be added.In rheumatoid arthritis, the immune system drives an attack against the joints, in the nervous disease multiple sclerosis against the protective coat of nerve cells.
 

Life expectancy and course in Sjögren syndrome

Sjögren's Syndrome is a chronic condition that accompanies life and progresses throughout life. Doctors can treat it, but not cure it. The Sjögren syndrome affects the glands and does not stop at other organs. Often the skin, the mucous membranes of the respiratory tract or the gastrointestinal tract are affected.

Overall, the prognosis in Sjögren's Syndrome is favorable. If it is a primary Sjögren Syndrome, sufferers have a life expectancy that is comparable to the normal population. However, the quality of life often suffers because of the variety of complaints. The most common causes of death in Sjögren's patients are cardiovascular diseases, infections or lymphoma (lymphoma). In secondary Sjögren's syndrome, life expectancy depends on the underlying disease.
 

Frequency and shapes

Sjögren Syndrome is almost exclusively a woman's problem. Out of ten patients there are about nine women, which corresponds to a ratio of 9: 1. In the literature, however, there is sometimes a frequency of 20: 1. In the group of rheumatic immune diseases, Sjögren syndrome is in second place - behind rheumatoid arthritis. Most Sjögren's syndrome begins in women between the ages of 30 and 65, on average at mid-40s.

Sjögren's Syndrome is relatively rare. An estimated four out of every one million adults are diagnosed with Sjögren syndrome each year. Doctors estimate that in Germany, two to ten out of 1,000 adults are affected by the disease.The reasons for the vague numbers are that many classify the symptoms "eye and mouth dryness" as harmless and do not consult a doctor. In addition, these symptoms also occur in many other diseases. Even for doctors, the Sjögren syndrome is therefore difficult to diagnose.

The Sjögrens Syndrome comes in two variants:

1. As an independent disease (Primary Sjögren's Syndrome): Symptoms first appear on the tear and salivary glands.The eyes and mouth dry out. Later, other mucous membranes and organs may be affected, such as the lungs or kidneys.
2. Sjögrens may be the result of other diseases of the immune system, such as rheumatoid arthritis or systemic lupus erythematosus. Then doctors refer to the disease as a Secondary Sjögren syndrome.
    

Cause is in the dark

Sjögrens Syndrome is an autoimmune disease. The misguided immune system falsely attacks the body's own structures. The organism forms antibodies (auto-antibodies) that are directed against the body's own tissue - in the case of Sjögren's syndrome, against the lacrimal glands and salivary glands. It causes inflammation that reduces the production of tear and saliva - they dry out.

Risk factors for Sjögrens syndrome

The cause of Sjögren Syndrome is unknown. Researchers discuss the following factors in the development of the disease:

1. Genes: Sjögrens syndrome is more common in some families. Maybe the inclination and the predisposition are inherited. 
2. Menopause and changes in hormone balance: This would explain why women in their mid-life around 45 years old are the first to get sick. 
3. stress 
4. infections
    

However, these relationships are not proven. So it is not possible to predict who gets ill and who does not.

Secondary Sjögren syndrome: cause is another disease

Secondary Sjögren syndrome is the reason for another disease. Doctors have found a connection with the following diseases:

1. Inflammatory rheumatic diseases such as rheumatoid arthritis, systemic lupus erythematosus (SLE) and other collagenoses such as scleroderma (skin "hardened"); Not a few of these patients develop a secondary Sjögren syndrome.
2. Other autoimmune diseases, such as the liver (primarily biliary cholangitis, formerly primary biliary cirrhosis), the thyroid (autoimmune thyroiditis) or autoimmune hepatitis.
    

Blood count and diagnosis

The Sjögren diagnosis is often made after several years of suffering. Many do not even visit a doctor, because they do not consider the complaints serious. And when they go to the doctor, they often conceal the symptoms of mouth and eye dryness. Conversely, the symptoms of Sjögren's syndrome are so varied that even experienced physicians initially do not interpret the disease properly and make a mistake in the diagnosis. This is how the doctor proceeds to diagnose Sjögren's syndrome:

Doctor-patient conversation

The doctor first asks you about your complaints and your medical history. There is a standardized questionnaire on Sjögren's syndrome diagnosis, which includes the following questions:

1. Have you been suffering from daily eye and mouth dryness for more than three months, which you find distressing?
2. Do you often have a foreign body sensation (like sand) in your eyes?
3. Do you use tear substitutes more than three times a day?
4. Have you been experiencing dry mouth every day for more than three months?
5. Do you suffer from recurrent or permanent swelling of the salivary glands? 
6. Do you always have to drink something to be able to swallow dry food?
7. These questions are also of interest to your doctor: Are you aware of any conditions, such as rheumatoid arthritis, systemic lupus erythematosus or scleroderma? 
8. Are there rheumatic diseases in your family? 
9. Do you take medications, if yes: which ones?
    

Blood test and other diagnoses

1. Test how well the tear and saliva production works: The Saxon test measures the amount of saliva produced, the Schirmer test determines the production of the tear fluid. It is measured with a cotton ball in the mouth or a filter paper in the lower lid.
2. Salivary gland examinations using imaging techniques and contrast agents: scintigraphy, sialography, MRI (magnetic resonance imaging = MRI)
3. Tissue sample (biopsy) from the inside of the lip, then microscopic examination of the glandular tissue
4. Sjögren syndrome diagnostics in the laboratory: It is helpful to have a blood test to detect certain antibodies: antinuclear antibodies (ANA); These are not available in all patients. Therefore, the determination of some subtypes is particularly important: the SS-A / Ro antibody and SS-B / La antibody; they should be present in Sjögren syndrome. In addition, the doctor determines the rheumatoid factors.
5. If the doctor suspects that Sjögren syndrome has spread to the lungs, kidneys, and other organs, further investigation will follow. This also applies if the Sjögren syndrome is a concomitant of other diseases.
    

therapy

The treatment of Sjögren syndrome belongs in the hands of specialists who work well together in the best cases.The right contact persons for Sjögren syndrome are an ophthalmologist, rheumatologist or ear, nose and throat doctor. Although the Sjögren syndrome is not curable, but doctors can treat it. However, there is not "the one" drug that relieves all discomfort at the same time.

Eye drops as a treatment for the symptoms of Sjögren's syndrome

The following therapies help with dry mucous membranes:

1. Artificial tears as eye drops, eye ointments or eye gels: Eye drops are usually only temporary and help during the day, eye ointments and gel rather at night, because they stick to the eyes
2. Artificial saliva as a spray or oral gel
3. Nasal gels, which counteract the formation of crusts (barking) in the nose
4. adequate hydration
5. Dry vaginal mucous membranes can be treated with hyaluronic acid gel; Also preparations with estrogens (suppositories, ointments) help, if from a medical point of view nothing speaks against their use.
6. Drugs that stimulate the glands and stimulate the production of fluids: they help against dry mouth and dry eyes.In Germany, the active ingredient pilocarpine is approved. The drug is available as a film-coated tablet, prescription and doctors can prescribe it. The active ingredient cevimelin also showed good effects in studies, but has no approval for the German market.
7. Punctum plugs are small implants that close the lacrimal ducts; then there is more tears available. They help some patients with moderate to severe eye dryness.
    

Tip! There are various products that counteract dryness in the mouth and eyes. You may need to try a little to know which eye drops help best with Sjögren syndrome. If you need the eye drops more than four times a day, you better access products without preservatives.

Are eye drops eligible for Sjögren syndrome? The answer is yes. The statutory health insurance companies cover the costs of artificial tear fluid in Sjögren's syndrome with marked dysfunctions (dry eye grade 2). The health insurance companies also pay for artificial saliva products.

Other treatments for Sjögren syndrome

If the Sjögren syndrome affects the entire body, there are several medications available for treatment. Some examples:

1. mild analgesics (nonsteroidal anti-inflammatory drugs, NSAIDs) in joint pain and salivary swelling
2. strong anti-inflammatory agents (corticosteroids) in arthritis, eg cortisone
3. Chloroquine and similar drugs as a long-term therapy for muscle pain
4. Corticosteroids over a short period of time when organs such as the lungs or the nervous system are affected
5. Immunosuppressants in vascular inflammation
6. Corticosteroids in fever and severe attacks without infection
7. vasodilatory drugs, such as the active ingredient nifedipine, in circulatory disorders of the fingers and toes (Raynaud's syndrome)
    

Sjögren syndrome and homeopathy

Some patients with Sjögren syndrome try homeopathy for their complaints. For dry eyes, alumina, Euphrasia (eyebright) in conjunctivitis or sodium chloratum may be helpful. Always look for a homeopath who has a lot of experience with various diseases. Although homeopathy does not cure Sjögren's syndrome, it may relieve the unpleasant symptoms.

Tips for patients with Sjogren's syndrome

You can also do a few things yourself to relieve your symptoms - the best tips!

1. Pay particular attention to your oral and dental hygiene. Use a mild toothpaste for brushing your teeth and provide your teeth with enough fluoride.
2. Do not consume too much sugar (cakes, sweets, sugary drinks), otherwise the caries risk increases.
3. Check with the dentist regularly. He discovers tooth decay and periodontitis in good time.
4. Chewing gum (sugar-free!) Stimulates saliva production.
5. Eat sour foods that boost salivary production
6. Sjögren syndrome often means that you are more susceptible to infection. Always seek medical attention promptly if you develop appropriate symptoms.
7. Ensure moist air in the rooms. For example, hang damp cloths or place a bowl of water on the heater. Air conditioners or cigarette smoke, on the other hand, increase the mucous membranes.
8. In strong winds, protect your eyes with glasses that have a side guard.
9. Treat yourself to more breaks during the day and relax.
10. Use consistently artificial tears, eye ointment and eye gel
11. Also helpful is the contact with a support group for Sjögren's syndrome. People are gathered there who are like you. Maybe you benefit from the exchange of experiences and get answers to specific questions. On the Internet or at the German Rheumatism League you will find contact details and contact persons for Sjögren syndrome.
     

Symptoms first affect the glands

The Sjögren syndrome causes various symptoms, initially on the eye and the oral mucosa. The following complaints develop:

1. dry eyes, eye pain
2. Conjunctival and corneal inflammation (keratoconjunctivitis sicca), swollen eyes
3. Foreign body sensation in the eye (like grains of sand under the eyelid)
4. Dry mouth: chewing, swallowing and prolonged speech are difficult
5. swollen salivary glands and lymph nodes on the neck (temporarily)
6. Fatigue: lead fatigue and heavy fatigue, many feel "paralyzed" and just want to sleep, which does not improve fatigue
7. Circulatory disorders in the fingers and toes (Raynaud's syndrome)
8. increased body temperature, fever
    

Later, these symptoms are often added:

1. Dental problems due to dry mouth, such as tooth decay or periodontitis; halitosis
2. Infections and inflammation of the oral mucosa
3. Disorders of taste and smell
4. Infections in the nose and throat, increased susceptibility to infection
5. hoarseness
6. Dryness of other mucous membranes, such as the vaginal mucosa
7. Skin changes (eg dry skin)
8. sleep disorders
9. Chronic gastritis
    

Rarely does the Sjögren syndrome spread to other organs and cause further damage:    (Editor’s Note  Please note patients with Secondary Sjogrens Syndrome can regularly suffer from these symptoms due to the link between Secondary Sjogrens Syndrome and another underlaying condition .  ie Arthritis etc.)

1. Lungs, kidneys and nervous system
2. enlarged spleen
3. Muscle and joint complaints: muscle pain, muscle inflammation, joint pain, joint inflammation)
4. inflamed blood vessels, skin redness, skin rash
5. Lymphoma (lymphoma)
    

Always consult a doctor for such symptoms. This is the only way to determine what is behind the complaints.There are a number of diseases that are also associated with eye and mouth dryness or tiredness. Examples are the diabetes mellitus diabetes mellitus, the fibromyalgia syndrome or viral infections.