Sjögren's Syndrome

What is Sjögren's syndrome?

Sjögren's syndrome is an autoimmune disorder. This means that your body's defenses against infection are attacking your own tissue. When you have Sjögren's syndrome, the immune cells attack and destroy the glands that produce tears and saliva. Damage to these glands keeps them from working properly and causes dry eyes and dry mouth. Sometimes other fluid-producing cells in the body are also damaged. This can affect other parts of the body, such as the kidneys, blood vessels, and nervous system.

How does it occur?

The cause of Sjögren's syndrome is not known. It may be inherited. Viral or bacterial infections may also play a role in its development.

The disease occurs most often in women between ages 40 and 65. You may have it along with other inflammatory diseases such as lupus, rheumatoid arthritis, scleroderma, or polymyositis.

What are the symptoms?

Sjögren's syndrome may cause:

• dry eyes and mouth
• pain in the eyes or the feeling that a piece of sand is in the eyes
• trouble chewing and swallowing
• sore mouth
• tooth decay
• swollen salivary glands
• vaginal dryness
• dryness of the upper respiratory system, causing nosebleeds, hoarseness, dry cough, or infections of the sinuses or lungs
• dry skin
• fatigue.

How is it diagnosed?

Your healthcare provider will ask about your symptoms and examine you. You may have tests such as:

• Mouth exams to see if the salivary glands are swollen. You may have a saliva test to see how much saliva the glands are producing and to check the quality of the saliva.
• Salivary gland biopsy of the inner lip. Your provider removes tiny minor salivary glands from the inside of the lower lip and sends them for examination under a microscope. This test is the best way to find out whether dry mouth is caused by Sjögren's syndrome.
• Eye exams to measure how well your tear glands produce tears, how dry your eyes are, and whether the outside of your eye is inflamed.

You may also have blood tests, urine tests, and chest X-rays.

How is it treated?

There is no known cure, but treatment can help the symptoms. Treatment is different for each person, depending on what parts of the body are affected. To relieve dry eyes or dry mouth, your provider may recommend:

• using artificial-tears eyedrops during the day and artificial-tears ointment at night
• using artificial saliva
• chewing sugarless gum to help keep the mouth moist
• drinking more fluids.

When Sjögren's affects other parts of your body as well as your glands, your provider may recommend or prescribe:

• a vaginal lubricant, such as K-Y jelly, for vaginal dryness
• nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or aspirin, for pain or discomfort (NSAIDs should be used with caution by older adults.)

In more severe cases, especially if other organs such as the kidneys are involved, treatment may include:

• steroids (prednisone)
• drugs that suppress the immune system, such as hydroxychloroquine, methotrexate, and cyclophosphamide.

How long will the effects last?

The effects of Sjögren's are different from person to person. The symptoms may vary with time, being sometimes better and sometimes worse. Treatment may help some people more than others. Sjögren's is a serious disease but most people with the condition have a normal lifespan.

How can I help take care of myself?

• Follow your healthcare provider's plan for treatment.
• Discuss all medicines you are taking with your healthcare provider. Drugs that can cause dryness include antihistamines, decongestants, and high blood pressure medicines.
• Visit a dentist at least 3 times a year to have your teeth examined and cleaned.
• Rinse your mouth with water several times a day. Don't use mouthwash that contains alcohol because alcohol is drying.
• Put a humidifier in the rooms where you spend the most time.
• Do not smoke. Avoid smoky rooms.
• See your healthcare provider promptly if you have new symptoms.

For more information, call the Sjögren's Syndrome Foundation at 800- 475-6473 or visit their Web site at http://www.sjogrens.org.

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