{"id":18134,"date":"2018-03-05T14:48:53","date_gmt":"2018-03-05T12:48:53","guid":{"rendered":"http:\/\/www.hygeia.gr\/%cf%83%cf%8d%ce%bd%ce%b4%cf%81%ce%bf%ce%bc%ce%bf-sjogren\/"},"modified":"2020-02-27T09:44:58","modified_gmt":"2020-02-27T07:44:58","slug":"syndromo-sjogren","status":"publish","type":"page","link":"https:\/\/www.hygeia.gr\/en\/syndromo-sjogren\/","title":{"rendered":"Sj\u00f6gren\u2019s syndrome"},"content":{"rendered":"

What is Sj\u00f6gren\u2019s syndrome?<\/strong>
\nSj\u00f6gren\u2019s syndrome (pronounced Shurgren\u2019s) is a condition which mainly affects the glands that produce saliva and tears, causing a dry mouth and\/or eyes. The syndrome most commonly affects women aged 40\u201360.<\/p>\n

\"\"<\/p>\n

There are 2 types of Sj\u00f6gren\u2019s syndrome:
\n\u2022 primary \u2013 when it occurs on its own
\n\u2022 secondary \u2013 when it also occur in association with another rheumatic disease such as rheumatoid arthritis, lupus or scleroderma
\nIt\u2019s estimated that many people may be affected by Sj\u00f6gren\u2019s syndrome, but the exact figures aren\u2019t known because many people never see a doctor about their symptoms.<\/p>\n

What are the symptoms of Sj\u00f6gren\u2019s syndrome?<\/strong>
\nSymptoms include:
\n\u2022 dry, sore, irritable or gritty eyes
\n\u2022 a dry mouth and\/or throat, which may cause difficulty chewing or swallowing food
\n\u2022 tiredness (fatigue)
\n\u2022 joint pain or general achiness
\nYou may also experience dryness of the skin, digestive tract, vagina or air passages.<\/p>\n

Other possible symptoms include:
\n\u2022 headaches
\n\u2022 fever
\n\u2022 swollen lymph glands in your neck, armpits or groin
\n\u2022 aggravated menopausal symptoms
\n\u2022 your fingers or toes turning blue in the cold (Raynaud\u2019s phenomenon)
\nSj\u00f6gren\u2019s syndrome can sometimes cause problems with your nervous system, liver and kidneys, inflammation of your blood vessels and chest pain.
\nMany people don\u2019t have any other symptoms, but the range and severity of symptoms can vary a great deal from person to person.<\/p>\n

Eye problems<\/strong>
\nYour eyes may be dry and feel sore, irritable or gritty. Some people find strong lights can be uncomfortable, while others find their eyes become sticky with mucus.<\/p>\n

Mouth and throat problems<\/strong>
\nYour mouth may become dry and you may have mouth ulcers, which can sometimes cause a sticky feeling in your mouth or throat. It may be difficult to swallow and your sense of taste may be altered. Your voice may be hoarse or weak, and some people have a dry cough.
\nOccasionally a very dry mouth can lead to other problems such as fungal infections (e.g. thrush), an unpleasant taste in your mouth and increased dental decay. Your salivary glands may also become painful and\/or swollen.<\/p>\n

Extreme fatigue<\/strong>
\nFatigue (extreme tiredness) is one of the most common symptoms, and it can\u2019t be cured by a good night\u2019s sleep. Some people may also feel down or depressed.<\/p>\n

Aches and pains<\/strong>
\nYour joints may be painful and swollen due to inflammation, while some people have a general achy feeling or tenderness at various points around their body. Joint problems are usually less severe than in conditions such as rheumatoid arthritis.<\/p>\n

Other symptoms<\/strong>
\nOther parts of your body may also be drier than normal, for example:
\n\u2022 your digestive passage, making it difficult to swallow food
\n\u2022 your bowel, causing symptoms similar to irritable bowel syndrome (e.g. abdominal pain)
\n\u2022 your vagina, making sex uncomfortable
\n\u2022 your skin, which may also be itchy or unusually sensitive to strong sunlight
\n\u2022 your air passages, making you more sensitive to irritants such as smoke or dust<\/p>\n

Other problems and complications that can sometimes be associated with Sj\u00f6gren\u2019s syndrome include:
\n\u2022 fever
\n\u2022 cold, blue fingers (Raynaud\u2019s phenomenon)
\n\u2022 migraine-like headaches
\n\u2022 swollen lymph glands in your neck, armpits or groin
\n\u2022 aggravated menopausal symptoms
\n\u2022 problems with your nervous system, such as weakness or numbness
\n\u2022 inflamed blood vessels (known as vasculitis)
\n\u2022 chest pain (caused by pleurisy) or breathlessness
\n\u2022 liver or kidney problems<\/p>\n

Who gets Sj\u00f6gren\u2019s syndrome?<\/strong>
\nWomen aged between 40 and 60 are most likely to be diagnosed with Sj\u00f6gren\u2019s syndrome. Only about 1 in 10 Sj\u00f6gren\u2019s syndrome patients are men, and the condition only rarely occurs in childhood.
\nIt\u2019s possible that some people are more likely to get Sj\u00f6gren\u2019s syndrome because something in their genes makes it difficult for them to get rid of certain infections. However, it\u2019s unusual for children to inherit the condition from their mother or father.<\/p>\n

How is Sj\u00f6gren\u2019s syndrome diagnosed?<\/strong>
\nYour doctor will ask about your symptoms and carry out tests to assess how dry your eyes and mouth are. You may also need to see an eye specialist (ophthalmologist), a dentist or oral surgeon, or a rheumatologist before you\u2019re diagnosed.
\nWhat tests are there?
\n\u2022 Tear production \u2013 a small piece of sterilized, pre-packaged blotting paper is used to measure your tear production. This is called Schirmer\u2019s test. The paper is placed in the corner of your eye and folded over your lower eyelid. This is a little uncomfortable and causes your eyes to water, making the paper wet. The amount of water that soaks into the blotting paper within 5 minutes is measured, and this tells the doctor how good your tear production is.
\n\u2022 Eye examination \u2013 an eye specialist will put a dye into your eyes and use an instrument called a slit lamp to examine them. The lamp shines a beam of light through a narrow slot and magnification allows the doctor to examine the surface of your eye more effectively. This makes it possible to see the film of liquid over the surface of each eye. If you don\u2019t have enough of this liquid, it could be a sign that you have Sj\u00f6gren\u2019s syndrome.
\n\u2022 X-rays of your salivary glands and ducts (sialography) \u2013 rarely used.
\n\u2022 Other scans \u2013 ultrasound scans of the salivary glands or MRI scans.
\n\u2022 Blood tests \u2013 Complete blood count, ESD, CPR and urine tests, as well as special immunological tests.
\nPeople with Sj\u00f6gren\u2019s syndrome often have high levels of antibodies in their blood. Two particularly important antibodies are called anti-Ro and anti-La antibodies, which can also be seen in patients with lupus erythematosus. If you have anti-Ro and\/or anti-La antibodies along with dry eyes and\/or a dry mouth, it\u2019s very likely that you have Sj\u00f6gren\u2019s syndrome.
\nPatients with Sj\u00f6gren\u2019s syndrome often have very high ESR levels regardless of whether they feel well or ill, unlike people who have other conditions such as systemic lupus erythematosus or rheumatoid arthritis. Measuring the ESR isn\u2019t a good way to tell how active your condition is, so other measurements such as C-reactive protein (CRP) are better because they only rise when Sj\u00f6gren\u2019s syndrome becomes more active.
\n\u2022 Lip and salivary gland biopsy \u2013 several tiny salivary glands may be removed from your lower lip under a local anesthetic and examined under a microscope. This is usually only done if the diagnosis is still uncertain after the other tests. Further specialized tests may be needed if you develop swelling in your lymph glands (in the neck, armpits or groin) or if you have complications involving your chest, kidney, liver or nervous system.
\nNote that dry eyes and dry mouth may be due to other causes, such as
\n\u2022 dryness syndrome (the glands do not produce enough saliva or tears) \u2013 it develops later in life
\n\u2022 other conditions apart from Sj\u00f6gren\u2019s syndrome, such as sarcoidosis, which affect the lachrymal of salivary glands
\n\u2022 some drugs, such as antihistamine or antidepressants
\n\u2022 inflammation of the sebaceous glands of the eyelids (blepharitis), which causes excessive evaporation of the tear film
\nYou must visit your doctor to be diagnosed. Your doctor will ask about your symptoms and perform tests to assess the dryness of your eyes and mouth.<\/p>\n

What treatments are there for Sj\u00f6gren\u2019s syndrome?<\/strong>
\nAlthough there\u2019s no cure yet, many treatments are available to help your symptoms. These include:
\n\u2022 eye drops and ointments
\n\u2022 mouth gels and sprays, chewing gums or lozenges that increase saliva production
\n\u2022 painkillers and non-steroidal anti-inflammatory drugs (NSAIDs)
\nYou may be prescribed other drugs, depending on the type and severity of your symptoms. Occasionally, a minor surgical procedure may be used to reduce the drainage of fluid from your eyes.<\/p>\n

Eye treatments<\/strong>
\nFor dry, sore or irritable eyes:
\n\u2022 You can use lubricant eye drops several times a day.
\n\u2022 If you need eye drops more than 6 times a day, you should use a preservative-free formulation because frequent use of drops containing preservative can increase dryness and sensitivity. Preservative free formulations can be used up to hourly if you need to.
\n\u2022 For very dry eyes, you may need to use ointments (for example cyclosporine) or hyaluronate preparations.
\nIf mucous and debris are causing stickiness:
\n\u2022 Mucolytic agents, such as acetylcysteine eye drops may be helpful.
\n\u2022 Paraffin-based ointments can be used at night if your eyes are dry and crusty when you wake up.
\nIf you have corneal ulcers (severe pain in the eye accompanied by photophobia and redness) or infections, you should NOT use any of these treatments and should seek advice from an eye specialist. In some cases, an eye specialist may suggest punctal occlusion.
\nIf your Sj\u00f6gren\u2019s syndrome is so bad that you have minimal tear production, punctal occlusion won\u2019t help you. If your eyes remain very dry, your puncta may be sealed by cauterization.<\/p>\n

Mouth and throat treatments<\/strong>
\nFor a dry mouth:
\n\u2022 Artificial saliva, such as gels, can be helpful.
\n\u2022 If you have your own teeth, fluoride mouth sprays are recommended because they may protect you against dental decay.
\n\u2022 If you\u2019re able to produce some saliva, you can take pilocarpine as a tablet (Salagen). This works by stimulating glandular tissue. Some people may notice side-effects such as sweating, flushing, a change of bowel habit or a more frequent need to urinate. These effects usually ease after a time, and it may help to start on a low dose and gradually increase it as the side-effects decrease.
\n\u2022 If your mouth is severely dry and is causing other problems such as fungal infections or dry coughs, your doctor may recommend an antifungal treatment such as nystatin.
\n\u2022 Chlorhexidine mouth rinses may help with dental hygiene, and you can use fluoride mouthwashes or high concentration fluoride toothpastes to help reduce dental decay. Non-sugar chewing gum or other dental care products or lozenges can also help.<\/p>\n

For mouth ulcers:<\/strong>
\n\u2022 Triamcinolone acetonide ointment can be applied to mouth ulcers. If this doesn\u2019t help, your doctor may prescribe corticosteroid pellets for you to keep in your mouth a few times a day.
\n\u2022 Oral rinses or sprays can help relieve discomfort from mouth ulcers.
\n\u2022 If the ulcers are causing stickiness in your mouth or throat, a diluted chlorhexidine mouthwash will help. Alternatively you could try rinsing and gargling with a mouthwash made from a mixture of a teaspoon of salt, a teaspoon of baking powder and a liter of water.
\nIf your salivary glands are painful, ask your doctor for further assessment and advice \u2013 they\u2019ll check whether you have an infection. If your salivary glands aren\u2019t infected, they may prescribe a short course of a corticosteroid (prednisolone).<\/p>\n

Other treatments<\/strong>
\nJoint pain, aching or tender spots:
\n\u2022 Painkillers such as paracetamol and\/or non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen may help.
\n\u2022 If your joints are inflamed, your doctor may suggest you have an intramuscular steroid injection or a short course of steroid tablets for short-term relief.
\n\u2022 Hydroxychloroquine can be used for longer term treatment (from 6 months to many years).
\nExtreme tiredness, lethargy, difficulty in concentrating:
\n\u2022 Your doctor may suggest blood tests to check your thyroid gland and to screen you for celiac disease.
\n\u2022 Hydroxychloroquine may help with fatigue and joint pain.
\n\u2022 Lifestyle changes, such as taking sensible exercise and pacing yourself in your daily activities, can also be helpful.<\/p>\n

Fever: Your doctor will want to rule out more serious problems, such as infection, thyroid problems or lymphoma.<\/p>\n

Raynaud\u2019s phenomenon:<\/strong>
\nSelf-help measures like wearing an extra pair of socks or gloves, will often improve your symptoms, but drugs such as nifedipine, which open up the blood vessels, may be prescribed if necessary.<\/p>\n

Migraine-like headaches:
\nPainkillers or specific anti-migraine medications are usually effective.<\/p>\n

Abdominal pain, irritable bowel syndrome:
\nAntispasmodic drugs, such as mebeverine (Duspatalin) can be helpful for disrupted bowel habits.<\/p>\n

Aggravated menopausal symptoms:
\nHormone replacement therapy (HRT) can be used if necessary, but it\u2019s important to discuss the risk of side-effects with your doctor.<\/p>\n

If you have a more severe form of the condition or if your peripheral nervous system is affected you may need other medications, including:
\n\u2022 high-dose cortisone
\n\u2022 cyclophosphamide
\n\u2022 painkillers, including gabapentin or pregabalin, for nerve pain
\n\u2022 rituximab
\n\u2022 mycophenolate<\/p>\n

The majority of people don\u2019t need these drugs because their symptoms mostly affect their eyes and mouth.
\nMild liver abnormalities aren\u2019t common and probably won\u2019t need treatment, but you should have regular checks. You may need specialist treatment if you develop a condition called primary biliary cirrhosis.<\/p>\n

Your lungs can occasionally be affected by fibrosis, which can cause breathlessness, a dry cough and chest pain. You\u2019ll need specialist advice if you have fibrosis, but your doctor will be able to prescribe cortisone for it.<\/p>\n

Self-help and daily living<\/strong>
\nTry the following self-help tips:
\n\u2022 Increase the humidity in rooms by introducing humidifiers, plants or bowls of water.
\n\u2022 Always have some water to hand.
\n\u2022 Follow a good dental routine and have regular check-ups.
\n\u2022 Increase the amount of fiber in your diet if you have bowel symptoms.
\n\u2022 Don\u2019t have too many sugary or caffeinated foods and drinks.
\n\u2022 Use lubricating gels if sex is painful.<\/p>\n

Some symptoms of Sj\u00f6gren\u2019s syndrome can be eased by simple self-help measures:
\n\u2022 Wear wraparound sunglasses or glasses with side shields to help keep moisture in your eyes.
\n\u2022 Keep your eyelids and the surrounding areas clean to maximize oil secretion from glands in your eyelids.
\n\u2022 Avoid contact lenses because they\u2019ll be uncomfortable if your eyes are dry.
\n\u2022 Consider wearing tinted glasses if you find strong lights uncomfortable.
\n\u2022 Increase the humidity in your home. This can help eye symptoms and a dry cough. Humidifiers, large-leaved houseplants or bowls of water all help to increase humidity in a room.
\n\u2022 Avoid strong soaps if you have dry, itchy skin. Water-based creams and emollients may be helpful.
\n\u2022 Wear sunscreen (factor 15 or higher) if your skin is sensitive to the sun or comes out in a rash.
\n\u2022 Wear warm gloves if you experience Raynaud\u2019s phenomenon. Exercise will help by improving your circulation, but you should avoid smoking because it\u2019s bad for the circulation.
\n\u2022 Good dental hygiene is recommended for any oral symptoms.
\n\u2022 Only take medications such as antibiotics if it\u2019s really necessary as Sj\u00f6gren\u2019s syndrome can slightly increase the risk of side-effects. It\u2019s important to have a good dental care routine and regular check-ups if you have oral symptoms of Sj\u00f6gren\u2019s syndrome.<\/p>\n

Exercise<\/strong>
\nYou should exercise to keep mobile, particularly if you have symptoms in your joints. You\u2019ll need to find the right balance between rest and exercise, especially if you also suffer from extreme tiredness. A physiotherapist will be able to give you advice on suitable exercises and increasing your activity level gradually.<\/p>\n

Diet and nutrition<\/strong>
\nNo special diet is recommended for Sj\u00f6gren\u2019s syndrome, but increasing the amount of fiber in your diet should help if you have abdominal pain or bowel problems. Cutting down on sweet food and drinks will reduce your risk of dental problems.
\nRemember that alcohol, tea, coffee and other caffeinated drinks can be dehydrating. Sipping water or sucking ice cubes regularly can help to relieve the discomfort of a dry mouth.
\nRead more about diet and arthritis.<\/p>\n

Complementary medicine<\/strong>
\nThere isn\u2019t scientific evidence that suggests any specific complementary medicine can ease the symptoms of Sj\u00f6gren\u2019s syndrome.
\nIf you have Raynaud\u2019s phenomenon, vitamins E and C, evening primrose oil, fish oils and ginger or Ginkgo Biloba can also help.<\/p>\n

Sex and pregnancy<\/strong>
\nOne less common symptom of Sj\u00f6gren\u2019s syndrome may be that you have a dry vagina, which can make sex painful. Lubricants should help and so can estrogen creams.
\nTreatments for infections such as thrush are readily available from chemists.
\nPeople with Sj\u00f6gren\u2019s syndrome don\u2019t usually have any increased problems during or after pregnancy. In about 2% of women who have anti-Ro and\/or anti-La antibodies, these antibodies are passed on to the baby during pregnancy and cause symptoms in the baby after birth. These symptoms can include rashes and abnormal blood tests, but both settle within a few weeks to a few months as the mother\u2019s antibodies are gradually lost from the baby\u2019s blood. In some cases the antibodies affect the baby\u2019s heart, causing it to beat slowly.<\/p>\n

Remember that 98% of mothers with anti-Ro and anti-La have no problems with pregnancy, but if you know you have these antibodies you should mention this to your obstetrician because your baby\u2019s heartbeat may need additional monitoring in the womb.<\/p>\n

Back to Rheumatology Division<\/a><\/strong><\/p>\n

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