Sjogren’s Syndrome is an auto immune disorder where the body produces an increase in beta lymphocytes which infiltrate exocrine glands, mainly salivary and lacrimal glands destroying the tissue. An antigen has been identified and established. The condition is 10 times more common amongst women than men and the peak onset is during the menopause. The prevalence ranges from 0.1% to 4.8% of the population. Sjogren’s Syndrome is classified as being primary and secondary. The primary syndrome consists of a localised disease of the exocrine glands which become destroyed by the body’s own lymphocytes and it is mainly manifested with oral and ocular dryness. Secondary sjogren’s Syndrome is associated with an established connective tissue disease such as rheumatoid arthritis, systemic lupus erythematosus and scleroderma.
It is not known as in the case for most autoimmune diseases why this occurs. Also it is important to note that a small proportion at around 10% result in non-Hodgkin’s lymphoma.
Diagnosis is therefore mainly on symptoms of ocular and oral dryness but also to measure the serum autoantibody levels and also by observing Beta lymphocyte infiltration in slide and biopsy samples.
The overall treatment is mainly to relieve the symptoms and to manage these secondary auto immune diseases.
The dryness of the eyes typically presents by the patient saying that they feel they have grit or sand in the eyes and they want to rub their eyes because they feel itchy.
Mouth symptoms include difficulty chewing or swallowing dry foods. They feel that the mouth is sore. This will also manifest with a high dental caries rate which includes root caries and also an increase in oral candida albicans infection so that if they wear a denture, denture stomatitis or denture sore mouth is common with Angular Cheilitis.
It is important to note that 50% of patients present with bilateral parotid gland enlargement which is firm to palpation and tender.
70% of patients experience an increase in fatigue and difficulty carrying out normal day-to-day activities.
How is Sjogren’s syndrome diagnosed?
Diagnosis is made on the basis of Clinical symptoms of oral and ocular dryness. Unstimulated saliva secretion should be measured and a normal value is greater than 1.5 ml of saliva produced in 15-minutes. A biopsy of a minor salivary gland should also be performed as a process and to look out the presence of B lymphocytes around the salivary gland epithelium. Furthermore antibody tests are also tested for.
Treatment of the dryness is mainly focused around the alleviation of symptoms and to prevent complications. Condition can also be managed in terms of avoiding measures which increase dryness such as alcohol, smoking and medications such as diuretics, and anti-histamines, anti-cholinergics, and antidepressants.
Ocular dryness drops containing sodium hyaluronate or prophyl methyl cellulose.
Painful enlargement of parotid glands can be eased by the local application of heat packs and the administration of non-steroidal anti-inflammatory medication such as ibuprofen after bacterial infection and lymphoma have been ruled out.
Salivary substitutes of being shown to decrease the symptoms of the dryness and there are many. These will ease the symptoms of burning mouth, sore mouth, and swallowing. Needless to say the salivary output cannot be increased.
Oral hygiene must be immaculate to avoid Dental caries proliferating especially around Restorations and Root surfaces. Sugar-free gum and citrus juice can stimulate saliva production and you must avoid oral candida albicans infections as in denture stomatitis and angular cheilitis.