Sjogren’s Syndrome: Diagnosis And Treatment

Sjogren's syndrome is a chronic disorder of the immune system which destroys glands producing saliva and tears. The condition is more common in women than men in their 40s but Sjogren's syndrome can develop at any age.

Sjogren’s syndrome diagnosis and treatment

Sjogren’s syndrome is often diagnosed with the help of blood tests, a salivary flow rate test, eye exam (e.g. Schirmer’s test), and imaging tests. A salivary gland biopsy may also be carried out to aid in the diagnosis. Sjogren’s syndrome treatment varies depending on the severity of the patient’s condition and which part of the body it affects.

“Since Sjogren’s syndrome affects each patient differently, a personalised plan is developed for each individual,” says Dr Chew Li-Ching, Senior Consultant, from the Department of Rheumatology and Immunology at Singapore General Hospital (SGH), a member of the SingHealth group.

In mild cases, patients may apply daily eye drops to relieve their dry eyes, and drink regular sips of water to relieve their dry mouth. Over-the-counter moisturizing creams, lubricants and painkillers may be used to treat other symptoms such as dry skin, vaginal dryness and joint pain, respectively.

“Patients with mild symptoms may use several approaches to conserve tears, including increasing ambient humidity indoors and using physical barriers such as wrap-around sunglasses to avoid drying or irritation of the eyes; and chewing sugarless gum to boost saliva production,” says Dr Chew.

In moderate to severe cases, a doctor may prescribe artificial saliva products or medication (e.g. pilocarpine), to increase production of saliva, and topical cyclosporine for dry eyes.

Systemic anti-inflammatory or immunosuppressive medications, such as steroids or hydroxychloroquine, may be beneficial in certain patients with joint pains and other extraglandular disease, although they are generally not used for the treatment of dry eyes or mouth alone.

For severe dry eyes, a minor surgical procedure, called punctal occlusion, may be recommended to temporarily seal the tear ducts and slow down the rate of tear drainage. A laser can also be used to permanently seal the tear ducts. The goal is to have the natural tears stay longer on the eyes, instead of being quickly drained out.

What is Sjogren's syndrome?

Sjogren’s syndrome is named after Swedish eye doctor Dr Henrik Sjogren who first identified it in 1933. It is classified as primary when it occurs on its own, and secondary when it occurs along with another autoimmune disorder, such as lupus or rheumatoid arthritis. Typically, Sjogren’s syndrome affects more women than men, and most patients are over the age of 40.

“As the symptoms of Sjogren’s syndrome can mimic other conditions, proper diagnosis and treatment are often delayed. Although there is no cure for Sjogren’s syndrome, treatments are available to alleviate the symptoms and to prevent complications,” says Dr Chew.

On the other hand, the classical symptoms of Sjogren’s syndrome (eye and mouth dryness) are common and can also occur in healthy people without Sjogren’s syndrome, especially in older individuals. Therefore, it is important to determine if there are medications or other conditions causing dryness.

SJOGREN’S SYNDROME CAUSES

The exact cause of Sjogren’s syndrome is unknown. Both genetic and hormonal factors play a role. Exposure to certain environmental triggers, such as viral infections, may also trigger the disorder.

SJOGREN’S SYNDROME SYMPTOMS

The symptoms can be mild to severe. The two main symptoms of Sjogren’s syndrome are:

Dry eyes: Unusual dryness with or without a burning, itchy, gritty sensation; mild blurring and light sensitivity; mucus discharge from eyes; swollen eyelids.
Dry mouth: Dry, sticky, burning sensation; difficulty talking, chewing food and swallowing; dry cough.

Patients can also present with the following symptoms:

Joint pain, muscle pain
Swollen saliva glands between the jaw and ears
Dental cavities
Fungal infection in the mouth
Dry skin
Vaginal dryness
Extreme fatigue

COMPLICATIONS OF SJOGREN’S SYNDROME

Sjogren’s syndrome is rarely life-threatening, but in patients presenting with the more severe disease, affecting organ systems such as the lung, heart, kidney, liver, and nerves, complications can develop if treatment is delayed or inadequate. These complications include the following:

Nerve damage in hands and feet causing loss of sensation (peripheral neuropathy)
Blindness due to untreated corneal ulcers
Interstitial pneumonitis and other lung problems
Cancer of the lymphatic system (lymphoma)
Anaemia, low white blood count or platelet count
Kidney disorders (interstitial nephritis)

Ref. R23(I)


	Singapore General Hospital
	Changi General Hospital
	Sengkang General Hospital
	KK Women's and Children's Hospital
	National Cancer Centre Singapore
	National Dental Centre Singapore
	National Heart Centre Singapore
	National Neuroscience Institute
	Singapore National Eye Centre
	SingHealth Community Hospitals
	SingHealth Polyclinics

Arthritis

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