Healthy Living

Did you know that dry eyes and dry mouth can be caused by an autoimmune illness? In the early 20th century, Swedish physician Henrik first described a group of women whose chronic arthritis was accompanied by dry eyes and dry mouth. Today rheumatologists know more about the syndrome that is named for Sjögren and—most significantly for patients—can provide advice about how to live with it.

Between 1 and 4 million Americans, or roughly 1 to 2 percent of the population, have Sjögren's syndrome(SS). This condition can affect people of any age, but symptoms usually appear between the ages of 45 and 55. It affects 10 times as many women as men. About half of affected patients also have RA or other connective tissue diseases, such as systemic lupus.

The cause of Sjogren’s is not known, but patients with this disease have abnormal proteins in their blood suggesting that their own immune system is reacting against them. Research suggests that genetic factors and possible viral infections may predispose patients to developing this condition.

Sjogrens Syndrome most often affects the tear and saliva glands. Patients with this condition may notice irritation, a gritty feeling, or painful burning in the eyes. Dry mouth or difficulty eating dry foods, and swelling of the glands around the face and neck are also common. Some patients experience dryness of other mucous membranes (such as the nasal passages, throat, and vagina) and skin. Some patients may have complications related to inflammation in other body systems, according to rheumatology.org and uptodate.com, including:
 Joint and muscle pain with fatigue
 Lung problems that may mimic pneumonia
 Skin rashes related to inflammation of small blood vessels
 Neurologic problems causing weakness and numbness
 Small number of patients may develop lymphoma, cancer of lymph glands.

Diagnosis depends on a combination of symptoms, physical findings, blood tests, and sometimes special studies. According to rheumatology.org and uptodate.com:
 Dry eyes and mouth may be early signs of the condition but require further investigation because these symptoms can be caused by many other conditions or medications. Special tests may be used to assess any decrease in tear production
(Schirmer test). An eye examination is helpful in detecting any eye changes seen in Sjögren's. Blood tests can determine the presence of antibodies typical of the disease, including anti-nuclear antibodies (ANA), anti-SSA and SSB antibodies, or rheumatoid factor. Biopsies of saliva glands may also sometimes be used to establish a diagnosis.
 Treatment is designed to lessen the most bothersome symptoms. Dry eyes usually respond to the use of artificial tears applied regularly during the day or to gels applied at night. Other measures, such as plugging or blocking tear ducts, can be used in more severe cases. Eyedrops that reduce inflammation in the glands around the eyes may be used to increase tear production. Dry mouth can be relieved by drinking water, chewing gum, or using saliva substitutes. Some patients benefit from using prescription medications that stimulate saliva flow, such as pilocarpine or cevimuline If patients develop yeast infections, these can be relieved by anti-fungal therapies. All patients should regularly see a dentist and an ophthalmologist to prevent complications.
 Hydroxychloroquine, an antimalarial drug, may be helpful in some patients with Sjögren's syndrome by reducing joint pain and rash experienced by some patients. Patients with rare but serious systemic symptoms, such as fever, rashes, abdominal pain, or lung or kidney problems, may require treatment with corticosteroids and/or immunosuppressive agents.

Sandeep Varma, MD, is a rheumatologist and Medical Director at the Backus Arthritis Center, located at the Backus Outpatient Care Center in Norwich. This column should not replace advice or instruction from your personal physician. E-mail Varma and all of the Healthy Living columnists at healthyliving@wwbh.org