Tackling Sjogren’s Syndrome
If you are a tennis fan, you’re probably aware that Venus Williams was diagnosed with Sjogren’s Syndrome in 2011. Her diagnosis came on the heels of typical quality of life symptoms of the disease, which include dry eyes, dry mouth, profound fatigue, and painful joints.
Sjogren’s is one of the more common autoimmune diseases in the U.S., and 90 percent of sufferers are women. With autoimmune diseases, the immune system attacks cells, tissues and organs of the body.
How is Sjogren’s diagnosed?
There are two types of Sjogren’s, primary and secondary. Venus Williams has primary Sjogren’s, the focus of this article. Secondary is caused by other autoimmune diseases.
Physicians diagnose primary Sjogren’s by its symptoms and blood tests that show two particular autoantibodies – anti-Ro/SS-A and anti-La/SS-B – in the blood. However, these autoantibodies are also found in Lupus and rheumatoid arthritis. In addition, clinicians perform eye and dental tests.
This is a diagnosis of exclusion, so it’s important to rule out Lupus and other autoimmune diseases before providing a Sjogren’s diagnosis.
Unfortunately, there are no known cures, so treatment involves management of symptoms as they occur. NSAIDs, such as ibuprofen and aspirin, can be used to manage inflammation. Corticosteroids can also be employed to manage disease flares, but should only be used for a short time, because of their significant side effects.
The two most common symptoms are dry eyes and dry mouth. These can be treated systemically (with oral medication), topically and/or with lifestyle adjustments. Humidity may help with dry eyes, and drinking plenty of water may help with dry mouth.
Dry eyes result from a deficiency in tear production. Therefore, this symptom can be treated with artificial tears or lubricants, in consultation with an ophthalmologist. If this doesn’t work, then punctual occlusions, an uncomplicated procedure that prevents the loss of tears, can be done by an ophthalmologist. Ocular (topical) 0.05 percent cyclosporine may be beneficial for moderate to severe dry eye.
Dry mouth needs to be treated to avoid increased cavities that occur without saliva. An effective treatment to increase salivary flow may be as simple as sucking on dried fruit, such as nectarines or peaches. A trial with 100 patients found that Maltose lozenges, which contain malic acid found in apples and pears, three times a day may increase salivary secretions. Participants experienced an improvement in both the dry mouth and dry eye symptoms. Eating these fruits directly might be beneficial as well.
An oral medication that has shown statistically significant result in trials is pilocarpine. This drug appears to stimulate the aqueous secretions that are beneficial for both dry mouth and eyes. The limiting factor for this drug is the side effects, which include sweating, abdominal pain, flushing and increased urination.
Immunosuppressive drugs, like hydroxychloroquine, address the underlying immune function issues. However, there are significant side effects of suppressing the immune system, including opportunistic infections.
Unfortunately, many supplements have shown mixed results. However, N-acetyl cysteine (NAC) in a very small randomized clinical trial showed improvement in eye symptoms with a dose of 200 mg three times a day. Another small randomized clinical trial showed that LongoVital, a combination of herbal-based tablets with vitamins, significantly increased saliva production and anti-inflammatory effects.
Vitamin D deficiency is seen commonly in Sjogren’s and other autoimmune diseases, so raising Vitamin D levels may have immunomodulatory effects, reducing inflammation.
Autoimmune diseases such as Sjogren’s tend to cluster and run in families. Diagnosis and treatment involve a multidisciplinary approach, including a primary care physician, rheumatologist and ophthalmologist.
The Sjogren’s Syndrome Foundation appears to be a valuable resource and support network for those who suffer from this disease.
This disease has robbed many of their quality of life. Don’t hesitate to seek treatment if you have similar symptoms.