Frequently Asked Questions
Sjogren's Syndrome
| Q. What is Sjogren's syndrome? |
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A. It is an autoimmune disorder, which is characterized by the presence of symptoms of dry eyes and/or dry mouth. It was described by a Swedish ophthalmologist Henrich Sjogren in the early 1930's in patients with both arthritis and dry eyes. Since then the definition of Sjogren's has been broadened to include symptoms other than arthritis. It typically affects middle aged women and has been estimated to affect more than 1-2 million people in the United States. |
| Q. How can a diagnosis be firmly established. How can I be sure that I have Sjogren's Syndrome? |
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A. In order to check for dry eyes there are two well accepted tests which can be performed by an ophthalmologist: 1. Schirmer's test which involves the use of Ophthaine to numb the eye from being irritated before placing a strip of paper (referred to as a Schirmer's strip) in the eye. This strip measures the amount of wetting that occurs over a five minute period. Less than 5 mm of wetting is a strong indicator of dry eyes. This test is not 100% accurate and should be performed again if the diagnosis remains an issue. 2. The second test is a Rose-Bengal dye test which stains for damaged areas of the cornea. To check for dry mouth generally a salivary gland biopsy is necessary to establish a firm diagnosis. The biopsy is generally taken from the inner surface of the lower lip and sent for evaluation. It should have a positive result revealing characteristic inflammatory features consistent with the diagnosis of Sjogren's syndrome. |
| Q. I have been diagnosed with Sjogren's syndrome. What can I do about my dry mouth? |
| A. When Sjogren's affects the salivary glands, the makeup of the salivary fluid also is affected. It is imperative then to maintain proper oral hygiene. Your dentist should be made aware of your diagnosis so that increased vigilance will be maintained so as to save your teeth from prematurely falling out. Sometimes the use of vitamin E Gelcaps have been shown to be helpful. They are used by biting them at night and then rinsing your mouth with the gel in order to maintain the moisture during the night hours. Another home remedy may be the use of frozen grapes to suck on during the day to stimulate salivary flow. A prescription drug named Salagen (pilocarpine hydrochloride) may also be used to increase salivary flow. |
| Q. What is Salagen? |
| A. Salagen promotes the salivary gland to secrete saliva. It does so by stimulating the smooth muscle that surrounds the salivary gland and its duct (tube) to contract, thereby increasing the flow of saliva. This is a prescription medicine with known side effects such as sweating, urinary frequency,chills and flushing, and its use should be discussed with your physician before taking it. Starting dose is 5 mg three times a day, up to four times a day. It is contraindicated if you have asthma which is not well-controlled. |
| Q. Is there treatment for Sjogren's syndrome other than the treatment of the dry eyes and dry mouth symptoms? |
| A. Plaquenil (hydroxychloroquine) is generally used to treat the systemic complications of SS, such as arthritis, fatigue, and skin rashes. Steroids may be required in some patients with more severe complications such as vasculitis or nervous system involvement. For some of these patients stronger medicines which suppress the immune system may be necessary. |
| Q.What is the long-term outlook for Sjogren's syndrome? |
| A. Most patients will suffer with continued symptoms of dry mouth and dry eyes over the years. These symptoms may gradually worsen. Some patients will develop well known associated illnesses with their Sjogren's Syndrome. These include thyroid, lung or kidney disease. Your doctor should be able to discuss these illnesses with you and know how to look for signs of their development should they occur. Occasionally some patients develop symptoms of other rheumatic illnesses such as SLE (lupus) or rheumatoid arthritis. |
| Q. What is Plaquenil (hydroxychloroquine)? |
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A. Hydroxychloroquine is actually an antibiotic that has been used in the treatment of malaria. For patients with rheumatic illnesses, Plaquenil has been useful because it also has been found to affect the immune system. Studies have shown that the medicine is capable of reducing the number of flare-ups experienced by a patient with these illnesses. |