Sjogren’s Syndrome

Sjogren’s syndrome is a disease that mainly means that you become very dry in the eyes and mouth. It is an autoimmune disease, which means that the immune system attacks its own tissue. The disease persists throughout life, but there are treatments that relieve the hassle.

The disease is divided into two types. In the primary Sjögren syndrome, you have the disease as a lonely disease. In secondary Sjögren’s syndrome, you have the disease together with another rheumatic disease such as arthritis or systemic lupus erythematosus, SLE.

You can have periods when you feel your illness more, and then get periods when you get better. It is called the forest when the disease becomes more intense. 

Symptoms of Sjogren’s Syndrome

Common symptoms of Sjögren’s syndrome are:

  • You have dry, stinging eyes.
  • You are dry in your mouth, nose, and throat.
  • You are dry in the genital area.
  • You are very tired.
  • You hurt the joints.
  • You have dry skin.
  • You have difficulty swallowing and have stomach pain.

You can read more about each symptom further down in the text.

Several of these are common even if you do not have Sjögren’s syndrome and may have other causes. For example, it is common to have trouble with dry eyes as you get older.

Dry and stinging eyes

Sjögren’s syndrome causes the eyes to become very dry and they easily turn red. You may feel it hurt when you blink and it may feel like you have grit in your eyes. Often the eyes feel tired and burning. The eyes can be sensitive to smoke, air traits, and bright light.

Dry in the mouth, nose, and throat

It is common to become so dry in the mouth that it becomes difficult to swallow food without drinking at the same time. It can also cause the food to taste different than it usually does.

It is also common to get dry in the nose and throat. It can cause you to have a sense of smell, nosebleeds, and you become hoarse. The dryness can irritate the trachea so that you get a dry cough.

Dry in the abdomen

It is common to get dry mucous membranes at the pubic lips, the muzzle and in the vagina. You can then easily get fungal infections. It can also cause it to hurt and bleed when you have vaginal sex.

In conjunction with menopause, hormone deficiency can make problems with dry mucous membranes worse. Seek care at a health care center or a gynecologist if you have any problems with this.

Tiredness

Many with Sjögren’s syndrome get very tired. Fatigue can be more pronounced at times.

Pain in joints and muscles

It is common to get sore joints, especially in the hands and fingers. Often the pain comes in periods and usually in the mornings. You can also get swollen joints and muscle aches in your arms and legs.

Skin conditions

The skin often becomes dry, which makes it itchy and irritated. You may have reddening rashes and the skin may become sensitive to the sun. Some may have a special type of blushing skin rash, usually on the lower legs, called purpura.

Stomach problems

You may experience stomach and intestinal discomforts, such as nausea and stomach pain. You may also get altered poop habits, some may become constipated and some may have diarrhea 

Sjögren’s syndrome can lead to inflammation of the pancreas. It can cause impaired digestion and impair nutrient absorption from the intestines.

The body may find it harder to absorb vitamin B12 from the food if the mucous membrane of the stomach is affected. Among other things, it can lead to anemia.

Other symptoms of Sjogren’s syndrome

The circulation in the hands and feet can become worse. Then the hands and feet can become white and blue when it is cold and then red when you get into the heat.

You may also feel that the lymph nodes in the armpits, neck, and groins are swollen. They are then larger than usual.

There is a small risk that you will have kidney problems, such as kidney inflammation and kidney stones.

When should I seek care?

Contact a health care center if you suspect you have Sjögren’s syndrome. You should also contact a health care center if you have been drier than usual in your eyes, mouth or genital area for two to three months.

You can seek care at any healthcare center you want throughout the country. There you also have the opportunity to have a regular doctor’s contact. This means that you get to see the same doctor every time.

What can I do for myself?

There is much that you can do yourself to relieve your symptoms.

Dry mouth

Rinse your mouth frequently, drink a little more water than usual and choose foods with a lot of chew resistance if you are dry in the mouth. It may be good to drink carbonated water to increase the amount of saliva.

There are several different remedies for oral dryness

You can try using a saline substitute if you are dry in the mouth. Saline substitutes are available as sprays or tablets. You can buy them without a prescription at a pharmacy or have them prescribed by a doctor.

There are also saliva-stimulating drugs in the form of tablets, sprays, chewing gum or jelly that you can buy without a prescription.

Take care of your teeth

Dry mouth increases the risk of getting holes in the teeth. Therefore, you need extra fluoride supplementation. For example, you can get this through prescription lozenges, liquid solutions or medical toothpaste.

You may be entitled to a special dental allowance if you have Sjögren’s syndrome. The special dental allowance can be used for preventive dental care. You can ask your doctor or dentist for more information.

Dry eyes

Try to avoid air drag and wear sunglasses when staying in bright light environments if you have dry eyes.

You can treat your eyes with tears

You can use tear supplements if you are dry in the eyes. There is a prescription to buy at a pharmacy. The agent contains substances similar to the natural tear fluid, which lubricates and moisturizes the eye.

Choose a tear substitute without a preservative if you are going to take it for a long time. Otherwise, the tissues of the eye may become irritated.

Dry in the abdomen

At pharmacies, there are non-prescription lubricants that you can try if you are dry in the genital area.

Pain in joints and muscles

It is good to work out in a hot water pool, walking, cycling or other types of quiet exercise if you have pain in the joints. It can also help with fatigue.

Painkillers help with pain in joints and muscles

You can also try different painkillers that can relieve the pain.

First, try a non-prescription painkiller containing paracetamol.

If it does not help with medicines with acetaminophen, you can take anti-inflammatory painkillers. They are also called NSAIDs. Consult your doctor before using NSAIDs. One disadvantage of these medications is that they irritate the stomach lining, which can lead to stomach pain and sometimes stomach ulcers. You may, therefore, need to combine these drugs with others that protect the lining of the stomach.

There are also other painkillers that you can get prescribed by a doctor.

Investigations

When you come to a doctor at a health care center, you are told about the problems you have. The doctor also asks:

  • If you have any other illnesses.
  • If you are taking any medication.
  • If you have any hereditary diseases in the genus.

The doctor also does a body examination. After that, the doctor decides what other examinations to do. For example, it can be measuring your saliva production and tear production. These examinations are usually done at various specialist clinics in hospitals and at dentists.

Saliva production is measured

To get an idea of ​​how saliva production works, it must be measured. It can be done in two different ways – resting salivation test and chew stimulated salivation test.

Resting the salivation test means that your amount of saliva is measured when you do not chew on anything. Before the examination you should be well-rested and must not eat, drink, smoke, sniff, suck on a throat tablet, chew gum or brush your teeth one hour before the examination. When the examination begins, swallow any saliva present in the mouth. Then a timer is started. For a quarter, sit leaning over a mug with half-open mouth and allow the saliva to flow freely. Then the amount of saliva in the jug is measured.

Chew-stimulated salivation test means that your amount of saliva is measured when you chew on something. The examination begins with the swallowing of all saliva you have in your mouth. Then you chew on a paraffin bit at a fast, even rate on both sides of your mouth. The measurement goes on for five minutes and during that time you spit out the amount of saliva that is collected in the mouth in a mug. Then the amount collected is measured.

Measurement of tear fluid

There are several ways to assess eye dryness.

A test involves getting a thin paper film inside the lower eyelid. Then close the eyelids. After five minutes, the doctor measures how much of the paper has been moistened by the tear fluid.

Another test is that the doctor drops eye drops with dye in the eye. The drops allow the doctor to see if you have any damage to the surface of the eyes caused by having dry eyes. Then the severity of the damage is measured.

The substance that is dropped in the eye may burn for a short time, but it will soon pass. The amount of dye used is very small but can be seen for a while after the dye but disappears with the tear liquid gradually.

You do not need to prepare in any special way before the examination. You look as usual afterward.

tissue Samples

You can also leave a sample from the inside of the lower lip. Then you first get stunning. Then the doctor takes a sample from the salivary glands and looks at them in a microscope. The sample is then sent to a laboratory where it is analyzed.

The survey does not hurt. The anesthetic releases a few hours after the examination and then you can be a little sore. 

Blood sample

You can have a blood test to see if you have antibodies that are typical of the disease. They are called anti-SSA and anti-SSB.

It is important that you understand the information

In order for you to be able to participate in your care and make decisions, it is important that you understand the information you receive from the healthcare staff. Ask questions if you don’t understand. You can also ask to have the information printed so that you can read it peacefully.

You may also have the right to get help from an interpreter if you have a hearing loss.

Treatment of Sjogren’s syndrome

The doctor who has ordered blood tests, saliva measurements, eye tests, and tissue tests compile the results and make a diagnosis. If you meet the criteria for Sjögren’s syndrome, you will receive treatment that relieves the symptoms and dental support.

There are several medicines that help well against the symptoms, such as saliva-stimulating tablets and chewing gums, tear supplements and anti-inflammatory drugs.

Vagitories can help if you are dry in the genital area

If you have Sjögren’s syndrome and go through menopause, your mucous membranes in the genital area may be drier than before. Then there are prescription drugs that you bring into the vagina, so-called vagitories, that can help with the problems.

Cortisone can reduce inflammation in the body

Sometimes you may receive cortisone or other anti-inflammatory drugs for inflammation in the body. You will often receive a low dose of cortisone in the form of tablets to avoid side effects. Cortisone can also be obtained as syringes in inflamed joints and tendon attachments. You may have a cortisone ointment to apply to your skin if you have eczema or other skin disorders. Other types of immunosuppressive drugs can also be used if you have major problems.

Physical therapy can help

Physiotherapy and physical activity are good if you have joint pain.

Together with a physiotherapist, you can set up a training program with exercises that are adapted to the joint problems you have. For example, it can be gentle stretching exercises or simple, relaxing muscle exercises. The physiotherapist can also do a so-called functional analysis. It involves a review of how the muscles and joints work in the body. It can be a guide to what treatment of Sjogren’s syndrome you need to get.

What happens in the body?

Sjögren’s syndrome is a so-called autoimmune disease. This means that your own immune system attacks the body.

The task of the immune system is to keep viruses and bacteria away from the body. In Sjögren’s syndrome, a reaction has been started that causes the immune system to turn on its own tissue and damage one or more organs. In the first place, the salivary glands that produce saliva and the tear glands that produce tear fluid are attacked and inflamed. The moisture-producing glands in the vagina can also be affected so that the fluid production there decreases. You can also get inflammation in the joints that can cause you pain.

Saliva

The mouth contains large mock glands and a large number of small mock glands.

The large salivary glands form saliva as you eat and help digest the food. Between meals they are dormant.

The small glands, on the other hand, form saliva all the time. The saliva is viscous and should protect and lubricate the mucous membrane of the mouth.

Tears

The tear fluid is formed by the tear gland located in the upper outer part of the eyeball. The tear fluid flushes over the eye as you blink, keeping the cornea free of dust and other particles present in the air. The tear fluid also protects the cornea from dehydration.

What is it?

Sjögren’s syndrome is more common among women than men and can occur at any time in life. It is most common for middle-aged women to get the disease. It is very uncommon for children to get the disease. What the disease is due to is not known but the risk of getting it may be partly hereditary. It appears that several people in the same family have Sjögren’s syndrome. Certain infections, as well as altered hormonal balance, can cause the disease.

Pregnancy and Sjogren’s syndrome

The disease usually does not affect the ability to become pregnant unless you have other illnesses at the same time or are taking any medicines that affect it.

There is little risk of autoimmune antibodies being transmitted to the child via the placenta. It can affect the baby’s heart so that the heart rate drops. It is unusual but can be serious for the child. Pregnancy is closely monitored in specialist maternity care because this risk exists.

If the baby’s heart rate is affected, you may receive cortisone that passes the placenta and improves the condition of the baby. Sometimes a doctor who specializes in heart disease needs to be present during childbirth.

If you, as a pregnant woman, have primarily Sjögren’s syndrome with autoimmune antibodies, the child may in some cases have a disease called neonatal lupus. It usually goes away by itself within six to eight months, but sometimes cortisone treatment of Sjogren’s syndrome is needed.

Neonatal lupus is a disease that affects the skin and liver. It can be present at birth or appear during the child’s first six months of life. 

Living with Sjogren’s syndrome

Most people with Sjögren’s syndrome feel good with the help of treatment, such as drugs and physiotherapy.

However, fatigue usually comes in periods, and then you may need to be on sick leave to some extent.

You need to go to a doctor regularly because there is an increased risk of getting other diseases if you have Sjögren’s syndrome.

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