Sjögren's syndrome - Medical experts

What is Sjögren's syndrome?

Sjögren's syndrome is an autoimmune disease that causes inflammation of the lacrimal and salivary glands and often leads to dry mouth and eyes.

Sjögren's syndrome occurs as an independent disease or as a concomitant symptom of other diseases of the immune system (e.g. rheumatoid arthritis, lupus erythematosus). In rheumatic autoimmune diseases, Sjögren's syndrome is the second most common (after rheumatoid arthritis).

The dryness of the eyes can severely damage the cornea, leading to scratching and irritation of the eyes @ PheelingsMedia /AdobeStock

Tips for Sjögren's syndrome

These tips help with Sjögren's syndrome in everyday life:

• Careful caries prophylaxis is advisable. Avoidtoo much sugar and take fluoride if necessary.
• Go for regular dental check-ups.
• Use chewing aids such as sugar-free chewing gum. This stimulates the salivary glands.
• Be aware of the increased risk of infection and, if in doubt, consult a specialist immediately to take antibiotics if necessary.
• Ensure that the air is sufficiently humidified and avoid unfavorable environmental conditions such as air conditioning or cigarette smoke.
• Use glasses with side protection in strong winds.
• Use an eye gel or eye ointment at night.
• Use a nose gel to counteract the risk of bark formation.
• A "leaden" tiredness is typical of SS, so allow yourself to rest as often as possible (afternoon nap).
• Talk to like-minded people.

Symptoms of Sjögren's syndrome

Clinically, Sjögren's syndrome is mainly characterized by inflammation of the lacrimal and salivary glands. The presenting symptom is dryness of the mouth and eyes. As the disease progresses, this "dehydration" can also affect other areas of the mucous membranes (e.g. genitals, respiratory tract).

Sjögren's syndrome is not just a disease of the glands, but of the entire organism. Other symptoms such as tiredness, fatigue or fever also occur.

Other symptoms include

• Swelling of the salivary glands
• Pain in joints and muscles
• Inflammation of the blood vessels(vasculitis)

Sjögren's syndrome leads to massive impairments and unpleasant after-effects, particularly in the mouth and eye area.

These include

• Chronic inflammation and frequent infections in the oral cavity and conjunctiva
• Caries and periodontal disease
• bad breath
• Difficulty swallowing solid and dry food
• Taste and odor disorders
• Hoarseness
• Constant respiratory tract infections

In rare cases (< 8 percent), a tumor of the lymph glands (lymphoma) can develop during the course of Sjögren's syndrome. As a tumor is usually located in the area of the salivary glands or cervical lymph nodes, your doctor should pay particular attention to a possible increase in size. In case of doubt, he or she will diagnose a tumor using magnetic resonance imaging or by taking a tissue sample (biopsy).

Diagnosis of Sjögren's syndrome

Unfortunately, Sjögren's syndrome is usually recognized late because the dry eyes and mouth are often not interpreted correctly.

1. In addition to the typical clinical findings, the doctor first carries out simple functional tests to determine the inadequate production of tears and saliva.
2. Further examinations of the salivary glands using imaging techniques (scintigraphy, sialography, magnetic resonance imaging) then lead to a suspected diagnosis.
3. A sample taken from the inside of the lips usually leads to proof.
4. Laboratory tests are helpful, but cannot confirm the diagnosis. Immunological detection of antibodies, which are found in the blood of many (but not all) patients, is useful here. The SS-A and SS-B antibodies are relevant.

Please note that there are many other causes of dry mouth and dry eyes:

• Diabetes mellitus, fibromyalgia syndrome or viral diseases (e.g. viral liver inflammation/ jaundice) also lead to similar symptoms.
• Medication (e.g. for high blood pressure and mental illnesses) can also lead to dry mouth.
• Increasing age in healthy people also reduces gland production.

Swelling of the salivary glands can also have numerous other causes. These can only be diagnosed by a specialist after a thorough examination. A visit to the ophthalmologist and ENT specialist is also recommended.

Scintigraphy is a nuclear medicine examination method in which the patient receives radioactively labeled substances @ Werner /AdobeStock

Treatment for Sjögren's syndrome

Although the disease cannot be cured and no helpful medication exists, there are a number of treatment options. There are also promising research approaches.

In the treatment of Sjögren's syndrome, doctors focus on these areas:

1. Dryness symptoms are treated with substitutes such as artificial tears, saliva or nasal gel, as well as adequate hydration. Various tear and saliva substitutes are available.
2. For the organism as a whole, on the other hand, a number of medications are available that are useful for specific areas of application. However, these medications have no effect on the symptoms of dryness. For example, if you suffer from muscle and joint pain, painkillers such as acetylsalicylic acid and anti-inflammatory drugs such as cortisone can be helpful.
3. Immunosuppressants are the drug of choice if there is a risk of damage to internal organs and blood vessels.

In the USA, substances such as pilocarpine and cevimelin, which increase fluid production, have been successfully tested. Of these substances, oral pilocarpine (trade name: Salagen®) has been approved in Germany since 2000 and can therefore be prescribed.

Specialists for Sjögren's syndrome

A specialist for Sjögren's syndrome is usually a rheumatologist, who is responsible for diagnosis and treatment. Collagenoses, to which Sjögren's syndrome belongs, also fall within the remit of the rheumatologist. A rheumatologist can be a specialist in internal medicine or a specialist in orthopaedics. In all cases, however, they have completed additional training in the field of rheumatology.