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  Sjogrens syndrome

This disease is characterized as an autoimmune disease that produces too many antibodies in the blood that attack various tissues in the body. This disease specifically causes an inflammation of the glands of the body. The glands of the eyes and mouth are primarily afflicted causing the lack of or reduced quantity of tears, eye dryness, lack of or reduced quantity of saliva and mouth dryness

Sjogrens syndrome
Sjogrens syndrome


Sjogren’s syndrome that solely involves gland inflammation and not connective tissue is referred to as primary Sjogren’s syndrome. Connective tissue disease and gland inflammation combined is called secondary Sjogren’s syndrome and is associated with rheumatoid arthritis, scleroderma and systemic lupus erythematosus.

There is growing scientific evidence that Sjogren’s syndrome is genetic. A definitive cause has not been identified. Sometimes the illness affects multiple family members. It is also more common in family members with connective tissue autoimmune diseases such as autoimmune thyroid disease, juvenile diabetes and systemic lupus erythematosus. Ninety percent of patients with Sjogren’s syndrome are female.

Symptoms

Symptoms for this disease primarily involve the glands, but can also affect other parts of the body and are referred to as extraglandular manifestations.

The lacrimal gland is the tear gland of the eye. When it is affected by Sjogren’s syndrome it becomes inflamed and the eye progressively becomes drier. The dryness produces a gritty sensation, infection and severe abrasions of the cornea.

When the salivary glands are affected the symptoms are dry mouth, swallowing difficulties, teeth decay, gum disease or gingivitis, mouth sores, swelling, stones and infection of the parotid glands found on the inside of the cheeks.

Sometimes the lining of the trachea and bronchi can be affected causing lung infections and the vagina resulting in dryness and painful intercourse.

Extraglandular symptoms include joint pain, arthritis, Raynaud’s phenomenon (fingers and toes turn blue in cold weather), lung inflammation, kidney, nerve and muscle disease, and lymph node swelling. A serious, but rare condition caused by Sjogren’s syndrome is vasculitis, which is an inflammation of the blood vessels. When the blood vessels are inflamed the tissues that are supplied by them become damaged.

There are some common diseases associated with Sjogren’s syndrome, such as Hashimoto’s thyroiditis (autoimmune thyroiditis) and gastroesophageal reflux disease (GERD). A rare disease is primary biliary cirrhosis which is an immune disease of the liver causing scarring of liver tissue. There is a small group of patients with Sjogren’s syndrome which develop lymphoma. This occurs after many years of having Sjogren’s syndrome. Any unusual swollen lymph nodes should be examined by a doctor.

Diagnosis

Diagnosis is dependent on detecting the amount of dryness in the mouth and eyes. Eye dryness can be determined using a Schirmer’s test. This involves checking the eyes ability to wet a small testing paper strip that is placed under the eyelid. An ophthalmologist can perform more significant tests.

Salivary glands are usually harder, larger and more tender than typical. Radiologic salivary scans can detect gland inflammation. A salivary flow test determines if the glands have a reduced salivary output. The glands in the lower lip are often the source of a biopsy to determine if Sjogren’s syndrome is present. The lower lip salivary gland biopsy is easier to perform. This procedure requires local anesthesia, a small incision on the inner section of the lower lip and the removal of a small sample of the salivary gland.

Antibodies against organ tissue can be measured via a blood test. Antinuclear antibodies (ANAs) are found in blood samples of almost all patients with Sjogren’s syndrome. Other antibodies that are found in most patients are the SS-A and SS-B antibodies and antibodies for the thyroid and the rheumatoid factor. A low blood count and atypical sedimentation rate, which is a testing for inflammation, are also present in patients with Sjogren’s syndrome.

Treatment

Treatment focuses on the areas affected by Sjogren’s syndrome. There is no cure for this disease, only controlling the complications and treating infections.

Dryness of the eyes is relieved via artificial tears and nighttime ocular ointments. When the dryness of the eyes becomes problematic, an ophthalmologist may plug the tear duct so that tears stay in the eyes longer. A newer medication called cylosporin eye drops (Restasis) have been approved to reduce the inflammation of the tear glands and lead to better functioning. Conjunctivitis, excessive redness, swelling, pus or pain should be examined by a physician.

Dry mouth is usually treated by drinking lots of water, good dental care and humidifying the air. Salivary glands can be stimulated by sucking on sugarless hard candy or glycerin swabs. Other treatments for dry mouth used are prescription saliva stimulants called Salagen(generic name is pilocarpine) and Evoxac (generic name is ceyimeline). These medications should not be used by individuals who have specific heart diseases, asthma or glaucoma. Artificial saliva products are available over the counter. Infections of the teeth, gums and mouth should be treated as soon as possible to avoid further complications.

Saline nasal sprays can be used to relieve dry nasal passages. Vaginal lubricants are used to treat vaginal dryness.

When a patient is experiencing vasculitis or inflammation of the blood vessels, immune suppression therapy is required. Cortiscone, azathiprine and cyclophsphamide are used to treat this complication.

Infections are treated with antibiotics.

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