American Medical Association Family Medical Guide - American Medical Association [637]
Symptoms
The symptoms of Sjögren’s syndrome usually develop slowly. If you have the disorder, you may notice that your eyes are dry, red, and itchy, and feel gritty. You may have blurred vision and be sensitive to bright light, especially fluorescent light. Your mouth will feel dry, making it difficult to swallow, speak, and taste. You may develop a dry cough. The lack of saliva makes you more vulnerable to developing cavities in your teeth and yeast infections in your mouth (thrush; see page 744). You may also have frequent nosebleeds. Intercourse may be painful because of vaginal dryness.
Sjögren’s syndrome can affect your entire body, causing skin rashes, thyroid problems, joint and muscle pain, and pneumonia (if bacteria from the mouth migrate to the lungs). Nerve problems can cause numbness and tingling in the fingers and toes, carpal tunnel syndrome (see page 699), and loss of feeling in the face. Many people with the disorder experience extreme fatigue. Sjögren’s syndrome can also cause poor kidney function, digestive problems, and connective tissue disorders. About 5 percent of people with Sjögren’s syndrome go on to develop the blood cancer lymphoma (see page 625).
Diagnosis
If you experience dry eyes and a dry mouth for more than 3 months, see your doctor for an evaluation. He or she will first take a detailed health history and ask you about your general health, your symptoms, and your family health history. After performing a complete physical examination, your doctor will order several tests of your eyes and mouth to check the severity of the dryness and determine if it has caused any damage.
The most effective test for detecting Sjögren’s syndrome is called salivary gland biopsy of the lip. During this test, the doctor removes one of the tiny salivary glands from the inside of the lower lip and examines it under a microscope for a characteristic pattern of infection-fighting white blood cells, which indicates Sjögren’s syndrome.
Your doctor may decide to do additional tests to determine if any other parts of your body are affected. These tests may include blood tests, such as a complete blood cell count, a blood glucose test, and tests that check for the presence of the abnormal antibodies (infection-fighting proteins) that are commonly found in people with Sjögren’s syndrome. The doctor may also order a chest X-ray to check for inflammation in the lungs and a urinalysis to determine how well your kidneys are functioning.
Making an accurate diagnosis can take time because the symptoms of Sjögren’s syndrome are similar to those of a number of other diseases. In fact, the time from the first appearance of symptoms to diagnosis usually ranges from 2 to 8 years.
Treatment
The treatment of Sjögren’s syndrome depends on the extent of the problem and the particular symptoms a person has. Because no cure for Sjögren’s syndrome exists, the main goal of treatment is to relieve symptoms, especially the dryness. To relieve eye dryness, doctors recommend eyedrops called artificial tears. At night, a thicker eye ointment can help protect the eyes for several hours. Another option is surgery that temporarily or permanently closes the tear ducts that drain tears from the eyes.
A saliva substitute can help relieve dry mouth temporarily, and medications are available that stimulate the salivary glands to produce saliva. It is very important to maintain good oral hygiene by flossing and brushing your teeth daily, because the absence of saliva makes your teeth more susceptible to cavities. See your dentist for check-ups and cleanings at least three times a year.
If Sjögren’s syndrome has affected organs in other parts of your body, your doctor will treat those problems also. For example,