Sjogren’s syndrome is an autoimmune disorder of the rheumatoid type. Rheumatoid type diseases are characterized by inflammation and pain, dry eyes and a dry mouth. There are two types. In Primary Sjogren’s syndrome, the disorder occurs without the presence of an accompanying autoimmune disorder. In Secondary Sjogren’s syndrome, it occurs in conjunction with another autoimmune disorder.
In autoimmune disease, the body’s immune system mistakes some of its own cells as foreign invaders and attacks them, leading to a breakdown of those types of cells. Depending on the types and range of cells attacked, patients develop varying complications related to tissue and organ disintegration and chronic inflammation.
In Sjogren’s Syndrome, the body attacks some of its exocrine glands. Exocrine glands are glands that secrete their products via ducts. Examples include: the sweat glands; the mammary glands, which produce breast milk in women; the liver; the salivary glands and the lacrimal glands, which produce tears. In Sjogren’s, the body primarily attacks the salivary glands and the lacrimal glands. As these glands are damaged, their production of saliva and tears declines, leading to dry eyes and a dry mouth.
Sjogren’s Syndrome Symptoms
Like any autoimmune disease, the course and severity of Sjogren’s syndrome varies widely from patient to patient. The most common symptoms are dry eyes (keratoconjunctivitis sicca) and a dry mouth (xerostomia), but dryness is often systemic including dry skin, a dry nose, vaginal dryness in women and bronchitis caused by dry airways. In addition, other organs of the body may be damaged. Lungs, kidneys, liver, pancreas, blood vessels and peripheral nerves may all be affected. Many patients also experience chronic fatigue. Elevated interleukins and cytokines affect the body similarly to when a person has a cold, giving rise to chronic fatigue.
Causes
Autoimmune disorders are complex and not yet fully understood, and a specific cause of Sjogren’s Syndrome has not been identified. It is believed to be due to a combination of genetic, hormonal and environmental factors. Exposure to certain viruses and fetal lymphoid cells in cases where a patient has a prior history of pregnancy have also been implicated.
Epidemiology
Sjogren’s is difficult to diagnose and often escapes diagnosis. Therefore, estimates on prevalence may not be entirely accurate. They range from 500,000 to 2 million people in the United States. Some studies have estimated 3-6 of every 100,000 people and some studies have estimated as high as 3% of the population. 9 out of 10 Sjogren’s patients are women. It occurs in all ages of the population, but its most frequent onset is between the ages of 40 and 60. Risk factors include coming from a family in which blood relatives have autoimmune disorders and a previous history of pregnancy. Secondary Sjogren’s occurs in 30-50% of rheumatoid arthritis patients and 10-25% of lupus patients.
Diagnosis
Definitive diagnosis requires several tests. Because the symptoms of Sjogren’s syndrome mimic many other disorders, it often takes years to get a diagnosis. Researchers estimate that as many as half of all Sjogren’s cases never do become accurately diagnosed. A blood test to measure levels of anti-nuclear antibodies and rheumatoid factor help to point toward an autoimmune disorder. Tests also exist to measure levels of saliva and tear production. When low, they can indicate Sjogren’s syndrome. A salivary gland biopsy can detect the presence of lymphocytes and inflammation in the salivary glands, indicating a possible Sjogren’s diagnosis. Other tests also exist to examine the state of the salivary glands.
Treatment
There is no way to prevent or cure Sjogren’s syndrome, so treatment is aimed at symptom management.
Dry Eyes – Dry eyes can often be initially managed with artificial tears. In severe cases, people may also choose to wear goggles to increase humidity around the eyes or to have punctal plugs installed in the lower tears ducts to prevent tear loss. Cyclosporine can help to reduce the damage to the tear ducts caused by inflammation. Salagen, a medication derived from the Jaborandi plant, can help to increase lacrimal and salivary production. See our page about dry eye support.
Dry Mouth – In addition to Salagen, pilocarpine and cevimeline can increase salivary production. A very important consideration for Sjogren’s patients is that a chronic dry mouth creates a perfect environment for dental caries to flourish. Regular and frequent dental care to maintain tooth health is extremely important. Many Sjogren’s patients do not realize this until it is too late and they may need dentures.
Vaginal Dryness – Vaginal dryness can be treated with vaginal lubricant and possibly, with estrogen. Sjogren’s patients often show low levels of estrogen which also has important immune-modulating effects.
Inflammation – Inflammation can be treated with NSAIDs, especially in the case of musculoskeletal pain.
Severe Complications – When Sjogren’s presents with severe complications, patients may be offered corticosteroids, immunosuppressive drugs, or DMARDs (disease-modifying anti-rheumatic drugs). All of these medications have severe, unpleasant side-effects and are a measure of last resort.
Alternative Treatments
Because Sjogren’s syndrome is an autoimmune disease of the rheumatoid type, measures aimed at improving immune function and decreasing inflammation can decrease symptoms and slow the progress of the disease. One therapy that many MS patients have had good results with is low-dose naltrexone. Naltrexone is an opioid antagonist, a drug that blocks the body’s opioid receptors. Studies show that autoimmune sufferers often have reduced levels of endogenous opiates. Endogenous opiates enhance immune system function. When a low dose of naltrexone is taken at night, the body compensates by producing extra endogenous opiates the next day, thereby up-regulating the immune system. Other potent natural immune system enhancers include beta-glucans – found plentifully in mushrooms, herbs such as astragalus, gynostemma and noni, probiotics, colostrum, and Vitamins K and D. Sjogren’s patients typically have low Vitamin D levels.
To reduce inflammation, attention to diet and supplementation are important. The typical Western diet is loaded with pro-inflammatory factors, including processed foods, refined grains and sugar, and Omega-6 fatty acids (from red meat). Sjogren’s patients show also show a sensitivity to gluten which is pro-inflammatory and should be avoided. Avoiding most, if not all grains and definitely avoiding all gluten are a good measures. Also increasing intake of vegetables and, secondarily fruits, and trying to eat organic food. Taking Omega-3 fatty acids, preferably in the form of fish oil, is a good anti-inflammatory measure. Many herbs also decrease systemic inflammation including all bitters. Neem and turmeric are extremely anti-inflammatory. New Chapter Organics makes a product called Xyflamend that contains a number of anti-inflammatory herbs.
If you suspect that you have Sjogren’s syndrome, you may need to make a case for yourself with your doctor in order to get the necessary tests to determine a diagnosis. Proper management of any autoimmune condition with attention to diet and lifestyle is important.
Editor’s Note: There are natural ways to help reduce inflammation and help promote natural tear production. Here are some examples of excellent nutrients to consider:
Natural Anti-inflammtories:
- MSM capsules – natural anti-inflammatory
- Serrazimes (serrapeptase) – enzymes taken on an empty stomach. Helps break down debris in blood and tissue that can contribute to chronic inflammation
For Dry Eyes:
- Women’s Tear Stimulation Homeopathic Eyedrops – preservative free homeopathic formula for dry eyes
- Oasis Plus eyedrops – preservative free lubricant of dry eyes
- Tranquileyes – eye patches worn at night that help recycle tears during the night.
You can read up more on the products above at: www.naturaleyecare.com