General Practice 2022

SíSjögren's syndrome: what é, symptoms, causes and treatment

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SíSjögren's syndrome: what é, symptoms, causes and treatment
SíSjögren's syndrome: what é, symptoms, causes and treatment

Sjögren's syndrome is a chronic, autoimmune rheumatic disease characterized by inflammation of some glands in the body, such as the mouth and eyes, which results in symptoms such as dry mouth and a feeling of sand in the eyes, in addition to the increased risk of infections such as cavities and conjunctivitis.

This syndrome is more common in young women, but can happen in people of all ages. In some cases, the first symptoms appear during pregnancy, as this is a period when hormonal changes and emotional stimuli can exacerbate this type of disease.

The treatment of Sjögren's syndrome should be guided by a rheumatologist, with the aim of relieving symptoms, and the use of eye drops or artificial saliva, for example, may be indicated.

Main symptoms

The main symptoms of Sjögren's syndrome are:

  • Dry mouth, known as xerostomia;
  • Difficulty swallowing dry food;
  • Difficulty speaking for a long time;
  • Tummy pain;
  • Dry eyes;
  • Feeling of sand in the eyes and redness;
  • Sight tired;
  • Sensitivity to light;
  • Risk of corneal ulcerations;
  • Increased risk of infections such as cavities, gingivitis and conjunctivitis;
  • Dry skin and dryness of the mucosa of the intimate parts.

Although it is rarer, Sjögren's syndrome can cause symptoms that are not related to the glands, called extraglandular manifestations, such as pain in the joints and body, tiredness and weakness, dry cough or skin changes, such as hives, bruises, skin sores and changes in sensitivity.

In addition, Sjögren's syndrome can cause neurological symptoms, being a more serious type of manifestation, which can present loss of strength in one part of the body, changes in sensitivity, seizures and difficulties in movement.

Although uncommon, people with Sjögren's syndrome may also have an increased chance of developing lymphoma, which can happen in later stages of the disease.

How to confirm the diagnosis

The diagnosis of Sjögren's syndrome is made by the rheumatologist, who evaluates the symptoms, performs a physical examination of the glands and may request tests as markers of immunity, called anti-Ro/SSA, anti-La/SSB and FAN.

A lip biopsy may be requested to confirm when there is doubt about the diagnosis or to evaluate the presence of other factors that can cause symptoms similar to this syndrome, such as viral infections, diabetes, use of some medications or psychological causes, for example.Check out what other causes of dry mouth can be and how to fight them.

In addition, it is also important to research the existence of Hepatitis C, as this infection can cause symptoms very similar to those of Sjögren's syndrome.

Possible causes

Sjögren's syndrome is an autoimmune rheumatic disease in which the immune system reacts against glandular cells, mainly salivary and lacrimal cells, attacking and destroying these cells as if they were foreign to the body, which leads to the appearance of symptoms.

Sjögren's syndrome can present in 2 ways:

  • Primary Sjögren's syndrome: when presented in isolation, caused by changes in immunity;
  • Secondary Sjögren's syndrome: when it arises in association with other autoimmune diseases, such as rheumatoid arthritis, lupus, scleroderma, vasculitis, or with chronic hepatitis.

It is not yet known exactly why this happens, but some factors seem to contribute to the development of Sjögren's syndrome, such as genetic and hereditary factors, sex and age, being more common in women over 40 years old, hormonal changes, or infections by viruses or bacteria.

How the treatment is done

Sjögren's syndrome treatment should be guided by a rheumatologist, with the aim of relieving symptoms and decreasing dryness of the mouth and eyes.

The main treatments for Sjögren's syndrome are:

1. Use of medication

Remedies that may be prescribed by a doctor for Sjögren's syndrome are:

  • Pilocarpine or Cevimeline, in tablet form, are useful for stimulating gland function and improving dryness symptoms;
  • Artificial tears, lubricating gels or eye drops, such as Lacrima plus, Optive, Hylo gel and Fresh tears, for example, are used to reduce eye discomfort and prevent possible complications in the corneas;
  • Hydroxypropyl cellulose-based lubricant extended release tablet can be placed on the lower eyelid and dissolves slowly throughout the day, used in cases more severe dry eye;
  • Propionic acid gel can be used to treat vaginal dryness;
  • Analgesics and anti-inflammatories, such as acetaminophen, ibuprofen or naproxen, for example, to relieve pain in the body and joints;
  • Immunity regulators, in pill or injectable form, of the corticosteroid and immunosuppressant type, such as dexamethasone, hydroxychloroquine, methotrexate, azathioprine, cyclophosphamide or rituximab, in the most severe cases, such as arthritis, neurological symptoms or impairment of the lungs, blood vessels and kidneys.

These drugs must be used with medical indication and guidance on an individual basis.

2. Physiotherapy

Physiotherapy in Sjögren's syndrome is particularly important in cases of body pain, joint pain and arthritis, as hot and cold compress techniques are performed to help reduce inflammation in the joints, as well as exercises to strengthen the muscles and increase joint range.

Learn more about the benefits of physical therapy to combat pain and relieve arthritis symptoms.

3. Surgery

Lacrimal point surgery may be indicated by the doctor in severe cases of dry eyes, being done with the placement of plugs or cauterization, in a hospital environment, and aims to keep the tear in the eye for longer, relieving dry eyes.

Treatment of the syndrome in pregnancy

Sjögren's syndrome can be triggered during pregnancy, as it is a period of hormonal changes and important emotional implications. In these cases, natural treatment and oral and eye lubricants can be done normally, however, in more serious cases, not all remedies can be used, requiring regular monitoring and following the rheumatologist and obstetrician's guidelines.

In addition, a woman who is already diagnosed with Sjögren's syndrome can become pregnant, however each case should be discussed with the rheumatologist and obstetrician, because in severe cases, there is a risk of worsening symptoms and some of the mother's autoantibodies impair the baby's development.

It is also necessary to suspend or replace some pills or injections, which can be harmful to the baby, such as corticosteroids and some immunosuppressants.

Care during treatment

Some care during treatment can help relieve symptoms with Sjögren's syndrome, and some of the options are:

  • Drink water in small amounts several times a day to keep your mouth moist;
  • Making mouthwash with water with drops of lemon or chamomile tea helps relieve dryness in the mouth;
  • Consuming sugar-free chewing gum or lozenges with xylitol are also good alternatives to keep your mouth lubricated;
  • Keep the environment humidified, with humidifiers or using damp cloths or aquariums, especially at night, inside the room;
  • Eat a diet rich in omega 3, such as eating fish, olive oil or flaxseed oil, as they help relieve inflammation.
  • Avoid acidic drinks, such as soda and energy drinks, or caffeinated drinks, as they increase the feeling of dryness;
  • Wear glasses with side shields or wide lens because they prevent tear evaporation, by blocking the wind and ensuring more moisture to the eyes;
  • Use moisturizing creams or lipsticks to reduce dry lips;
  • Remember to always blink your eyes, as it is common to forget during activities such as watching television or using the computer;
  • Avoid environments with low humidity and excessive use of fans or air conditioning, smoke or dust;
  • Avoid using excessive makeup, as it may contain substances that irritate the eyes and face.

In addition, it is important to always brush your teeth after meals, avoid the consumption of sugary foods, to prevent infections in the teeth and eyes, which are common in people with this syndrome, as bacteria can proliferate due to lack of lubrication.

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