Sjogren's Syndrome: Treatment, Procedure, Cost and Side Effects

Sjögren’s syndrome is a chronic, that is long term, autoimmune disease that causes dryness of the eyes, mouth and other body parts. In Sjögren’s syndrome, the infection-fighting cells of the immune system which are called the lymphocytes or white blood cells, attack the normal cells of glands that produce moisture in the eyes, mouth and other tissues. This action damages the exocrine glands, thus, making them unable to produce moisture. The condition often accompanies other immune system disorders, such as rheumatoid arthritis and lupus. It is most common in women after the age of 40. Sjögren’s syndrome is classified under two heads- primary Sjögren’s and secondary Sjögren’s. Primary Sjögren’s is when the gland inflammation is not associated with any other connective tissue diseases. When Sjogren’s syndrome is associated with inflammation of the exocrine glands along with other connective tissue diseases, like arthritis and lupus, it is called secondary Sjogren’s syndrome.

Two main symptoms of Sjogren’s syndrome are dry mouth and dry eyes. The lacrimal gland or tear gland is inflamed by Sjogren’s and thus causes dryness in the eyes. It can progressively lead to other symptoms such as eye irritation, decreased tear production, a 'gritty' sensation, eye infection, and serious abrasion of the dome of the eye. Dry eyes are also prone to infections and inflammation of the eyelids (blepharitis). Inflammation of the salivary glands causes dryness of the mouth, dental decay, cavities, gum disease, mouth sores and swelling, dry cough etc. Other symptoms associated with Sjogren’s syndrome are joint pain, skin rashes or dry skin, vaginal dryness, prolonged fatigue etc.

Treatment of Sjogren’s syndrome depends on the symptoms noted. Doctors may prescribe medicines that lower the eye inflammation, increase production of saliva etc. For moderate to severe dry eyes, doctors provide medicines like eye drops and ointments. Drugs such as pilocarpine (Salagen) and cevimeline (Evoxac) can increase the production of saliva. Use of lubricants and moisturizers can also aid to keep the body parts from drying. A minor surgery can also be done to seal the tear ducts that drain the tears. Also, collagen or silicone plugs are inserted into the ducts to help preserve the tears and provide relief from dry eyes.

It is difficult to diagnose Sjogren's syndrome as the signs and symptoms vary from person to person and can be very similar to those caused by other diseases. Early diagnosis is important to lessen the effect of Sjögrens syndrome on the eyes, mouth and other organs. Physical tests help to rule out other conditions and provide a proper treatment for the disease. Physical tests include blood tests, dry eye tests, saliva test, chest x ray etc. Blood tests help to detect specific proteins in their blood called autoantibodies. The anti-SSA (also called anti-Ro) or anti-SSB (also called anti-La) blood tests are the most specific ones for Sjögren’s syndrome. In the blood test reports, doctors are able to check the levels of different types of blood cells, presence of antibodies common in Sjogren's syndrome, evidence of inflammatory conditions and indications of problems with the liver and kidneys. Doctors measure the dryness of the eyes with a test called a Schirmer tear test. To check the surface of the eye (cornea) for dryness-related damage, a slit-lamp test is done. Certain imaging tests like Sialogram and Salivary scintigraphy help to check the function and dryness level of the salivary glands. Chest X-Ray may also be done to detect the inflammation of cells in the lungs.

Treatment for Sjogren's syndrome depends on the parts of the body affected and symptoms noted. Using over-the-counter eye drops and sipping water more frequently can help treat dry mouth and dry eyes. Eye drops and ointments will help treat dry eyes. If the surface of the eye is irritated (inflamed), doctors prescribe drops that contain steroids to be used for a short period. Sometimes other anti-inflammatory drops, such as ciclosporin drops, may be prescribed by an eye specialist. Artificial production of tears can be done by use of certain medicines, namely, pilocarpine. Dry mouth can be kept moisturized by using products like saliva substitutes. The medicine pilocarpine can also be used to treat a dry mouth. In order to treat dry skin, moisturising cream (emollient) should be used every day. Lubricants, moisturizers and hormonal replacement therapy are done to treat vaginal dryness. Surgery can also be done to seal the tear ducts that drain tears from the eyes (punctal occlusion). This helps to relieve dry eyes. Collagen or silicone plugs can also be inserted into the ducts to help preserve the tears.

People are eligible for the treatment of Sjogren’s syndrome when the symptoms are not going away and becoming botheration. Dryness in mouth and eyes can be caused by other problems too. So, after proper diagnosis, people should be given medicines particular to Sjogren’s syndrome.

People with temporary dryness in the mouth and body parts do not need to consult a doctor. Dryness can be caused due to various reasons, including weather conditions. In those cases, using moisturizers and lotions and mouth washes, keeping eyes and eye lids wet with water can help alleviate the dryness. Such people do not need to seek medical assistance.

There are certain side effects of the medicines used in the treatment of Sjogren's syndrome. Medicines like pilocarpine can cause side effects such as sweating, headaches, abdominal pain, flushing and increased urination.

Sjogren's syndrome, a type of arthritis, cannot cured but can be treated effectively. After treatment, with proper care and attention, people can recover soon. With proper attention to eye and oral care, the outlook for patients with Sjögren's syndrome is generally excellent. Proper medicines and personal care should be taken. People should avoid dry, smoky or windy places. Eyelids should be cleaned regularly and use of sunglasses can help prevent Sjogren’s syndrome. People should also avoid smoking and drinking to prevent dry mouth. Regular exercises and physiotherapy can help increase strength and flexibility of the muscles.People should fix a check up and monitoring appointment with the doctor every three to six months.

There is no definitive time duration for betterment as symptoms of Sjogren’s syndrome varies from people to people. Treatment and recovery also depend on the type of the disorder and method of treatment undertaken. People usually take around eight months or a year to recover from the symptoms. In surgical operations, people take much time to recover and regain normalcy.

Approximate expenditure for the treatment of Sjogren’s syndrome will range from Rs 600- Rs 2000/-. Surgeries done to seal the tear glands will incur greater costs.

Treatment for Sjogren’s syndrome is permanent even though there is no known cure for this disease. Patients should take care and precautionary measures and also follow doctor’s advice to prevent drying up of eyes and mouth.

Alternative ways are available to treat Sjogren’s syndrome. Homeopathic treatment and Ayurveda may be used to lessen dryness of eyes, mouth and other body parts. Most importantly, home remedies which especially includes a proper diet food can help to get rid of dryness. Some homeopathic medicines like Nux-m, Tub, Tub-m, Silica, Brass-n-o, Lapr, etc. have shown positive outcomes in the treatment of Sjogren’s syndrome. Herbal or ayurvedic remedy for Sjogren's syndrome intends to control the symptoms and relieve the disease. Ashwagandha capsules, Boswellia-Curcumin capsules, etc. can be helpful in the alternative treatment of sjogren’s syndrome. Besides these, maintaining a healthy diet is vital in the treatment. People should avoid spicy food, alcohol and beverages, smoking etc and consume healthy beneficial foods like proteins, juicy fruits, cucumbers etc. People should also increase the liquid or water intake to keep the body hydrated and prevent it from drying up.