Sjogren’s syndrome is a very common systemic Autoimmune disease. It has a female predominance and is highest in the 40–60 year age group. Sjogren's is often referred to as the 'sicca syndrome' (from the Latin siccus meaning dry or thirsty), since characteristic symptoms include dry eyes and dry mouth. In 1933 Henrik Sjogren, a Swedish ophthalmologist, noted a patient with low salivary and lacrimal gland secretions. He published this finding in his PHD thesis, which subsequently raised awareness to the syndrome worldwide.
Symptoms
The immune system attacks moisture producing glands in the mouth and eyes causing dryness. However, as the disease progresses, it can attack other parts of the body, including joints, nerves, kidneys and lungs. Chronic inflammation is a hallmark of Sjogren's syndrome.
Sjogren's exists as either a primary syndrome, or as a secondary syndrome when associated with other autoimmune diseases, such as rheumatoid arthritis, systemic lupus erythematosus and systemic sclerosis. It it can be difficult to diagnose and can often take years since there are many signs and symptoms and they often look similar to other diseases.
Signs and symptoms in primary Sjogren’s syndrome:
Sjogren's progresses through many stages of disease that occur over many years and may be completely different in each individual. Therefore each patient may experience some of the following symptoms at varying levels:
Dry Eyes •Dry, itchy, burning, sore, tired, blurred vision, sensitive eyes
•Various inflammatory eye conditions
•Conjunctivitis
•Corneal issues
•Decreased visual acuity
•Eye fatigue
•Photosensitivity
Dry Mouth •Adherence of food to the mucosa
•Candida or other local infection
•Difficulties in speaking or eating, loss of taste
•Disappearance of the usual pooling of saliva in the floor of the mouth
•Dry and glazed oral mucosa
•Dry lips
•Difficulty swallowing
•Swollen glands
•Partial or complete depapillation of the tongue, red or lobulated tongue
•Gum disease
•Soreness, burning mouth
•Tooth decay
Other
•Chronic, non productive cough
•Skin dryness
•Fatigue
•Pain
•Persistent hoarseness
•Pruritis in the outer ear and ear canal
•Constipation
•Vaginal pruritis, dryness
•Heartburn or reflux
•Disturbed sleep
Extra-glandular or systemic symptoms:
Skin
•Dryness, rashes
•Purpura/ ulcers
•Raynaud phenomenon
Joints
•Arthralgia
•Arthritis
•Inflammatory joint and muscle pain
Neurologic
•MS-like disease
•Various Neuropathy
•Depression, Anxiety
Pulmonary
•Interstitial lung disease
•Pulmonary arterial hypertension
Renal
•Glomerulonephritis
•Interstitial cystitis
Other (more rare)
•Lymphoma
Pathophysiology of Sjogren's syndrome
The pathogenesis of Sjogren's may involve genetic susceptibility, a dysregulated immune system and microbiome and an environmental trigger(s):
Genetics - Genome wide association studies have identified the human leukocyte antigen (HLA) genes are closely associated with Sjogren's, as well as, genes belonging to interferon signalling. Other specific genes have also been identified.
Immune dysregulation -
lymphocytes infiltrate the lacrimal and salivary glands leading to tissue damage.
both innate and adaptive immune systems may be involved
Antinuclear antibodies (ANA), Rheumatoid factor (RF) and anti-SSA/SSB are the most prevalent autoantibodies that indicate Sjogren's syndrome.
inflammatory cytokines such as IFN, IL-17 are variable at different disease stages
different mechanisms occur and may not be the same in all patients
Environmental trigger - viral infection may trigger the disorder. Different viruses such as hepatitis C virus, Epstein–Barr virus , cytomegalovirus, coxsackievirus have been suggested as possible inducers of the disease.
Microbiome - several studies have demonstrated dysbiosis of the intestinal microbiota in Sjogren's patients.
Hormones - abnormal levels of hormones may play a role in the pathogenesis of Sjogren's especially since it is female dominated in the menopause age group.
Managing Sjogren's syndrome
As with most Autoimmune diseases, there is currently no cure, but the disease may go into remission if managed well. Most patients tend to be under the care of a dentist, ophthalmologist, and rheumatologist. Therapy may be tailored to reduce symptoms, avoid complications, and improve quality of life. Quite often patients take various immunosuppressive medications. Other treatments may include: eye drops, saliva stimulating medications, painkillers, steroids and anti fungal medications.
There aren't as many clinical trials available on Sjogren's as other Autoimmune diseases, however some findings from studies on natural remedies include:
Vitamin A deficiency should be considered in any patient with severe dry eyes.
Data suggests that fat-soluble vitamins may be important in immunoregulatory processes in patients with Sjogren's.
Adherence to a Mediterranean diet was associated with lower likelihood of Sjogren's.
In mice studies, a gluten free diet reduced infiltration of monocytes/macrophages and T cells in salivary glands, indicating that Sjogren's may be alleviated by a gluten free diet. A rectal mucosal inflammatory response after eating gluten is often seen in patients with Sjogren's, signifying gluten sensitivity.
Serum vitamin D levels were found to be lower in Sjogren's than controls.
Curcumin reduced pro-inflammatory cytokines secreted by minor salivary glands in patients with primary Sjogren's.
Sjogren's patients had deficient omega 3 intake in a clinical trial. Many studies indicate that Omega 3 is important for reducing inflammation in Autoimmunity.
CoenzymeQ10 was evaluated in a double blinded study, the treatment group had an increased salivary secretion rate after supplementation.
In a study, administration of resveratrol resulted in increased saliva secretion in mice, confirming a therapeutic effect for resveratrol on salivary dysfunction in Sjogren’s.
ECGC in green tea was shown to be protective against autoimmune-induced tissue damage in Sjogren’s syndrome in a mouse model.
Systemic antibiotic treatment and germ-free mice have demonstrated that commensal bacteria have a protective role for the ocular surface and lacrimal gland. Therefore it is important to nourish the microbiome.
In addition, the following tips may be useful:
Using a humidifier to add moisture to your surroundings
Use an aromatherapy diffuser to diffuse essential oils into the air
Drink lots of water, herbal teas, smoothies
Avoid inflammatory food and drinks, consider an elimination or Mediterranean diet.
Consume more moist foods such as soups, casseroles, curries
Ensure vitamins, minerals, omega 3 and other suggested nutraceuticals are optimised
Practice good oral hygiene such as flossing, water pick or oil pulling
It is clear that a personalised, multi-disciplinary approach must be taken in Sjogren's due to how the disease progresses so differently in each individual and the many symptoms that may occur. Working with an experienced autoimmune health professional in addition to your GP may help to better manage your condition. This may involve a multifactorial, personalised plan including looking at the gut and microbiome, infections, toxins, hormones, deficiencies, stressors, sensitivities, inflammation and rebalancing the immune system.