Sjogren’s Syndrome

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Sjogren’s syndrome is an immune disorder characterized by its most common symptoms, which include dry eyes and dry mouth. These symptoms result when the immune system attacks the mucous membranes that line the eyes and mouth, which results in the decreased production of tears and saliva. Other symptoms including swelling, stiffness, and pain in the joints; swollen salivary glands (especially those located behind the jaw); skin problems including rash and dryness; vaginal dryness; persistent, dry cough; and prolonged fatigue. In addition to its effects on the eyes and mouth, Sjogren’s syndrome can also result in damage to the joints, thyroid gland, kidneys, liver, lungs, and skin. Nerve problems can also occur and are characterized by numbness, tingling, and burning in the hands and feet (a condition known as peripheral neuropathy). Cavities are more likely in individuals with Sjogren’s syndrome, due to the decreased production of saliva. Oral thrush (yeast infection in the mouth) is also a common complication of Sjogren’s syndrome. Vision problems can also result.

Sjogren’s syndrome is understood to be an autoimmune disorder, in which the immune system mistakenly attacks the body; however, researchers do not fully understand what causes some individuals to develop Sjogren’s syndrome when others do not. Although certain genetic mutations have been identified that can place people at an increased risk of developing Sjogren’s syndrome, a specific trigger, such as a specific viral or bacterial infection, is also required. In terms of demographic characteristics, Sjogren’s syndrome is most commonly diagnosed in individuals over the age of 40, and like fibromyalgia, it occurs much more often in women than in men. Additionally, individuals with rheumatic diseases, such as rheumatoid arthritis and systemic lupus erythematosus (lupus), are also more likely to develop Sjogren’s syndrome.

The diagnosis of Sjogren’s syndrome can be rather difficult due to the wide variation in its signs and symptoms, as well as their non-specific nature and overlap with other symptoms of other conditions. Furthermore, side effects of many medications can also mimic the common symptoms of Sjogren’s syndrome. In general, a diagnosis of Sjogren’s syndrome is reached after a battery of tests are used to rule out other possible conditions. Such tests may include: blood tests to check levels of specific blood cells, including antibodies that are commonly seen in individuals with Sjogren’s syndrome; blood glucose (sugar) tests; tests to determine the presence of certain inflammatory conditions; and tests designed to specifically identify liver and kidney problems. In addition, certain eyes tests can be administered to measure eye moisture, and various imaging techniques (such as x-rays) may be needed to evaluate the status of salivary glands.

Treatment is geared toward symptom control, and for many people, Sjogren’s syndrome can be effectively managed with simple over-the-counter eye drops and increased fluid intake. Depending on individual symptoms, certain medications such as pilocarpine and cevimeline (prescription medications used to increase saliva and tear production) may be useful, as well as anti-inflammatory pain medications to relieve joint pain and swelling. In addition, a drug commonly used to treat malaria – hydrozychloroquine – may also be effective at treating multiple symptoms of Sjogren’s syndrome.

Sjogren’s Syndrome and Fibromyalgia

The research related to Sjogren’s syndrome and fibromyalgia is sparse and limited by studies conducted in small samples of patients, or studies that are observational in nature.

A recent study by Kang & Lin (2010) found that ethnic Chinese patients with Sjogren’s syndrome had an increased prevalence of fibromyalgia. An Italian study evaluated 250 patients (including 100 with lupus, 50 with systemic sclerosis, 100 with Sjogren’s syndrome, and 75 with fibromyalgia, in addition to 30 healthy individuals. The authors found that 22% of the patients with Sjogren’s syndrome also met the study’s criteria for a diagnosis of fibromyalgia (Ostuni et al., 2002). An earlier German study noted a 44% frequency of fibromyalgia in patients with Sjogren’s syndrome (Dohrenbusch et al., 1996). Other researchers have estimated that 6% to 11% of fibromyalgia patients may have coexisting Sjogren’s syndrome (Bonafede et al., 1995).

Lindvall et al., (2002) also noted that patients with Ostuni Sjogren’s syndrome frequently present with muscle pain characteristic of fibromyalgia. et al., 2002 found in their study that patients who had both Sjogren’s syndrome and fibromyalgia had physical symptoms that were similar to those of patients who had only a diagnosis of fibromyalgia. In contrast, a 2001 retrospective review of patient data for 100 patients evaluated in a Sjogren’s syndrome clinic found no significant association between the widespread pain that is characteristic of fibromyalgia and Sjogren’s syndrome (Pendarvis & Pillemer, 2001). Priori and colleagues recently found that among Italian patients with Sjogren’s syndrome, those who also met the American College of Rheumatology (ACR) criteria for the diagnosis of fibromyalgia experienced significantly greater fatigue than those who did not (Priori et al., 2010). Conversely, Giles & Isenberg (2000) found no evidence to support the idea that increased fatigue in patients with Sjogren’s syndrome is related to comorbid fibromyalgia.

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References

1.        Sjogren’s syndrome. The MayoClinic. August 6, 2011; Accessed June 13, 2012.

2.        Priori R, Iannuccelli C, Alessandri C, Modesti M, Antonazzo B, Di Lollo AC, Valesini G, Di Franco M. Fatigue in Sjogren’s syndrome: relationship with fibromyalgia, clinical and biologic features. Clin Exp Rheumatol. 2010;28(6 Suppl 63):S82-S86.

3.        Kang JH, Lin HC. Comorbidities in patients with primary Sjogren’s syndrome: a registry-based case-control study. J Rheumatol. 2010;37(6):1188-1194.

4.        Ostuni P, Botsios C, Sfriso P, Bertagnin A, Cozzi F, Doria A, Todesco S. [Prevalence and clinical features of fibromyalgia in systemic lupus erythematosus, systemic sclerosis and Sjögren's syndrome] [Article in Italian] Minerva Med. 2002;93(3):203-209.

5.        Lindvall B, Bengtsson A, Ernerudh J, Eriksson P. Subclinical myositis is common in primary Sjögren’s syndrome and is not related to muscle pain. J Rheumatol. 2002;29(4):717-725.

6.        Pendarvis WT, Pillemer SR. Widespread pain and Sjögren’s syndrome. J Rheumatol. 2001;28(12):2657-2659.

7.        Giles I, Isenberg D. Fatigue in primary Sjögren’s syndrome: is there a link with the fibromyalgia syndrome? Ann Rheum Dis. 2000;59(11):875-878.

8.        Dohrenbusch R, Grüterich M, Genth E. [Fibromyalgia and Sjögren syndrome--clinical and methodological aspects] [Article in German] Z Rheumatol. 1996;55(1):19-27.

9.        Bonafede RP, Downey DC, Bennett RM. An association of fibromyalgia with primary Sjögren’s syndrome: a prospective study of 72 patients. J Rheumatol. 1995;22(1):133-136.

 

 

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