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0:06
What are symptoms that patients
with Sjogren's may have?
Certainly, dry eye,
there's data
that 1 in 10 persons
that present to an eye care
specialist have Sjogren's.
It's also important
to know that patients
may not complain of dry eye
but they may have
objective measures of dry eye
and may have a positive
ocular staining score.
So again, there is some defect
in the neurotransmission
in such patients
that may have damage
but no pain
and no perception of dry eye.
Dry mouth, this can be certainly
uncomfortable for patients,
can impact their ability
to speak.
I have had patients
who had to change jobs
from being a TV newscaster
because of something
like this with Sjogren's.
It impacts your ability
to enjoy food
and to even digest food
which can affect nutrition.
Dry mouth can predispose
to yeast infections
in the oral cavity.
As previously stated,
it can predispose
to dental caries
resulting in a need
for increased restoration work,
which carries a huge financial
cost for patients.
Other types
of autoimmune processes
can occur in the oral mucosa,
lichen planus
and lichen sclerosis.
Joint pain, tendon pain,
and swelling can also occur.
It's usually not erosive
such as it would occur
in rheumatoid arthritis
but may require similar disease
modifying drugs
in certain patients.
1:38
The fatigue
that's seen in Sjogren's
is a profound fatigue
and can be quite disabling.
The mechanism is still unknown
as it is with many
autoimmune diseases
associated with marked fatigue.
It may either be cytokine driven
with certain cytokines
such as Interleukin 6 crossing
the blood-brain barrier,
or it may be involved
with the autonomic
nervous system dysfunction.
There's even recently a report
of a certain gene
signature pattern
connected with fatigue
of Sjogren's.
So more research is needed.
Neurocognitive dysfunction
or as patients refer to it
as "brain fog"
is also a prominent feature
of Sjogren's,
even more so than with lupus
or rheumatoid arthritis.
This type
of neurocognitive dysfunction
seems to target
the executive functions.
There are some data to suggest
there is an
immune-mediated component
but controversy
over this continues.
Should be noted
that there are reports
of certain antibodies,
particularly NR2
which is directed
at a glutamate subunit
that is present in the CSF
and associated
with neurocognitive
dysfunction in Sjogren's.
Prominent symptoms,
also sometimes
not attributed to Sjogren's
but very commonly involved,
are GI dysmotility,
especially
esophageal dysmotility.
