Sjogren’s disease - symptoms, clinical signs and treatment

Published on October 31, 2016   30 min

Other Talks in the Category: Immunology

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.
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Sjogren’s disease - symptoms, clinical signs and treatment

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