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Sjogren Syndrome in Seniors

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What is Sjogren syndrome?

Sjogren syndrome is a chronic inflammatory disorder of the immune system in which there is progressive destruction of the salivary and tear glands resulting in dry mouth and dry eyes. The deformity can exist on its own but is usually seen accompanying other immune system disorders like  rheumatoid arthritis. Sjogren syndrome is more commonly seen after the age of 40 years and is more common in women. The condition is sometimes missed in the elderly, as the main symptoms dry eyes and dry mouth, is thought to be associated with chronic medication or is a part of the aging process.

Signs and symptoms

There are two main symptoms of Sjogren syndrome are :

  • Dry eyes: There could be grittiness or burning of the eyes along with itching.
  • Dry mouth: Dryness of the mouth with difficulty in chewing or swallowing solid foods. Mouth ulcers may be seen. Hoarseness of the voice may occur due to dryness of the upper respiratory tract.

Other symptoms that may be present include :

  • Swollen salivary glands usually the parotid glands
  • Joint pain, stiffness and swelling
  • Dryness of skin
  • Dryness of the vagina
  • Dry cough
  • Fatigue
  • Cracks or fissuring of the corners of the mouth

Dental caries (tooth cavities) and oral thrush due to an yeast infection are the common complications. Photosensitivity (light sensitivity) due to dryness of the eyes along with redness of the eyes may also be present. Other organ involvement such as kidney, lungs, liver, nerves and lymph nodes may also be present thereby producing symptoms such as impaired kidney function, bronchitis, cirrhosis or numbness and tingling.

Causes

Sjogren syndrome is an autoimmune disease in which the immune system mistakenly recognizes the normal tissues of the body as foreign and attacks it. The exact reason why this abnormal immune process commences is not known though genetics factors or previous infections  are believed to trigger such a reaction. Initially the autoimmune system targets the exocrine glands (secretory glands) and then later may attack other parts of the body such as thyroid, kidney, liver, lungs or joints of the body.

Treatment

Blood tests may identify antibodies commonly seen in Sjogren disease. Shirmer test, sialogram, salivary scintography and biopsy help in the diagnosis. Milder symptoms of dry mouth and dry eyes can be treated with sipping water intermittently and over-the-counter eye drops. However, in more severe cases, prescription medication and sometimes even surgery is necessary.

Medication

  • Drugs that increase the secretion of saliva and sometimes tears such a pilocarpine or cevimeline.
  • Artificial tears or eyes lubricants may be helpful in reducing dryness of the eyes.
  • Arthritis symptoms can be treated with NSAIDs.
  • Antifungal medications are used for oral thrush.
  • Immunosuppressant drugs such as methotrexate or cyclosporine are used which help reduce the symptoms.
  • Hydroxychloroquine, an antimalarial drug, may be helpful.

Surgery

Surgery is generally reserved for severe cases that do not respond well to medication. Surgical intervention may be helpful to treatment dryness of the eyes. It consists of blocking the tear duct that drains tears from the eyes. This can be done by laser or by placing collagen or silicone plugs.

Other

  • Chewing sugarless gum or drinking sour or bitter drinks can increase salivary secretions.
  • Artificial saliva agents can be used which can keep the mouth moist for a longer period of time.
  • Proper oral hygiene with topical fluoride treatments and antimicrobial mouth washes can help prevent caries.

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