#157: Understanding Sjogren's Syndrome (Part 1)
I am honored to have a special guest with me, Dr. A Pavly Moawad, MD, MRCSEd(Ophth), FICO. She is a Lecturer and Consultant Ophthalmologist at Cairo University Hospital in Egypt. In her ophthalmology practice she specializes in seeing patients with Sjogren's Syndrome.
What is Sjogren's Syndrome?
Sjogren's syndrome is an autoimmune disease. The main characteristics are dryness in the eyes, mouth, skin, and vagina. Sjogren's syndrome attacks the glands that make secretions which lubricate our different parts of our body. But, the main two organs are the eyes and mouth.
How is Sjogren's syndrome defined?
- Using lubricating eye drops more than three times per day
- Experiencing these symptoms more than three months
- Also has dry mouth
What's the next step in a Sjogren's Diagnosis?
Consultation with an immunologist or a rheumatologist. The patient may also need to see other specialists depending on their specific set of symptoms. The most common specialists needed are dentistry, dermatology, and gynecology.
It's important for these patient to work with a team of physicians. Lubrication of the eyes may give symptomatic relief. But the patient will feel best once they have systemic immunosuppression. And this is very important part of the story, because if we didn't control the autoimmune disease, then the disease will continue to be active and can progress. The patient will continue to have complications, which could have been preventable.
The earlier a patient is diagnosed, the better. If any of the warning signs are present, get a consult with a rheumatologist. The earlier we start treatment early the easier it will be to prevent more complications.
What Happens at the Rheumatology Visit?
There are certain criteria for the diagnosis of Sjogren's syndrome. It's not as simple as just having dry eye and dry mouth. Those two symptoms are part of the puzzle.
The rheumatologist may take a biopsy of the salivary glands or lip to be analyzed. There are also several blood test to specifically look for the antibodies associated with Sjogren's syndrome, which include anti-Ro (SS-A) and anti-La (SS-B) antibodies, rheumatoid factor, and antinuclear antibodies.
Why is diagnosing Sjogren's Syndrome so Important?
Patients with Sjogren's Syndrome are at a higher risk than the normal population to develop lymphomas.
Three Major Cornerstones of Management:
- Symptomatic relief for symptoms of dryness.
- Systemic immunosuppression.
- Frequent monitoring of these patients.
Sjogren's Syndrome patients must be followed closely because they are at a slightly higher risk for developing lymphomas. The diagnosis of Sjogren's Syndrome is very important to have a better prognosis.
The earlier we catch the patients as actually having Sjogren's syndrome, then the earlier they can be on systemic medications. The early the immunosuppression therapy is started then the better to prevent, systemic complications.
CONCLUSION
That's a ton of information for everyone. I really appreciate your time. To recap: if you think that you use eyedrops more than three times a day and you also have dry mouth, then you should see your eye care practitioner right away. Let them know that you have these symptoms. Your eye doctor can make the referral to rheumatology.
The rheumatologist can have the blood work and biopsy done, then you'll know if you have Sjogren's syndrome. The earlier you are diagnosed with Sjogren's syndrome the better because systemic treatments are an important part of calming the inflammation.
Thank you again, Dr. Moawad for explaining Sjogren's syndrome to us. I truly appreciate your expertise in this area. Thanks again for joining me. And, if you don't already have a favorite artificial tear, download the guide here.
