#165: Understanding Sjogren's Syndrome Part 3

This week's blog is a continuation of the discussion I had with Dr. Pavly Moawad.  A. Pavly Moawad, MD, MRCSEd(Ophth), FICO 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. She has graciously agreed to share her vast knowledge on the subject of Sjogren's Syndrome with my readers.

In honor of World Sjogren's Day, July 23, 2022, I wanted to take a deeper dive into the types of Sjogren's Syndrome.  And, give some tips on treating dry eye disease in relation to Sjogren's Syndrome.  If you missed the other two posts about Sjogren's Syndrome, please review the symptoms of Sjogren's Syndrome in this blog and how to treat dry eye disease in patients with Sjogren's Syndrome here.

Does Sjogren's Syndrome tend to be hereditary? 

It's not hereditary, but there is a genetic predisposition. Some patients are genetically predisposed more than others to Sjogren's Syndrome.

In addition, there are infections which can trigger Sjogren's Syndrome. The exact etiology or pathogen is not clearly understood at this time.  (Utomo SW, Putri JF. Infections as Risk Factor of Sjögren’s Syndrome. Open Access Rheumatol. 2020;12:257-266)  Some research has shown that chronic infections can trigger autoimmune disorders due to continuous T-cells and B-cells activation.  This leads to autoimmune reaction with large numbers of activated cells surrounding healthy cells.  This can cause the immune cells to kill off the healthy cells and trigger autoimmune disease.

But the research in this mechanism of developing Sjogren's disease is not conclusive.  A chronic infection is not the only risk factor needed for the development of Sjögren’s syndrome.  There are still various unknown factors that trigger infection to develop into Sjögren’s syndrome that need continued research to understand completely.

The infections that have been shown to lead to Sjogren's Syndrome include:

• Hepatitis C
• Epstein Barr Virus
• Cytomegalovirus
• Human T-lymphotropic virus-1 (HTLV-1) 

 2 Types of Sjogren's Syndrome

There are two major types: primary and secondary. Primary Sjogren's is what we have already been discussing.  It is Sjogren's Syndrome in the absence of other autoimmune disease.

The secondary Sjogren's occurs when you already have an autoimmune disease and then develop Sjogren's Syndrome as well.  The most common autoimmune diseases associated with Secondary Sjogren's Syndrome are:

• Rheumatoid arthritis
• Systemic Lupus
• Scleroderma

The primary type of Sjogren's Syndrome is not common as the secondary one.  Patients may present to the office without any autoimmune of systemic disease diagnosis.  But, the patient may have symptoms of dryness as well as other manifestations like joint pains, swelling, stiffness, rashes, or fatigue. The key is to pick up these cases at early stages in order to reach a diagnosis and proper treatment.

If you are a patient with rheumatoid arthritis, systemic lupus or other autoimmune disease, and you have dryness in your eyes or in your mouth, please consult your rheumatologist for further testing.  Tell them specifically about your symptoms of dry eyes and mouth. 

Treating Sjogren's related Dry Eye Disease:

No matter where the Sjogren's Syndrome comes from (primary or secondary), a diagnosis of Sjogren's Syndrome warrants a visit with your Eye Care Practitioner (ECP) for further testing.  Your ECP should start you on a regimen of prescription eye medications to decrease the inflammation in the eyes.  Other treatments may also be necessary to heal the front surface of the eyes.

It is important to remember that lifestyle changes may be necessary to relieve the symptoms of dryness.  Since dry eye disease is multifactorial, getting systemic therapy for the Sjogren's Syndrome won't necessarily cure all the dry eye symptoms.  Making some lifestyle shifts to improve the daily care of your eyes is important.    

CONCLUSION

Wonderful, that that is a ton of awesome information for everyone. I really appreciate Dr. Moawad taking the time to explain Sjogren's Syndrome treatment options to us so thoroughly. 

Whether you have Sjogren's Syndrome from a family history, a viral infection, or another auto-immune disease the effects on your eyes are the same.  The cause of dry eye disease is multifactorial, even with a Sjogren's Syndrome diagnosis.  When you have a systemic diagnosis that is known to cause dry eyes, that doesn't mean that spending time on the computer or over wearing your contact lenses won't increase the dryness.

Learning to make simple lifestyle adjustments can make a huge difference in how your eyes feel no matter what is causing the dry eye disease.  Taking a 3 Pillar approach to dry eye treatment with the EYE Method will get the eyes feeling better.  Get started on your personalized dry eye treatment plan by scheduling a consultation call with Dr. T.