Long-term dry eyes, dry mouth, dry nose, and dry throat may indicate Sjögren's syndrome!

Author: Zhang Zhuoli, Chief Physician, Peking University First Hospital

Vice Chairman of the Rheumatology Branch of the Chinese Medical Association

Reviewer: Chen Yong, Chief Physician, Beijing Chaoyang Hospital, Capital Medical University

Many people from the south feel that the weather in the north is too dry after coming here, which makes their skin dry, their eyes dry, and their mouths thirsty. If it is winter and heating is turned on, it will be even drier.

Every morning when I wake up, my throat is smoking, my skin is tight and flaking, and I feel like a dry old branch. My body is extremely dehydrated and I even wonder if I have Sjögren's syndrome.

In fact, Sjögren's syndrome is a disease.

1. What is Sjögren's syndrome?

Sjögren's syndrome is a chronic autoimmune disease caused by a disorder of the immune system.

Unlike heart disease, which is located in a fixed location, once there is a problem with the heart, everyone can feel that it may be a heart problem. The immune system is located in various parts of the body and is relatively complex.

Under normal circumstances, the immune system is like the "police department" in the human body, responsible for clearing out garbage (apoptotic cells, etc.), traitors (tumor cells) and foreign enemies (viruses and bacteria) in the body.

Once the immune system becomes dysfunctional, the "police department" that is supposed to provide protection will lose its ability to distinguish and will attack normal organs and cells in the body.

Sjögren's syndrome is one such autoimmune disease.

2. What symptoms do patients with Sjögren's syndrome have?

The most important symptom of Sjögren's syndrome is "dryness", including dry eyes, dry lips, dry nose, dry throat, dry vagina, etc.

There are two common symptoms of dry eyes. One is that you feel like sand is rubbing against your eyes, and your eyes gradually become dry. The other is that you feel like crying but can't when you see something touching, and your eyes become dry. People with Sjögren's syndrome have dry mouths, and they need to drink water to moisten their lips after talking for a few minutes.

Figure 1 Original copyright image, no permission to reprint

In addition to "dryness", what other symptoms does Sjögren's syndrome have?

Sjögren's syndrome develops insidiously and may affect organs throughout the body.

For example, if the lungs are affected, mildly affected patients may experience dry cough, while severe patients may develop pulmonary interstitial fibrosis;

Involving the blood system, Sjögren's syndrome can cause a decrease in white blood cell count and/or thrombocytopenia;

Involvement of the kidneys can cause abnormal kidney manifestations, such as large amounts of protein in the urine;

Involvement of the liver may cause abnormal liver function;

Involvement of the nervous system. Some patients may experience numbness in the hands and feet, or even joint swelling and pain, arthritis, muscle pain or weakness. These are all manifestations of Sjögren's syndrome involving the nervous system.

If the skin is affected, an allergic purpura-like rash may occur, mostly on the lower limbs.

Sjögren's syndrome can cause problems in almost every system of the body, causing harm to the human body, so everyone must be vigilant.

So, what causes Sjögren's syndrome?

3. What causes Sjögren’s syndrome?

The cause of Sjögren's syndrome is not very clear at present, but after so many years of research, it has been found that there are some risk factors or related factors. Sjögren's syndrome is related to the following aspects.

First, genes. Sjögren's syndrome has a certain genetic tendency. Many people in the family suffer from immune diseases, such as lupus erythematosus, rheumatoid arthritis, thyroid disease, etc. If you have a family history, the risk of getting Sjögren's syndrome will be higher, but it does not mean you will definitely get it.

Second, viral infection. Based on the genetic background, if there is a viral infection, such as Epstein-Barr virus infection, the immune system will be disrupted and the risk of Sjögren's syndrome will increase.

If you have obvious dry mouth and dry eyes in recent time and it lasts for a long time, and it cannot be relieved by drinking water, adjusting your diet, controlling blood sugar, etc., and it has caused trouble in your life, then you should see a doctor.

Many patients will first see an otolaryngologist. After the otolaryngologist conducts relevant examinations, if he suspects Sjögren's syndrome, he will recommend further consultation and screening at the rheumatology and immunology department.

Rheumatologists will select appropriate tests based on the patient's specific situation. For example, immunological tests can detect some autoantibodies, such as antinuclear antibodies, anti-SSA antibodies, and anti-SSB antibodies, which are very important antibodies for diagnosing Sjögren's syndrome. 60% of Sjögren's syndrome patients will have positive rheumatoid factors, which are often checked. In addition, immunoglobulins will also be checked, which can determine the severity of the disease and whether it is in an active or inactive stage.

For the diagnosis of Sjögren's syndrome, lip gland biopsy is also a very meaningful examination. After special staining and observation under a microscope, if it is Sjögren's syndrome, we can see that there are many inflammatory cells infiltrating inside, and the number must reach a certain level, which is helpful for the diagnosis of Sjögren's syndrome.

Sjögren's syndrome is an exclusive diagnosis. After excluding other diseases, the diagnosis is finally made based on various examinations.

4. How to treat Sjögren's syndrome?

Sjögren's syndrome is a chronic systemic disease. The symptoms of each patient are different. The treatment should be individualized according to the specific situation of each patient.

For patients with Sjögren's syndrome, such as those with dry eyes and dry mouth, replacement therapy is the main treatment. For dry eyes, you can drop artificial tears. When they are dry, just apply a little, and the eyes will not be dry anymore. For dry mouth, you can use artificial saliva instead.

Figure 2 Original copyright image, no permission to reprint

In addition to replacement therapy, other methods can also be used to stimulate the secretion of tears and saliva. The simplest method is to chew gum. By chewing gum and eating something sour, you can stimulate glandular secretion. Drugs can also help stimulate glandular secretion, such as anethole trisulfide tablets.

If Sjögren's syndrome is more serious, systemic medication must be taken orally or by infusion. Systemic medication, such as hydroxychloroquine, can relieve dry eyes and dry mouth, and is helpful in controlling the development of the disease. It is a very important drug. White paeony total glucosides can also relieve dry eyes, dry mouth, and dry stool.

The symptoms of dryness can be relieved to a certain extent after treatment, but not all patients can completely eliminate the symptoms of dry eyes and dry mouth, which depends on the early or late treatment.

When patients with Sjögren's syndrome develop thrombocytopenia and lung and liver lesions, they need to use stronger drugs, namely hormones and immunosuppressants. Immunosuppressants can suppress the immune response and achieve the purpose of treating the disease. Common drugs include methotrexate, cyclophosphamide, azathioprine, mycophenolate mofetil, leflunomide, etc.

Sjögren's syndrome is an autoimmune disease and usually does not require surgical treatment. However, if some serious symptoms occur, such as intestinal obstruction, surgery may be required in an emergency. Surgery only solves local symptoms and medication will still be needed for treatment in the future.

Sjögren's syndrome is a chronic disease, which means that long-term treatment may be required. If there are only symptoms of dry eyes and dry mouth, and the disease does not progress, lifelong replacement treatment is sufficient, and medication is not required. For more serious patients, some patients who take systemic medication may need to take medication for five years, some may need to take medication for ten years, and some may need to take medication for life.

Once you get Sjögren's syndrome, it cannot be cured, but you can control the symptoms with medication and live like a normal person. In addition, since the cause of Sjögren's syndrome is unclear, it is also difficult to prevent.