Thursday, June 8, 2017

Sjogren's Treatment & Diagnosis, What Your Eye Doctors Should Know.


Sjogren's Treatments & Diagnosis- What the Eye Doctors Should Know.


Diagnosis of Sjogren's disease can be ambiguous and difficult.  It is helpful if the patient goes into the doctor's offices know some of the basic tests that are available to accurately diagnose this condition. which is the objective of this blog post.

Sjogren syndrome is one of the most common rheumatological diseases. Primary symptoms are dry eye, dry mouth.  

On average, it takes 7 years to diagnose Sjogrens Disease

Sjogrens is a chronic, slowly progressive autoimmune disease that affects the  moisture producing glands- eyes, mouth, lungs, vaginal areas.  Sjogrens is a clinical condition of aqueous tear deficiency combined with dry mouth. The syndrome is classified as primary Sjogrens in people without an another autoimmune disease, and secondary Sjogrens in people who have a confirmed autoimmune disease such as  rheumatoid arthritis, thyroiditis, Raynaud’s, Lupus, and more.  It affects primarily females, sometimes males of all age and races.

According to the National Institute of Neurological Disorders and Stroke (NINDS), between 1 and 4 million people in the United States have Sjogrens.

Although the hallmark symptoms are dry eyes and dry mouth, Sjogrens may also cause dysfunction of other organs such as the kidneys, gastrointestinal system, blood vessels, lungs, liver, pancreas, and the central nervous system. Patients may also experience extreme fatigue and joint pain and have a higher risk of developing lymphoma.


Diagnosis

The following tests are commonly used to determine the presence of Sjogrens in addition to the person's report of symptoms and health history.

Common blood tests include:

• Complete blood cell count often shows anemia.
• Serum erythrocyte sedimentation rate and C-reactive protein are indicators of inflammation and are frequently elevated in patients with Sjogrens.
• Serum immunoglobulins are antibodies are usually elevated in Sjogrens.
• Serum antinuclear antibody is elevated in approximately 90% of patients with Sjogrens and other immune diseases.
• Serum rheumatoid factor is present in about 60% of patients with Sjogrens, as well as with RA.
• Serum Sjögren antibodies (Ro/SS-A and La/SS-B) are more specific for SS but can also be detected in people with other autoimmune diseases,  Having a negative serology does not mean one do not have the disorder.
Lip biopsy is the best single test to establish a diagnosis of Sjogren syndrome. While this is the most definitive test, performing it is not absolutely necessary from a clinical standpoint. Patients with Sjogren syndrome are essentially treated symptomatically and observed for the development of other rheumatic disorders or lymphoma. This can be initiated without performing a biopsy. If the diagnosis is in doubt or if a definitive diagnosis is needed, then this is the best test.

Management of Sjogrens Syndrome

Goals of ophthalmic management of Sjogren syndrome are: to relieve symptoms, to promote healing of the ocular surface, and to prevent complications such as persistent corneal ulcers.

The treatment of dry eyes depends on the severity of eye dryness, which is graded according to degree of symptoms, conjunctival injection and staining, corneal damage, tear quality, and lid involvement.

Drugs often prescribed for Sjogren’s patients include;

1. Immunosuppressive drugs- e.g. Plaquenil, methotrexate – these drugs often have side effects that affect vital body organs such as liver, kidney, retina, and more.
2.  Dry mouth  –  drugs such Salagen, Evoxac to stimulate salivary gland function.
3.  Dry Eye- traditional modalities include eye drops, eye gels, and prescription eye drop.  Often dry eye symptoms persists.  Learn more about TheraLife Autoimmune Dry Eye formula below.
4.  Dental care is important as those affected are prone to cavities.

Conclusion

Sjogrens can damage vital organs of the body with symptoms that may remain stable, worsen, or go into remission. Some people may experience only the mild symptoms of dry eyes and mouth, while others go through cycles of good health followed by severe disease. Many patients are able to treat problems symptomatically. Others are forced to cope with blurred vision, constant eye discomfort, recurrent mouth infections, swollen parotid glands, hoarseness, and difficulty in swallowing and eating. Debilitating fatigue and joint pain can seriously impair quality of life.

Abstract from Optometric Management- May, 2011

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How does TheraLife Autoimmune Formula Work?
  • Intracelluar stimulation of tear and salivary glands
  • Regulate immune system to reduce flares
What is in TheraLife Autoimmune Formula?
  • Immunomodulators - to help modulate and normalize the immune system
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Learn more
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REFERENCES
1. Phelan D. Sjögren syndrome. 2009. http://emedicine.medscape.com/article/809290-overview.
2. Sommers MS, Johnson SA, Beery TA. Diseases and Disorders: A Nursing Therapeutics Manual. Philadelphia,PA: F.A. Davis; 2007.
3. Yanoff M, Duker JS, eds. Ophthalmology, 3rd ed. Elsevier, 2009.
4. Invernizzi P, Battezzati PM, Crosignani A, et al. Antibody to carbonic anhydrase II is present in primary biliary cirrhosis (PBC) irrespective of antimitochondrial antibody status. Clin Exp Immunol. Dec 1998; 114(3):448-54.
5. D'Arbonneau F, Ansart S, Le Berre R, et al. Thyroid dysfunction in primary Sjögren's syndrome: a long-term follow-up study. Arthritis Rheum. Dec 15 2003;49(6):804-9.
6. National Institute of Neurological Disorders and Stroke (NINDS) http://www.ninds.nih.gov/disorders/sjogrens/sjogrens.htm. Accessed May 10, 2010.
7. Fox R, Michelson P, Wallace DJ. Sjögren syndrome. In: Wallace DJ, Hahn BH, eds. Dubois’ Lupus Erythematosus. 7th ed. Philadelphia, PA: Wolters Kluwer/Lippincott Williams & Wilkins; 2007.
8. Sjögren’s Syndrome Foundation. http://www.sjogrens.org.
9. Daniels TE. Labial salivary gland biopsy in Sjögren's syndrome. Assessment as a diagnostic criterion in 362 suspected cases. Arthritis Rheum. Feb 1984; 27(2):147-56.
10. Tabbara K, Wagoner MD: Diagnosis and management of dry eye syndrome. In New Drugs in Ophthalmology. Edited by Smolin G. Boston: Little, Brown and Company. Cited in: Ophthalmol Clin 1996, 36:61–75.
11. Management and therapy of dry eye disease: report of the Management and Therapy Subcommittee of the International Dry Eye Workshop (2007). Ocul Surf. Apr 2007;5(2):163-78.
12. Behrens A, Doyle JJ, Stern L, Chuck RS, McDonnell PJ, Azar DT, et al. Dysfunctional tear syndrome: a Delphi approach to treatment recommendations. Cornea. Sep 2006;25(8):900-907.
13. Kruszka P, O’Brian RJ. Diagnosis and management of Sjögren syndrome. Am Fam Physician. 2009; 79(6):465-470.
14. Wallace DJ. The Lupus Book: A Guide for Patients and Their Families. New York, NY: Oxford UniversityPress; 2008. 
 15. Pullen, RL, Hall DA. Sjogren syndrome: More than dry eyes. Nursing. 2010; 40(8): 36-41.

1 comment:

  1. Learn what you should know before going to your eye doctor's office. Learn from TheraLife. Call us tolll free 1-877-917-1989. US/Canada, International (650) 949-6080

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