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Do I Have Sjögrens?

If your eyes feel gritty and you need to blink more than you used to, if you need more drinks of water through the day because your mouth feels like a desert, and/or your skin feels dry itchy, burning, cracked; if you feel a profound fatigue most of the time, it’s a possibility. You needn’t have all, or even most of these symptoms; One or more can lead your doctor to a diagnosis. The trouble is that in the early stages, the symptoms come and go and are often non-specific, until later when the disorder becomes acute. Some symptoms of Sjögrens are:

  • Dizziness
  • Tiredness
  • Generally ill with low-grade fever
  • Itching, gritty eyes
  • Difficulty swallowing
  • Loss of sense of taste
  • Severe dental cavities
  • Hoarseness
  • Joint pain or swelling
  • Swollen glands

In spite of the fact that Sjögrens (Sjs) is the cause of suffering for 4 to 5 million Americans, it is not on the tip of all Doctor’s tongues, If your doctor evades your questions and you think that Sjs could be the cause of your troubles, keep looking for a Doctor who has others like you in their practice. Then, the necessary tests to make an objective diagnosis can be performed.  Check out our Resources Page for a list of institutions where you can get more information.  And remember, the earlier you have this checked out by your Doctor, the better.

Below, you can find some of the most recent questions answered by Dr. Carteron, you can find more by searching the menu on the far right. Questions and Answers are organized by topic, or you can ask Dr. Carteron a question by visiting this page.


Tender Carotid Artery (carotidynia) in Sjs ??

Q:  Thank you for your forum. I have Sjogren's Syndrome with chronic fatigue. At times when I have been dehydrated I have experienced carotidynia for weeks. I do not have a headache with this. I have been treated with solumedrol and Indocin. I do take plaquenil. Is carotidynia related to Sjogren's? Do you have any suggestions for relieving this inflammation since I have to lie down to get better blood flow to my brain. A:  Pain on the side of the neck with tenderness of the carotid artery is not commonly associated with Sjs. I have not encountered a Sjs pt with this, and a quick Pub Med search of the literature did not reveal a published reference. However, it could occur if there was inflammation in the blood vessel (vasculitis). If present, vasculitis may need to be treated with anti-inflammatory/immune modulators like Solumedrol. Vasculitis in Sjs usually affects the small/medium size vessels and the carotid artery is usually classified as a large artery, so again not a common association.... Read More →


Elevated Eye Pressure and Evoxac (Cevimeline)

Q:  I have been taking evoxac for many years to help alleviate my dry mouth symptoms. During the years the pressure in my eyes has slowly been rising. My opthalmologist prescribed ophthalmic drops to be used twice a day to control the pressure. I have recently read that a person should not take evoxac if she has glaucoma. I have not received a glaucoma diagnosis but I continue to have elevated pressure (around 19-21) and have a family history of glaucoma. Please describe the contraindications of having glaucoma and taking evoxac. A:  Evoxac (cevimeline-generic) is a cholinergic agonist (simulant) that binds the muscarinic receptor. It is contraindicated in glaucoma, as it may worsen the glaucoma quickly...I believe by increasing intraocular pressure and contraction of important tiny muscles in the eye..BUT..better to review that with your Opthalmologist. The drug has also been reported to cause eye pain (RARELY). Thus, in your case, I would review with your Opthalmologist and consider... Read More →


GI Manifestations in Sjogrens

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3150032/ Good Review of GI (gastrointestinal) manifestations in Sjs.   Thanks to Sjogrens Canada for bringing it forward.   dr c  Read More →


Severe Shoulder Pain "Flare"

Q:  Hi Dr. Carteron. I am one of your grateful patients. Recently my primary care doctor increased my T3 because I was at the bottom of the normal range. My blood level then went off the scale into hypertyroidism. This triggered the worse flare of my lifetime. The shoulder pain was a 10. Vicodin didn't work, Narco made me vomit,went to ER with a 114mg blood sodium. After 3 days on Morphine and infusions of sodium I went home still in painful acute flare. How would you have treated the shoulder pain besides increasing my doxycycline? The Hospitalist didn't address my Sjogren's. My Whole chest felt inflamed and caused shortness of breathe and painful to inhale. The flare lasted almost 8 weeks. 2 trips to ER before Hospitalized. Thank you so much for giving me an aimost normal life along with Dr. G's supplements. A:  If the shoulder pain was a flare-up of the inflammatory arthritis in the glenohumeral (shoulder) joint or the insertion of the rotator cuff tendons/ligaments, then options: Steroid... Read More →


Dry Mouth and Crestor ??

Q:  I was diagnosed with Sjogren's Syndrome 8 years ago. I am on Plaquenil and Evoxac. My dry mouth symptoms are severe lately, but I have not changed any medications. A friend sent me some information on Crestor and SS. I have taken Crestor for many years. Is there really a correlation to the dry mouth symptoms and Crestor? I have taken myself off Lunesta for sleeping issues because I thought that might be making my dryness worse. It took a few weeks to get off that. My sed rate is now up to 72. Could this be a cause of the Crestor? I am confused and really want to get some relief from the dry mouth issue. My eyes are doing quite well. I take extra Vitamin D and also Evening Primrose (after reading an NIH report on a study of Sjogren's patients and EP Oil. I have been taking it for 2 months and my eyes really are more comfortable. Now if I could just get my mouth to feel better ! I am getting anxious over it and I know that anxiety is not good for SS patients. Thanks ! A: Dry mouth was... Read More →


Pins/needles (Paresthesias) and Burning Sensations = Neuropathic Symptoms

Q:  Hi, I have sjorgens and all the usual symptons, last few days have had what Feels liike pins and needles cold/burning sensation on both legs and today started in my lower arms, my rheumatologist said it is not linked to Sjorgens and my Dr does not no what it is can you help? A:  Neuropathic symptoms can be a part of Sjs and other Autoimmune disorders.  However, they also can occur in many other settings for example after a viral infection. Most often they resolve or come and go over extended periods of time. SO most physicians will not start investigating the cause until they are more persistent or associated with weakness of the part of the body affected...suggesting motor neuropathy not just sensory neuropathy. A Neurologist would be more familiar with sorting through nerve pain than a Rheumatologist may, and many Rheumatologists are not yet aware of how common various neuropathies are in Sjs.   The SSF is developing Clinical Practice Guidelines to help increase awareness... Read More →


Sneezing

Q:  I just have gotten a diagnosis of Sjogrens, I can not stop sneezing! I have MCTD, also.The Sjogrens has been in a flare. had the sneezing before the Medication, so do not think it is related to that. I sometimes sneeze for hours at a time. My nose is very stuffy also. I hope this is not a stupid question! thank you. A:  Sneezing is primarily associated with allergic reactions to some environmental antigen, or part of the early stages of a viral upper respiratory infection. The dry nasal passages than can occur in some Sjs patient's can cause crusting and affect air flow. In my experience, sneezing is not a common complaint of Sjs pts. However, Allergies/Allergic responses seem to be more common in Sjogren's than in other autoimmune diseases, like SLE. An ENT/Allergist could help you understand what is happening if it persists. Antihistamine allergy medications can be drying and thus make Sjogren's dryness worse. dr c  Read More →


All those Symptoms...Again

Q:  I have an unspecified autoimmune sero-negative disease. I have been to 3 rheumatologists(had to change because of insurance) and several orthopedic specialists for individual joint issues.. I started Restasis in December and found nodules in what I remember as being my submandibular glands a few years back. I asked my dentist and Endocrinologist (I have thyroid nodules and parathyroid level of 104 with no parathyroid growth) about them but neither seemed concerned.With all of these issues plus dry mouth, dry skin, recent hair loss, constant joint pain, documented joint damage, and fatigue plus Meniere's, could I assume that Sjogren's is the primary issue or could it be a group of unrelated ones? I am taking amtriptyline for sleep and triamterine for the Meniere's. The opthalmalogist who prescribed restasis reviewed my medication list, in fact all the doctors are aware of the varying symptoms.I take plaquinil for the arthritis. As you can see I am dealing with a bunch of symptoms, none... Read More →


"Flitting" Joint Pain or Arthralgias

Q:  Hi Dr. Carteron, I have been struggling for some years to obtain a diagnosis for the collection of symptoms I have. Eventually finding details of Sjogren's I find the closest match so far. As one of my symptoms is "flitting" joint pain, my doctor has in the past ordered tests for rheumatoid arthritis but these have returned negative. My question is, does that negative result rule out Sjogren's too? Would you expect to see anything on such a test if I have Sjogren's? Kind regards A:  "Flitting" joint pain could be joint pain without obvious inflammation or synovitis. Arthralgia (joint pain) could involve the same joints with each episode or the joint pain could move around (migratory arthralgia). Joint pain can be a part of Sjogren's.  Series often report about 50% of Sjs pts having Arthralgias. One report below from Denmark, found 70% of pts had Arthralgias, with only 17% having Arthritis (itis=inflammation). So a negative RF (rheumatoid factor), negative CCPAb, and normal inflammatory... Read More →


Tearing Muscles in Sjs??? Enthesitis?

Q:  Hi Dr Carteron My doctors still haven't made a definitive diagnosis but believe all my symptoms point to Sjogrens and/or RA. I use to play a lot of tennis but over the last 2 years started to constantly tear muscles keeping me out of the game. About 6 months ago the my hand joints started swelling and aching, my eyes became so dry, painful and very sensitive to light. Followed by more joints being affected and constant fatigue. My question is could the muscle tears be caused by Sjogren's. Thanks for your time A:  If some of the same inflammation you are describing elsewhere was occurring at the site of muscle/ligament/tendon insertion on bone, it is plausible there is a relationship. Generally, muscle involvement with Sjogren's is a myalgia (muscle pain), and MUCH less commonly a low-grade myositis (muscle inflammation). However, since Sjs can overlap with alot of other autoimmune processes, the possibilities are larger, rather than smaller. Seems to be a small subset of Sjs patients... Read More →




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