diflucan mechanism of action

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.

Steroids and Diabetes

Q:  I am 66 yars, old, was diagnosed in 2010 with Sjogrens after 40 years of these symptoms. I am on Plaquenil 200 mg twice a day, and 10 mg Prednisone, since April of this year. I am having recurrent flares that increase my Prednisone to 20 mg, which makes me feel normal again. What are the chances of developing Diabetes on the repeated increases of the Prednisone? A:  Probably depends on presence of other risk factors...for example, does Diabetes run in the genetic family....is weight greater than "ideal".....type of diet/exercise. Chronic use of steroids can be a risk factor for development of Diabetes, but there are clues it may happen that can be followed ie...blood glucose and HbA1c. dr c  Read More →

? Any Medications that Slow Progression of Sjogrens?

Q:  Early diagnosis has been said the be important. Are there any medications that slow the progression of the disease? Thank you for your answer A:  GREAT Question. No published studies designed to answer that. There is some data in SLE (Lupus) that Plaquenil (Hydroxychloroquine) lessens flares and associated with milder flare, if they occur. As targeted therapies become available, these type of questions can be asked and data collected....IF such studies can be Funded..... dr c  Read More →

Transverse Myelitis and Sjogrens

Q:  I have a definitive diagnosis of TM (they're pretty obvious via MRI) but it's cause has yet to be pinpointed. My concern is the possibility that Sjogrens as a cause was missed partially to my ignorance and partially to symptoms not being blatantly present at that time. My ANA pos, SSA pos, SSB neg, NMO's neg. lately my eyes have been bothering me but optometrist says allergies but the steroid drops aren't helping and I go thru massive amounts of artifial tears. Would that technically classify as dry eyes?the back of my mouth and throat feel dry but have lots of saliva in the front, is that what dry mouth can feel like? My body aches like the flu, i keep getting massive headaches, and the fatigue is horrible. Should I push my new neurologist to start looking for a cause again, and possibly try to see a rheumatologist? A:  Transverse Myelitis (TM) can occur in Sjogren's (http://www.ncbi.nlm.nih.gov/pubmed/24913964). Frequent use of artificial tears during the day suggests Dry Eye. Dry... Read More →

Consider Autoimmune Thyroid

Q:  I have had dry eyes off and on since I started wearing contacts 35 years ago--rarely though are they "gritty". But recently, with menopause I have noticed I have to have water at my bed because my mouth is so dry. And then just this week, I had a weird super dry tongue. Seemed like my salivary glands were working though.... I also had chills, no fever, and have always had cold hands/feet. The super dry tongue went away in a day, but my mouth still feels a tiny bit parched. I do not have lupus and my ANA was negative. I have not had SS tests though. Oh yeah, I've been losing weight without trying and my heart rate seems to go back and forth between 60 and 100 bpm... Does this sound like I need to have the tests? thank you! A: Fits more with thyroid. Other causes for weight loss and fast heart beat (tachycardia) need to be excluded first. dr c   Follow-up:   thank you. My thyroid test about a month ago was fine.... low T3. Could thyroid change that fast? Also my dry mouth has not... Read More →

Immune Deficiency and Recurrent Sinus Infections

Q:  I recently went to UCSF and Ava Wu recommended that I read your blog. I have found the information informative. My question that I would like your feedback on is if there are benefits of taking subcutaneous IgG therapy shots if you have SS. I understand this is to boost the immune system. My allergist has recommended this base on my recent Ig blood test panel. I often get sick, usually sinus infections and already have had 3 sinus surgeries. I understand that SS is an immune system issue where the body mistakes the moister producing glands as foreign and attacks them. I'm currently taking plaquenil and sulfasalazine. Is boosting the immune system a good idea for someone that has an immune system that doesn't function properly? A:  If an immune deficiency is leading to increase frequency of infections, and low levels of immunoglobulins (Humoral Immunity) are present, then treatment with "IgG therapy shots" or by infusions can lead to less infections. In this setting it does not result... Read More →

Could Neuropathy cause symptoms of Sjogrens?

Q:  Differential Diagnosis? Dr C , I have many of the classic symptoms ; swollen parotids, reduced saliva and tears, fatigue. I also have some nuero symptoms; pins and needles in arms , burning and cold sensations, inability to sweat. ENT referred me to a rheumatologist to be assessed for Sjögren's. A full panel of blood work was done and everything was in normal range. I went to a major university med center for a lip biopsy and it is negative with no signs of inflammation. All my symptoms are screaming Sjögren's, but no evidence of an autoimmune disease. My Q is could the nueropthy cause the symptoms of Sjögren's rather than Sjögren's causing nueropthy? A:  I think the answer could be yes. The inability to sweat and fatigue could be signs of Autonomic Neuropathy. The pins and needle sensation (paresthesia) could suggest Small Fiber Neuropathy. Nerves are involved in the salivary glands secretion...http://en.wikipedia.org/wiki/Salivary_gland A Neurologist could connect these dots. dr... Read More →

Ideas....SSB Antibody

Q:  Hello, I have just recently undergone a battery of tests to try to ascertain what is going on with me. I am a 48 year old female with a family history of auto immune disease ( sister has MS; Aunt had vasculitis; Mother has an undiagnosed AI disease with very high ANA levels). My symptoms include joint pain in hands and feet, excessively in the morning upon waking, have had migraines for the last 10 years at least 3x week (almost always upon waking or early hours of the morning), intermittent bilateral lower back pain and left mid back pain. Lab test results showed a sed rate of 69, normal c reactive protein, normal rheumatoid factor, positive SSB. Serum protein electrophoresis was normal. Rheumatologist thinks I may have emerging Sjogrens? I do have a fissured tongue as well, but have not noted severely dry mouth or eyes, just some slight irritation as if there is something in my right eye sometimes. I am nearsighted and my prescription gets stronger each year, which my optometrist... Read More →

Positive Salivary Gland Bx...Negative SSA/SSB in Sjs

Q:  Hello, Dr, Carteron. I am a 55 year old female, recently diagnosed with Sjogren's, The diagnosis came not from blood work, but from a lip biopsy. And this is exactly what I have a question about: how common is it to have negative blood work and a positive lip biopsy? Is it possible to have a false positive Sjogrens diagnosis based on a lip biopsy alone? A:  Don't think there is enough good data to really answer the Q, and diagnosis of a single patient requires more info...for example are dry eyes or mouth present or arthritis, renal tubular acidosis (kidney), neuropathy etc. SO, a positive biopsy (focus score >= 1.0) is suggestive of Sjogrens, but BY itself is not diagnostic. Positive biopsy and negative SSA/B may be more common in Sjogrens with neuropathy (nerve) involvement. Below are current criteria used for diagnosis to enter a Clinical Trial.  In the real world of 1 patient, they are not designed to definitely rule in/or out a best-fit clinical diagnosis.... 2002  Modified... Read More →

Tests for Pulmonary Sjogrens

Q:  Hi Dr. Carteron I was diagnosed with sjogrens a few months ago. I had severe burning in my chest resolved with cymbalta. I still have costochondritis but less painful since plaquenil. I just had pfts and now have to be on steroid puffers for asthma.  My question is my x-ray was clear but would a ct scan show early stages of interstitial lung disease before it shows problems with diffusion capacity in the pfts? A: Pulmonary Function Tests with DLCO (diffusing capacity) does not involve radiation. A high resolution CT scan, which is the most sensitive measure of interstitial lung disease, involves alot of radiation. Most Pulmonary/Interstitial Lung Clinics will recommend both initially. I am not sure there is good data in Sjogren's to guide what are the most appropriate, safest, and most cos-effective tests for Pulmonary Sjogren's. Studies have shown as many as 40% of Primary Sjogren's patient's will have abnormalities on Chest CT, but most of those will not have clinically significant... Read More →

Early Detection

Q:  You say that early detection is best. Why? How does it help the patient? What is the best course of initial treatment for someone newly diagnosed who primarily has mild dryness and some vague joint pain? Thank you very much for your time! A:  Early detection/diagnoses helps the individual understand Why they are experiencing certain symptoms, and thus if anything can or should be done to improve the symptoms and/or prevent progression (possible damage). For mild dryness, it may be discussing with their eye care professional and/or dentist if any treatment or preventative measures are recommended. For vague joint pain, it may be discussing with their primary care provider or rheumatologist if there are any signs of inflammation or possibly rheumatoid arthritis. In my experience, most people are reassured with understanding their symptoms, but of course... not all. For someone with Sjogren's and mild dryness and joint pain, the best first step is reviewing diet, exercise, stress, and... Read More →

  • Brought to you by the authors of "A Body Out Of Balance". Sjögrens Forum features blog posts by Ruth Fremes and Dr. Nancy Carteron. You can also ask Dr. Carteron questions about living with and your treatment of Sjögrens.

    Buy Now