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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.

NMO Neuromyelitis Optica

Q:  Hi I been having NMO for 3yrs an within the past week my eyes have been very dry that they hurt nothing is working at all when I go to sleep an wake up my eyes are crusted together what does this mean A:  NMO (Neuromyelitis Optica, Devic's disease) is a demyelinating disease of the CNS (central nervous system) associated with an autoantibody, Aquaporin 4 Ab. It affects the spinal cord (can cause Transverse Myelitis) and Optic nerve. It may be associated with other autoimmune diseases, like Sjogren's. Would discuss your new symptom with your Neurologist and Ophthalmologist. They may want to refer you to a Rheumatologist for further evaluation. Reference for NMO and Sjogren's: http://www.ncbi.nlm.nih.gov/pubmed/22568275 dr c  Read More →

Relapsing Polychondritis and Sjogren's

Q:  Hello, My wife has Sjogren's disease with soft tissue and cartalige involvement. We suspect but hope that she does not have relapsing polychondritis. Do you know of any one or center that specializes in this complicated type of auto immune syptoms? Thank you so much! A: Most major academic university medical centers will have some form of Specialty Clinic that would be a good starting point, depending on where you live. Most of them will be within the Rheumatology - Immunology division of the Department of Medicine. One Clinic where they are also doing basic immunology research on the cause of RPC (relapsing polychondritis) is at Virgina Mason Medical Center in Seattle WA. https://www.benaroyaresearch.org/our-research/research-programs/translational-research-program/relapsing-polycondritis/relapsing-polycondritis-clinic dr c    Read More →

"Idiopathic Sicca"

Q:  Hi Dr Carteron, A diagnosis question: I am a young female in UK. No health complaints whatsoever till this: 1 year: - Blepharitis + dry eyes 2 months: - dry mouth (night waking, trouble speaking + eating) - hoarse voice and hard to speak - regular heartburn - persistent swollen, sore lymph nodes in neck and armpits - moderate daily joint pain (knees only) - thrush - interrupted sleep, tired + feel unwell Visited Sjogren's specialist. All blood tests negative, C3 ever so slightly low. Neg for HIV, Hep C, liver function and thyroid function and antibodies fine, no indication of sarcoidosis on bloods. Didn't do salivary flow test or schirmers. We don't have access to new 'Sjo' test here. A salivary ultrasound showed swollen lymphs and slightly small parotids but nothing else unusual. Specialist felt it was thus unlikely to be sjogrens and recommended against lip biopsy. Diagnosed idiopathic sicca. Advised to treat with gum etc. Not given any indication I should be followed or return for... Read More →

Could I Have Sjogren's?

Q:  I have had swollen salivary gland under my tongue on right side of throat on and off for a few years and then constant dry uncomfortable throat on right side for the next three years. My eyes feel dry often. swallowing food is a little hard at times. I have abdominal pain on right side and frequent constipation. this past year I had my lips peel and crack and my eyelids get really strange and dry. I have had my right lung feel like asthma and lots of acid reflux. Could this be sjogrens because the Dr just keeps sending me to different specialists and they never find much. A:  Decrease in exocrine gland secretion/function can lead to dry eye, dry mouth, trouble swallowing from dryness, constipation, non-productive cough (dry upper respiratory tract), dry skin, vaginal dryness. So yes, it is possible. Chronic viral processes could also result in similar symptoms. If lab tests (SSA/SSB or ANA/RF) are negative, then currently the diagnosis of Sjogren's would only be definite, if a lip... Read More →

Newly Diagnosed with Sjogren's...Road Map

Q:  I have been recently diagnosed with Sjogren's and have been suffering with severe symptoms of dry mouth and sialadenitis, etc.. I have an appointment at UCSF sjogren clinic in a few weeks. I don't have a treatment plan and am struggling with "putting out the fire" of symptoms right now. I need direction and follow up on my submandiblar gland. I do not have an ENT. Any guidance or help is appreciated. Diet and eye drops are not enough. A:  A good place to start is the Sjogren's Syndrome Foundation (SSF ) www.sjogrens.org Many resources are available including a DVD, Product Resource Booklet, Support Group contact info ... to name a few. There are a growing number of on-line resources and communities available to explore, such as http://www.reasonablywell-julia.blogspot.com    This is a Blog and Resources provided by an RN who herself has been on the journey. Putting together a team of medical guides depends on what specifically one needs at a given time in the journey of discovery.... Read More →

Diagnosing Sjs NOT Always Straightforward

Q:  I am a 61 year old female, 5’5”, 135 lbs. (nurse practitioner), who has seen my internist and various specialists over the past couple of years for a variety of symptoms that I am now wondering could be indicative of Sjogren’s. Although my ANA (IFA) and C-reactive protein were both negative in July 2014, I would like your professional opinion as to whether further evaluation for Sjogren's should occur. I have not been referred to a rheumatologist and have not had Anti-SS-A and Anti-SS-B labs ordered. My symptoms and significant medical history include: Periodic severe flaring of pain and aching in joints throughout body, particularly in the small joints of hands and feet. I am currently experiencing a flare up, which also results in fatigue. In July 2014, I noticed bilateral swelling of parotid glands, more pronounced in right parotid. This past Fri., Nov. 21, I underwent a right parotid gland ultrasound-guided needle biopsy and do not yet know results.) Heartburn and reflux... Read More →

"Sjogren's Disease" OR Not ???

Q:  Hi, Several years ago, I was diagnosed with Sjogren's Disease, although I have not developed any of the normal symptoms. At the time, I was tested, I had a chest congestion and a lump in my throat, as well as insomnia, which is the only symptom that remains to this day. I am thinking maybe I do not have Sjogren's disease but some other type of autoimmune disease. Have you heard of anyone testing positive for Sjogren's but actually it was a different autoimmune disease? Thanks A:  Important to know how the diagnosis was made to weight in. The grouping of chest congestion, throat lump and insomnia with out dryness signs or symptoms or neuropathy symptoms would be very unusual for Primary Sjogren's. However, if SSA and/or SSB or perhaps ANA AND Rheumatoid Factor were positive and there was a biopsy of the lower lip or lung or the lump that showed focal lymphocytic infiltrates (that were not abnormal lymphocytes i.e. lymphoma)....then a diagnosis of Sjogren's would be a possibility. However,... Read More →

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 →

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