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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.

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 →

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 →

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