diflucan mechanism of action

Symptoms other than dry eye and mouth

Q: I was diagnosed with Sjogren's Syndrome over a year ago when I went to my GP
with severe fatigue, muscle weakness, gi issues, and costochondritis. I had no
dryness issues to speak of but my test results came back with positive ANA and
SS-B.  I've had very little success in feeling better after 6months on
Plaquenil.  I feel better during Medrol tapers though.
My questions are: Are many people diagnosed with Sjogren's despite having not
having issues with dryness?  How closely related are Sjs and Lupus symptoms?
Being that long term steroid use is out of the question, is there anything that
may help me more than Plaquenil?

A: It is more challenging to diagnosis Sjogrens if dryness symptoms are not present. Many health care providers may not think of Sjs when patients do not have dry eyes or mouth.  But up to 40% of patients ultimately diagnosed with Sjs do NOT have dryness at presentation of their AI process.

Distinguishing between Sjogrens and Lupus in early stages may be challenging, and many will have Lupus as primary with Sjogrens as secondary. Autoimmunity can occur on a spectrum-so what is really important is defining what is abnormal now and tayloring treatment to that. It is like a book with many chapters, the story usually changes over time.  The chostochondritis is more often seen in Lupus. It did not sound like you had recurrent oral/nasal/scalp ulcers or Raynauds or phopholipid antibody symdrome - so I would not be highly suspicious of SLE at this time.

Although, many physicians may be reluctant to increase the Plaguenil dose above 400mg/d, in my experience this can be done . Sometimes, increasing to 600-800mg per day for 1-2 months can decrease a flare, after which the maintenance dose can be decreased. It is very important that you follow up closely with your eye doctor during this time.

Since you respond to steroids (Medrol), your doctor could consider a trial of a DMARD (disease modifying anti-rheumatic agent). This could give you the benefit of steroids without their side effects. But you have to accept the risk/benefit of the new medication.  Examples used are: Imuran (azathioprine); CellCept (myclophenolate mofitil); Methotrexate.

With GI symptoms you want to know that you do NOT have Celiac or Inflammatory Bowel Disease or severe Motility Disorder-as these can be treated and may improve some of the other AI/Sjs symptoms.

dr c

Printed from: http://www.sjogrensforum.com/ask-the-doctor/symptoms-other-than-dry-eye-and-mouth/ .
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3 Comments   »

  • Christina says:

    Thank you Dr. Nancy Carteron...your answers to all these questions about Sjogren's are an answer to prayer!! I will send you my questions soon as I am having difficulty obtaining a diagnosis even though having some serious neurologic symptoms because don't have access to the right doctors....have had huge list of tests...thank you again!

  • prim allen says:

    It's a great help to find others having similar problems. I have strong Crest ANA but not the symptoms.I have all the Sjogren probs everything so Dry ,eyes mouth tongue lips dreadful.Voice changes Shingles glands under chin -just goes on and on. Plaquenil is helping and lots of vitamins B D etc Any other thoughts? Thank you Prim

  • Barrie Eitelberg says:

    Hi Dr. Carteron,

    I was diagnosed with Sjogren's back in 2004. I was 43 years old at the time. Now 12 years later, each day is a struggle. Most recently, I've had problems with my feet. They become so swollen I literally can't put my shoes on. I have such excruciating pain and nothing seems to help. My ankles swell as well. In addition, my arms are so weak I can barely lift them over my head. I know this is Sjogren's at it's best, but I was wondering if you can suggest something?? I know that you generally have to see the patient before making any suggestions. Still, perhaps you can shed some light as to what the problem might be. Why am I having such problems with my feet?

    Thank you.

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