Sjogren's Can Damage Many Organs, Not Just Eyes

While some of the symptoms of Sjogren's syndrome (such as dryness, grittiness, blurred vision and chronic discomfort and pain) may be most obvious in the eyes, the autoimmune disorder can affect organs throughout the body and has been linked to a host of other serious medical problems.

In Sjogren's (pronounced "show-grins"), immune cells attack the cells that produce tears and saliva. Once those cells are destroyed, the tear and salivary glands can't secrete fluid normally because they become infiltrated with lymphocytes (a type of white blood cell). Sjogren's typically occurs in middle-aged women, but has been diagnosed in women of all ages and in men as well. It is difficult to diagnose and there is no cure.

"Sjogren's syndrome is a systemic disease that has many manifestations," said E. Lee Stock, MD, Medical College Professor of Ophthalmology, who practices at the The Eye Institute of the Medical College of Wisconsin and Froedtert Hospital. Sjogren's syndrome is recognized as an autoimmune disease - in which the body mistakenly attacks its own tissue - but the causes of autoimmune disorders are not understood.

"I see quite a few Sjogren's patients here. We try to separate out patients who have isolated dry eyes and patients who have dry eyes related to Sjogren's," explained Dr. Stock. "The problem with Sjogren's is that because it has so many different manifestations it's sometimes not all put together. The patient may have dry eyes and also have a lot of other symptoms, but only the eyes will be looked at. Or they may have dry mouth, but only the dentist will see it."

Patients with dry eyes secondary to Sjogren's need a slightly different approach, since systemic medication for arthritis or other inflammation can alter the signs and symptoms of dry eye.

Painful Symptoms Include Dry Mouth
Dry mouth is another "classic" symptom of Sjogren's syndrome, which can also cause skin, nose, and vaginal dryness and affect the brain. Sjogren's symptoms may develop slowly over several years and in that time other complications often arise. According to the National Institutes of Health, about half of people with Sjogren's go on to develop rheumatoid arthritis, lupus, or lung and kidney problems within five to ten years after diagnosis.

Sjogren's symptoms can be highly irritating and painful. Patients may experience increased sensitivity to light and itching, burning, and redness in the eyes. Dry mouth can increase the incidence of sores and dental cavities, affect taste, and make swallowing dry food difficult. Over-the-counter preparations to enhance eye moisture are available and drinking plenty of fluids provides temporary relief for some symptoms, but these are not cures and do not help with the major systemic problems.

"From my point of view the important thing first of all is to see if they have Sjogren's and then to make sure that they're managed systemically, not just their eyes," said Dr. Stock.

Diagnosis Is Complicated
Dr. Stock noted that there is no single diagnostic test for Sjogren's syndrome. Physicians must rely on their ability to diagnose clinically, based on what can be a complex array of symptoms and medical history information gleaned from each patient.

"It's not simple because of all the manifestations," said Dr. Stock. "For instance, all my patients are asked if they have arthritis or if they have anything dry: dry eyes, dry mouth, dry throat, or vaginal dryness. Sjogren's is first a clinical diagnosis, but there are certain autoimmune antibodies, called SSA and SSB, which may be helpful in diagnosing Sjogren's.

"There have been new developments in treatment recently. For instance, for the eye we have a drug called Restasis (cyclosporin) that potentially can have a basic effect on the chain of inflammation and dryness. In addition it may protect the lacrimal gland. That's a new treatment that's only been out for a few years." Froedtert & The Medical College and the Eye Institute may soon be involved in studies of new artificial tears, said Dr. Stock.

According to the National Institutes of Health, moisture replacement therapies may ease the symptoms of dryness, non-steroidal anti-inflammatory drugs may be used to treat musculoskeletal symptoms, and for individuals with severe complications, corticosteroids or immunosuppressive drugs may be prescribed. But until more is learned about autoimmune disease - the root cause - treatment for Sjogren's syndrome will remain generally symptomatic and supportive.

Dan Ullrich
HealthLink Contributing Writer

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.