LUPUS: A Guide for Nurses
Henrik Sjögren was a Swedish ophthalmologist who described the dry eyes and dry mouth that people with lupus and other forms of arthritis sometimes experience. For many people with lupus this is one of the most annoying features of the condition, all the more so because it is often not obvious to those around. The condition is caused by inflammation of the salivary and tear glands, which then fail to produce as much saliva and as many tears as before.
There are two sorts of Sjögren's syndrome, primary and secondary. Secondary means that the syndrome is present in someone with another condition, such as lupus or rheumatoid arthritis. Primary means the features of Sjögren's syndrome predominate and there may be inflammation in other areas, such as the joints.
Yes - a recent study has suggested that as many as 1 in 30 people may suffer with the symptoms.
Generally, no. Sjögren's syndrome is more of a nuisance than anything else. However, sometimes quite powerful treatments are necessary if the symptoms are severe or complicated.
Often the first sign is grittiness and some redness. There may also be some blurring of vision, which can be worrying, but settles once the eyes are moistened by blinking or adding eye drops.
A dry mouth is common. Because saliva also protects against tooth decay the first sign can be more fillings. Sometimes the salivary glands can become swollen and painful. Lack of saliva can also lead to difficulty in swallowing, difficulty with dentures and candida (thrush) in the mouth. Rarely, the salivary glands may swell up.
Occasionally the vagina may also be dry, sometimes leading to thrush and discomfort on intercourse.
There are a number of ways of telling whether the mouth and eyes are dry. For the eyes the simplest is to put a piece of blotting paper to the eye and watch how wet it gets - this is called Shirmer's test. Ophthalmologists can also tell if the eyes are dry by looking with a special lamp and giving eye drops. For the mouth a close look is usually enough, though very occasionally a biopsy of one of the small salivary glands in the lip (under local anaesthetic) is suggested. Blood tests can also be helpful, because certain autoantibodies (proteins reacting against the body's own tissues) called Ro and La may be present.
Unfortunately there is no quick cure for Sjögren's syndrome, although often the condition will settle as the lupus or other condition is treated. However, simple things can be done to relieve the symptoms.
Artificial tears and eye gels can help here. Sometimes the tear ducts can be blocked with tiny tubes, which helps to hold more tears in the eyes.
Regular mouthwashes and very good mouth hygiene are effective ways of keeping symptoms at bay. Chewing sugar-free gum can help stimulate saliva. Recently researchers have found that rinsing the salivary glands out with a steroid solution may help - this is still experimental.