A potential cause of dry mouth, dry skin and dry eyes
This is a continuation of last week’s article on Sjögren syndrome in which I discussed its causes and symptoms. Sjögren syndrome is an autoimmune condition linked to other rheumatic conditions like rheumatoid arthritis. Main symptoms are dry eyes and dry mouth and enlargement of the parotid glands (salivary gland located in the cheeks just in front of the ears). Fatigue and joint and muscle pains are other debilitating features in many who have the condition.
There is no specific cure for Sjögren syndrome; the aim of treatment is to control symptoms. The person must be referred to a rheumatologist for assessment and diagnosis. An ophthalmologist is often involved in the treatment of the eye problems. Blood tests are required to confirm diagnosis. Alcohol and smoking should be avoided, and thorough oral hygiene is essential. Environmental irritants such as smoke, wind, air conditioning, and low humidity may exacerbate eye symptoms. Exercising as much as possible and a healthy balanced diet are important.
To relieve the dry eyes, artificial tears are effective and should be used regularly. They come in drop form and gel form (gel form has a longer lasting effect so is especially suitable before going to bed). There are many brands available over the counter from pharmacies; there is no evidence that one brand is any more effective than the next. Artificial tears are available on the Medical Card Scheme and the Drug Payment Scheme with doctor’s prescription.
To relieve dry mouth, drinking plenty of fluids helps keep the mouth moist. Artificial saliva comes in the form of mouth gels, mouthwashes and chewing gum; brands include BioXtra® and Biotene®. As well as moisturising, these brands of artificial saliva have enzymes that help stimulate the saliva glands. Xerostom® is a new oral hygiene line especially formulated for people suffering with dry mouth or xerostomia (ask in Whelehansfor more details). It is of particular benefit to diabetics and cancer patients or those with sjogren’s syndrome. Another option for dry mouth is pilocarpine tablets (prescription only); they are licensed for those that have some residual salivary function left.
Vaginal lubricants may be required. Infections such as vaginal candidiasis (thrush) are more likely.
Hydroxychloroquine (Plaquenil®) has be shown to useful in some studies to relieve and control joint and muscle pain, relieve fatigue and skin symptoms. Non-steroidal anti-inflammatory drugs such as ibuprofen can help relieve muscle and joint pain but must be used in moderation as they can cause side effects like stomach irritation and ulcer, raised blood pressure, kidney problems and must be used in caution with other conditions like asthma, heart disease and kidney disease. Mild corticosteroid cream such as hydrocortisone 1%cream used sparingly and occasionally may give some relief from the dry skin irritations
Treatment of complications
Sjögren's syndrome may progress to involve organs such as the kidneys, lungs, skin and lymph glands. Stronger anti-inflammatory medication may be required in these situations. These include:
Steroids: Tablets taken orally that reduce inflammation. They are usually limited to when symptoms are particularly bad as they can cause side effects if used long term (eg) prednisolone.
Immunosuppressants: these drugs suppress the abnormal antibody production that causes Sjögren's syndrome (ie) stops the body attacking itself. Examples include methotrexate, azathioprine, penicillamine and hydroxychloroquine. They are reserved for more severe cases as they can have side effects and are only commenced by specialist rheumatologists. Close monitoring with regular blood tests is required while taking them as they can cause blood disorders and can reduce the immune system. It is recommended that use of immunosuppressive agents is limited to cases where Sjögren's syndrome is affecting the major organs such as skin, lungs and kidneys. Hydroxychloroquine (Plaquenil®) tends to be used more frequently than other immunosuppressants but some studies suggest that evidence towards the benefits of hydroxychloroquine is lacking.
Some natural anti-inflammatory supplements have varying degrees of success for inflammatory conditions like Sjögren syndrome. Some may ease symptoms but will not cure them. Omega 3’s are natural anti-inflammatories and may give some relief. Omega 3 fatty acids are primarily found in oily fish such as salmon, fresh tuna, mackerel, herring, sardines and pilchards. We should eat two portions of fish per week, one of them oily. The most potent anti-inflammatory fish oil supplement is Lyprinol®. Lyprinol® from Whelehans is 200 to 300 times more potent than other fish oils and flax seed.
Co-enzyme Q10 is a vital enzyme and its main roll is to release energy. It may be beneficial to those with Sjögren syndrome. Whelehans own brand Co Enzyme Q10 is an affordable option and unlike many Co Enzyme Q10 supplements, it only needs to be taken once daily. Always check with your pharmacist or GP before trying supplements, natural or herbal medicines.
Prognosis is generally good. Sjögren syndrome is not usually life-threatening. Sometimes symptoms can disappear for long periods. Rarely, it can develop into more serious problems such as the kidney and lung conditions. About 1 in 100 people with Sjögren syndrome develop a form of cancer called lymphoma, most commonly non-Hodgkin's lymphoma. People with Sjögren's syndrome should pay close attention to any abnormal swelling in glands around the face or neck, under the arms or around the groin area as this can be a sign of lymphoma.
Upcoming talk on depression and mental health
Whelehans Pharmacy in conjunction with Aware have organised an expert panel to discuss depression and mental health on Thursday August 6th in the Greville Arms Hotel Mullingar; some leading local experts will be talking. This talk is free of charge and is open to all. Keep an eye on this column in the coming weeks for more details. To avoid disappointment, book your place in advance by calling Whelehans at 04493 34591.
For comprehensive and free health advice and information call in to Whelehans, log on to www.whelehans.ie or dial 04493 34591.