10 Signs of Sjogren’s Syndrome – a very complex autoimmune disease

10 signs of Sjogren’s Syndrome Sjogren’s Syndrome is one of the most common  diseases in my practice, Rheumatologist Oncall.   So, today I decided to give you  all the information you need   to understand this disease better. In this video, we will discuss the most common 10   manifestations of Sjogren’s Syndrome. Let’s begin! Hi, I’m Dr. Diana Girnita, a board-certified  rheumatologist and the Founder of Rheumatologist   OnCall. If you are new here, welcome to  my Youtube channel, where I educate people   about rheumatoid arthritis, and autoimmune  diseases, like Sjogren’s Syndrome. So,   don’t forget to subscribe and never miss  one of my videos. If you’ve been following   this channel for a while, I am excited to have  you back and share more information with you! Sjogren syndrome is a rare disorder affecting  about 1.0% of the population. Between   400,000 and 3.1 million adults have Sjögren’s  Syndrome. Females are more affected than males,   and many patients with rheumatoid arthritis  can also have symptoms of Sjogren.   Dryness. The most common   symptom of patients suffering from SS is  dryness of the eyes and mouth. Patients   mostly describe dryness of the eyes as itching,  irritation, grittiness, a foreign body sensation,   and blurry/change in vision. The lacrimal  glands’ secretion from your eyes will decrease   over the years, and you will start feeling  these changes that can become very upsetting.  Suppose you go to see an eye doctor. In  that case, they can quantify your lacrimal   gland secretion using a test called Schiermer  test, where they put a special type of paper   in your eyes that will tell your doctor  how much lacrimal secretion you have.
00:02:21
Dryness of the mouth is also common in patients  with Sjogren. Your saliva keeps your mouth healthy   and prevents the onset of cavities.  When your saliva secretion decreases,   you may experience frequent tooth  decay, and multiple cavities.  You may also experience difficulty  eating and swallowing dry food,   such as crackers, without drinking liquids. You may need to drink frequent sips of water   to be able to talk. You may have changes  in your taste due to a lack of saliva.  Some patients can have frequent  episodes of parotiditis.  Dryness can affect your skin  and can cause itchiness. Rarely,   the skin can develop a more complicated  disease called small vessel vasculitis. Some females will describe  vaginal dryness, irritations,   pain with sexual intercourse, and itchiness,  which can dramatically affect their sex life.   Joint and muscle pain.  Patients with Sjogren frequently complain of joint  and muscle pain. The joints can hurt without being   swollen. Usually, the pain is symmetric, and it  may come and go. Unlike Rheumatoid arthritis,   Sjogren’s arthritis is not deforming the joints. The hands, wrists, and knees are usually affected.  About 40% of patients can have a  rheumatoid factor test positive,   especially in patients with joint pain. More rarely, patients could have positive anti-CCP   antibodies, these are antibodies frequently  seen in patients with Rheumatoid arthritis,   and these patients could have more aggressive  disease and even develop erosions in their joints.
00:04:35
As I mentioned, muscle pain is also frequently  seen and could cause weakness in the arms or legs.   It is essential to fully evaluate the weakness as  this could also indicate inflammatory myositis, an   autoimmune disease of the muscles. Lung Disease  About 20% of patients with Sjogren disease can  have their lungs affected. Patients can develop   upper respiratory infections, like sinusitis  or present with a dry, irritating cough.   The cough could be due to severe dryness of the  airways, mucus plugs or reflux from the stomach.   Sometimes, the patients can see  changes in their voices and hoarseness.  In some cases, along with dry cough,  patients will present to the doctor   due to severe shortness of breath that we call  dyspnea. The shortness of breath can initially   affect you after walking a short distance,  going up a flair of stairs, or even resting.  Pulmonary function tests and a high-resolution  CT scan are indicated in these cases.  The CT can identify if you have lung fibrosis  or interstitial lung disease. Some patients   will present with shortness of breath and cough,  before developing dryness of the eyes and mouth.  In these cases, the pulmonologist that  found the lung fibrosis might decide to   test you for autoimmune diseases like Sjogren or  Rheumatoid arthritis, to name a few possibilities. Neurologic manifestations Many neurologic manifestations may   occur in Sjogren patients, including peripheral  and central nervous system abnormalities.  From frequent headaches, paresthesias or tingling  in the hands and feet, even tingling in the   face or other parts of the body, to complicated  neurological diseases like transverse myelitis   and optic neuritis, or  inflammation of the optic nerve.  Some patients can even present with  symptoms that look like multiple sclerosis.  Rarely patients with Sjogren can present with  brain inflammation that we call encephalitis. Heart disease Yes, Sjogren can affect your heart.   Chronic ongoing inflammation can  increase your cardiovascular risk.   What does it mean? Heart attacks, fluid around  your heart, arrhythmias like heart blocks,   strokes, hypertension, and thrombosis  can be seen in patients with Sjogren. Gastrointestinal tract Patients with Sjogren can   have difficulties swallowing due to  decreased saliva and develop nausea,   abdominal pain, and gastritis. Liver  function changes, and sometimes PBC   or autoimmune hepatitis can sometimes happen. Celiac disease is seen in patients with Sjogren.  KIDNEY Bladder dysfunction,   interstitial nephritis and kidney dysfunction,  leading to acidosis, are seen in patients   suffering from Sjogren. Patients develop  an increased frequency of urinating, or   they will have to urinate at  night, affecting their sleep.  These symptoms can be confusing as patients  often think they have a urinary infection.   Still, their urinary tests do not show that. I had a patient that initially developed   kidney problems about five years before  developing dryness of the eyes and mouth. Depression, fatigue and Fibromyalgia  Fatigue is a debilitating symptom and  can lead to depression as patients can’t   understand why they can’t complete their daily  activities and can’t participate in the normal   activities of their families. Depression is most  likely a response to the stress of the disease,   and some researchers believe this is a consequence  of the inflammation affecting the brain.  Hematologic manifestations Patients with Sjogren can develop anemia,   low white blood cells, elevated Gammaglobulins,  cryoglobulinemia, and increased lymphoma risk. Anemia is most likely induced by chronic  inflammation. Still, it may have other causes,   so it is crucial to have a complete  evaluation done by your rheumatologist.  The white blood cell counts can be low,   but most times does not increase  your risk of developing infections.  Elevated levels of IGG immunoglobulins are seen  in up to 60% of patients. In these patients, we   also see positive rheumatoid factors and positive  SSA and SSB antibodies. We will talk in another   lecture about the lab test we follow in Sjogren  patients. In patients with monoclonal gammopathy,   meaning that certain abnormal proteins are in the  blood, we need to carefully evaluate them as they   can be at increased risk of multiple myeloma and  lymphoma. These are two types of blood cancers.
00:11:15
Lymphoma -Patients with Sjogren Syndrome have an  increased risk of non-Hodgkin lymphoma compared   with the general population; the prevalence  of lymphoma increases with time: For example,   following diagnosis was 4 percent during the  first five years, 10 percent at 15 years,   and 18 percent at 20 years. So, if you notice changes   in your skin, enlarged lymph nodes, or salivary  gland enlargement, call your doctor immediately.  As a rheumatologist, I educate  my patients extensively about   these changes and follow their labs regularly. If you want to learn more about Sjogren and other   autoimmune diseases, please watch my channel, as  I will continue to share my knowledge with you.  Remember, these videos are just for educational  purposes and are not supposed to offer you a   diagnosis or medical evaluation. If you like  the educational content of these videos,   don’t forget to like, share, subscribe  and press the notification button.  Please leave your comments and questions  below, as I would be happy to help you!  Thank you and I will see you soon with  another educational lecture!