Dry mouth, dry eyes, itchy skin. Could it be Sjogren’s syndrome?

Sjögren”s syndrome is also called Sicca Syndrome. It is an auto-immune disease. The body’s immune system normally protects us from bacterial and viral infections and other dangerous, threatening diseases such as cancer. At times the immune system attacks the body by mistake and we call this auto-immunity. In Sjögren’s’s syndrome, white blood cells called lymphocytes mistakenly attack the bodies saliva and tear glands. A minority of these patients also develop inflammation of blood vessels called vasculitis. Some also have shortness of breath from inflammation in their lungs called interstial lung disease. Most patients are over 50 years old and the vast majorities are women. Sometimes Sjögren’s is a disease in its own right but in some patients Sjögren’s is seen with other auto-immune or connective diseases such as lupus. These later patients have other symptoms such as low white cells in the blood, protein in the urine, and arthritis. 

Inflammation of the salivary glands in the mouth leads to a deficiency of the normal flow of saliva. This causes speaking and eating more difficult, and decreases in the ability to taste.  Patients also have increased decay in their teeth. Sucking sour candies stimulates the saliva in these patients. Patients also mucous membrane dryness leading to increased crust in the most and decreased ability to smell. Eyes can feel gritty with blurred vision. Fatigue is common. Most patients with have dry itchy skin. 

If you suspect Sjögren’s syndrome then discuss your situation with your primary care doctor or a Rheumatologist to make the diagnosis. Treatment of Sjögren’s syndrome is beyond the scope of this blog. Simple measures to discuss with physicians if you are diagnosed with Sjögrens syndrome may include artificial lubricants for the eyes, mouth, nasal mucosa and even the vagina. As for dry skin, lubricants in the form of creams should be applied after showers or bathing. Approximately 40% of Sjögren’s patients suffer from itchy skin even if the skin is not dry. Some systemic anti-inflammatory treatments of Sjögren syndrome may help in relieving itchy skin. Cooling topicals such as Sarna Original Anti-Itch Lotion often alleviate these symptoms. Other techniques to mitigate itching include relaxation, meditation, exercise and behavioral modification techniques. Sometimes doctors prescribe oral medication that has been shown help itching in Sjögren syndrome. Most of these prescriptions are off-label. Off-label prescribing is defined as physicians prescribing an FDA approved medication for a condition that it is not approved for. Up to 20% of medication prescriptions are off-label. Off label perscriptiojn for itching in Sjögren syndrome and other uato-immune connective tissue disease  include Gabapentin and selective serotonin reuptake inhibitors such as Celexa and Lexapro. Serotonin and norepinephrine reuptake inhibitors are another group of prescription medications that have been prescribed for itching in Sjögren. Examples of these are Mittazapine and Duloxetine. Finally, some physicians prescribe cannabinoids such as Dronabinol, a man-made form of cannabis for itching in connective tissue diseases. These medications should not be taken without a prescription and a long discussion with your doctor about potential side-effects and effectiveness/