How to treat Sjögren's syndrome?

Sjögren's syndrome is a common disease, often manifested by dry mouth, which requires constant drinking of water; there are also symptoms such as keratoconjunctivitis sicca. The best way to deal with these situations is to improve them, maintain oral hygiene, rinse your mouth after meals, and use anti-inflammatory drugs when necessary.

1. Clinical manifestations

1. Local manifestations

(1) Xerostomia. Due to salivary gland lesions, salivary mucin deficiency causes the following common symptoms: ① Most patients complain of dry mouth. In severe cases, the oral mucosa, teeth and tongue become sticky, so the patient needs to drink water frequently when speaking, and solid food must be taken with water or liquid food. ② Rampant dental caries is one of the characteristics of this disease. About 50% of patients develop multiple uncontrolled caries, which are manifested by the gradual darkening of the teeth, followed by small pieces falling off, and ultimately leaving only residual roots. ③ In adult mumps, 50% of patients present with intermittent alternating parotid swelling and pain, involving one or both sides. Most of them can disappear on their own in about 10 days, but sometimes the swelling persists. A few people have submandibular gland enlargement, while sublingual gland enlargement is less common. ④ The tongue manifests as tongue pain, dry and cracked tongue surface, and atrophied and smooth tongue papillae. ⑤Ulcers or secondary infections occur in the oral mucosa.

(2) Keratoconjunctivitis sicca. This condition is caused by a decrease in mucin secretion from the lacrimal glands, resulting in symptoms such as dry eyes, foreign body sensation, and less tears. In severe cases, the patient may even cry without tears. Some patients have recurrent purulent infections of the eyelid margin, conjunctivitis, keratitis, etc.

(3) Others. Exocrine glands in superficial areas such as the nose, hard palate, trachea and its branches, gastrointestinal mucosa, and vaginal mucosa may be affected, causing less secretion and resulting in corresponding symptoms.

2. System performance

In addition to dry mouth and eyes, patients may also experience systemic symptoms such as fatigue and low fever. About 2/3 of patients experience systemic damage.

(1) Skin. Allergic purpuric rash may occur, mostly on the lower limbs. It is a rice-sized red papule with clear borders that does not fade when pressed and appears in batches. Each episode lasts about 10 days and will fade on its own, leaving behind brown pigmentation.

(2) Joints. Joint pain is relatively common, and damage to the joint structure is usually not present.

(3) Kidney. About half of the patients have renal damage, mainly affecting the distal renal tubules, and renal tubular acidosis may occur. A small number of patients develop more obvious glomerular damage, with clinical manifestations including massive proteinuria, hypoalbuminemia, and even renal insufficiency.

(4) Lungs. Most patients have no respiratory symptoms. Mildly affected people experience a dry cough, while severe cases experience shortness of breath. The main pathology of the lungs is interstitial lesions, and a small number of patients develop pulmonary hypertension. Patients with pulmonary fibrosis and severe pulmonary hypertension have a poor prognosis.

(5) Digestive system. Non-specific symptoms such as atrophic gastritis, decreased gastric acid, and indigestion may occur, and patients may have liver damage.

(6) Neurological disease: A few cases involve the nervous system. Peripheral nerve damage is the most common.

(7) Blood system. This disease may cause a decrease in white blood cell count or (and) thrombocytopenia. Severe thrombocytopenia may cause bleeding. The incidence of lymphoma in this disease is much higher than that in the normal population.

II. Treatment

1. Improve symptoms

(1) Alleviate dry mouth symptoms, keep the oral cavity clean, rinse the mouth frequently, and reduce the possibility of tooth decay and secondary oral infection.

(2) For keratoconjunctivitis sicca, artificial tear eye drops can be used to relieve dry eye symptoms and prevent corneal damage.

(3) Nonsteroidal anti-inflammatory drugs and hydroxychloroquine can be used for muscle and joint pain.

2. Systemic damage should be treated according to the damaged organ and severity.

Patients with concurrent neurological diseases, glomerulonephritis, interstitial lung disease, liver damage, low blood cells (especially low platelets), myositis, etc. should be given adrenal cortical hormones in the same dosage as for the treatment of other connective tissue diseases. For patients with rapidly progressive disease, immunosuppressants such as cyclophosphamide and azathioprine can be used in combination. Patients with malignant lymphoma should undergo active and timely combined chemotherapy.