Patients with Sjögren's Syndrome often have other conditions related to anomalous functioning of the immune system, such as systemic lupus erythematosus, scleroderma and rheumatoid arthritis.

Symptoms

Patients with Sjögren's Syndrome mainly have symptoms related to a lack of tear and saliva production, which causes dryness in the mouth and eyes. The main symptoms suffered by patients are a burning, gritty sensation in the eyes, red eyes, blurred vision, the need to drink water frequently, difficulty swallowing dry food and a higher propensity for tooth decay and mouth infections. This dryness may also affect the skin and vaginal area, which causes painful sexual relationships. Other symptoms that Sjögren's Syndrome patients may show are joint or muscle pain and fatigue. Less frequently, other organs, such as the lungs, kidney and nerve endings, may be affected.

Who is affected by the condition?

Above all, the disease affects women aged between 40 and 60. It is calculated that the incidence is between 0.5% and 3% of the population.

How is it diagnosed?

There is no single test enabling diagnosis of Sjögren's Syndrome.  Diagnosing Sjögren's Syndrome in a patient referred with dry eyes and mouth is based on tests that confirm the existence of a deficit in tear and saliva production and that prove that the dryness is associated with an imbalance in the immune system.

Standard treatment

Treatment of Sjögren's Syndrome is essentially based on measures that alleviate the feeling of dryness shown by the patient. The treatment includes the use of artificial tears, eye gels, eye drops, nebulisers and tablets to stimulate saliva production. Particular patients may be given treatment to stimulate glandular secretion. In serious cases, where there are symptoms in organs other than the glands (lungs and peripheral nerves, etc) it may be necessary to administer medication that acts to decrease immune system activity (immunosuppressant drugs).

Standard tests

Patients with Sjögren's Syndrome must undergo a series of eye tests, blood and urine tests and, on certain occasions, it is necessary to do a small biopsy of lip mucous to confirm the existence of inflammation in the glands producing saliva.

Symptoms

The symptoms usually begin with symmetrical pain in the shoulders, and difficulty raising the arms and doing everyday tasks like combing hair or washing. If it affects the hips, the patient usually has difficulty getting up from a chair without using their hands. Less frequently, it may affect the neck and lower back. Pain and rigidity are more intense after long periods of rest, such as getting up in the morning.

Everyday activities such as getting up from a chair or the toilet, turning over in bed, combing hair or getting dressed become difficult and, in many cases, help is needed.

On some occasions it is accompanied by other, less specific symptoms, such as fever, loss of appetite or weight loss. All these changes usually appear in a relatively short space of time, either within a few weeks or months.

Who is affected by the condition?

Rheumatic polymyalgia typically appears in over 50 year-olds. 50 out of every 100,000 people over this age suffer from it each year. It is twice as common in women than in men and is most frequent in white people.

The exact cause is unknown.  Its appearance in the elderly leads to thought of some factor (unknown) linked to ageing, along with genetic factors and anomalies in the individual’s immune system.

With regard to genetic factors, it is known that familial aggregation exists. That is to say, it is more frequent in members of the same family.

Diagnosis

There is no single test to diagnose this disease. The diagnosis is reached using the combination of the symptoms, physical examination by the rheumatologist and blood test results, where all this is presented in people over 50.

The most significant discovery in the blood test is the increase in ESR, which occurs in the majority of patients. It is worth pointing out that this change in the blood is not specific to this disease as it is elevated in any inflammatory or infectious process occurring in the body. In general, ESR is considered normal up to 15mm in the first hour in men, and up to 20mm/hr in women, but this increases with the age of the individual. In the event that there is Rheumatic polymyalgia, these figures reach much higher values, generally above 50mm/hr.

In the same way, C-reactive protein (CRP) is also a marker that serves to detect inflammation and is usually found to be high.

Typical treatment

The basis for treatment of rheumatic polymyalgia is corticosteroids. Corticosteroids are given in low doses (between 10mg and 20mg per day), preferably taken in a single dose in the morning. The symptoms effectively improve quickly (usually in the first 24-48 hours), the pain and stiffness disappear, and function and autonomy are recovered.

Once the symptoms have disappeared, the dose prescribed by the rheumatologist will be progressively decreased in order to find the lowest possible dosage to control the disease. For controls, EST and CRP values are also taken into account as they usually go back to normal as the symptoms disappear, which demonstrates response to the treatment.