Sjögren’s Syndrome-related nerve damage
It is estimated that one to four million people in America suffer from Sjögren’s syndrome, an autoimmune disease in which the body attacks its own healthy moisture-producing glands. The disease typically affects people in their 40s, and 90% of the patients are women. Its hallmark symptoms are dry eyes and a dry mouth, which are caused by a reduction in the production of tears and saliva, respectively. Some patients with Sjögren’s may develop peripheral neuropathy.
0.1% or more
Sjögren’s syndrome is considered a relatively common autoimmune disease, affecting between 0.1% and 1% of the population
15%
An estimated 15% of patients develop PN
90%
Women are significantly more likely to develop the condition than men, with about 90% of cases occurring in females.
Sjögren’s is often called a rheumatic disease, which means it is characterized by inflammation in joints, muscles, skin, or other body tissue. Sjögren’s is also considered a disorder of connective tissue, which is the framework of the body that supports organs and tissues (joints, muscles and skin). People with Sjögren’s may have features of rheumatoid arthritis, systemic lupus erythematosus, and vasculitis.
Sjögren’s progresses slowly and is often difficult to diagnose because the symptoms are similar to other diseases. The characteristic dryness may be hard to accurately detect because dryness is often a side effect of various medications used to treat other medical conditions. Researchers think Sjögren’s is caused by a combination of genetic and environmental factors. The onset of the disease may be triggered by a viral or bacterial infection.
Without proper treatment, Sjögren’s may cause significant damage to important organs such as the kidneys, liver and lungs. People with unexplained dryness in their mouth or eyes that lasts for several months should discuss their symptoms with a doctor.
Symptoms & Signs
(Not all symptoms and signs may be present)
- Dry eyes
- Dry mouth
- Bruising
- Dental cavities and mouth infections
- Difficulty swallowing or chewing
- Enlarged parotid glands (glands behind the jaw, in front of the ears)
- Fatigue
- Inflammation of lungs, kidneys or liver
- Joint pain
- Low-grade fever
- Nosebleeds
- Oral yeast infections
- Skin rashes or dry skin
- Vision problems
Tests
(Not all evaluation and tests may be necessary)
For peripheral neuropathy:
- Neurological exam
- Electromyography
- Nerve conduction velocity test
For Sjögren’s syndrome:
- Blood tests:
- ANA (anti-nuclear antibody)
- Anti-SSA and SSB antibodies (tests for antibodies that are often present in people with Sjögren’s)
- RF antibody (rheumatoid factor)
- Erythrocyte sedimentation rate
- Immunoglobulin electrophoresis
- Lip biopsy or biopsy of minor salivary glands (tests for evidence of inflammation)
- Urine test (to test for kidney damage)
- Additional tests relating to the mouth and eyes (e.g., Schirmer’s test to determine whether eyes are excessively dry)
Treatment & Therapy
(Not all treatments and therapies may be indicated)
- Self-care to relieve symptoms
- Artificial tears
- Eye drops
- Body creams / moisturizers
- Drink more fluids
- Increase humidity
- Stop smoking and avoid exposure to second-hand smoke
- Pain medication
- Medication to reduce inflammation (Cevimeline (Evoxac®))
- Corticosteroids
- Hydroxychloroquine (Plaquenil®, Quineprox®)
- Nonsteroidal anti-inflammation drugs (NSAIDs)
- Pilocarpine (Salagen®)
Today, doctors are exploring a link between pre-diabetes (also known as impaired glucose tolerance or IGT) and peripheral neuropathy. Approximately 10% of adults in America have what is being called “pre-diabetes” or “borderline diabetes”—a condition where the body has higher than normal blood sugar levels, but not high enough to be diagnosed as true diabetes. If left untreated, people with pre-diabetes are at risk of developing type 2 diabetes, heart disease, and nerve damage (which could result in peripheral neuropathy.)
People with pre-diabetes or IGT can significantly reduce their risk of developing type 2 diabetes through diet, exercise and learning to control their blood sugar levels.
Symptoms
(Not all symptoms and signs may be present)
People with IGT often have no symptoms. People who actually have diabetes—and who therefore are at greater risk of developing peripheral neuropathy—often don’t realize it because the symptoms of diabetes come on so gradually. Pre Diabetic symptoms and its complications include:
- Frequent urination
- Blurred vision
- Constant thirst
- Fatigue
- Frequent infections
- Cuts and bruises that heal slowly
- Tingling or numbness in the hands or feet
Tests
(Not all evaluation and tests may be necessary)
To test for pre-diabetes:
- Blood test
- Oral glucose tolerance test
Treatments
(Not all treatments and therapies may be indicated)
- Over-the-counter pain medication for mild pain
- Take safety measures to compensate for loss of sensation.
- Ask your doctor about special therapeutic shoes (which may be covered by Medicare and other insurance).
The first sign of diabetic neuropathy is usually numbness, tingling or pain in the feet, legs or hands.
Over a period of several years, the neuropathy may lead to muscle weakness in the feet and a loss of reflexes, especially around the ankle.
As the nerve damage increases, the loss of sensation in the feet can reduce a person’s ability to detect temperature or to notice pain. Because the person can no longer notice when his/her feet become injured, people with diabetic neuropathy are more likely to develop foot problems such as skin lesions and ulcers that may become infected.
Diabetic neuropathy may suddenly flare up and affect a specific nerve or group of nerves. When this occurs, the result may be weakness and muscle atrophy in various parts of the body, such as involvement of the eye muscles or eyelid (e.g., causing double vision or a drooping eyelid) or thigh muscles. Alternatively, neuropathy caused by diabetes may slowly progress over time. It also can interfere with the normal functioning of the digestive system and sexual organs.
Symptoms
(Not all symptoms and signs may be present)
- Numbness, tingling, or pain in the toes, feet, legs, hands, arms, and fingers
- Indigestion, nausea, or vomiting
- Diarrhea or constipation
- Dizziness or faintness due to a drop in blood pressure especially when rising to a standing position
- Problems with urination
- Erectile dysfunction (impotence) or vaginal dryness
Tests
(Not all evaluation and tests may be necessary)
- Comprehensive foot exam
- Physical examination
- Neurological exam
- Electromyography
- Nerve conduction velocity test
- Quantitive sensory testing (QST)
- Nerve or skin biopsy
- Blood studies (to verify diabetes (e.g., HbA1C) and to rule out other potential causes)
Treatments
(Not all treatments and therapies may be indicated)
The goal of treatment for diabetic neuropathy is to relieve discomfort and to prevent further tissue damage. The first step is to bring blood sugar levels under control by diet and medication. Another important part of treatment involves taking special care of the feet.
- Over-the-counter pain medication for mild pain
- For severe pain, take over-the-counter pain medication or prescription drugs used for peripheral neuropathy, on a regular basis—rather than waiting until nighttime when symptoms can become more severe
- Keep blood sugar levels in normal range
- Get regular exercise
- Maintain a healthy weight
- Antidepressants (for pain relief)
- Foot care: inspect your feet daily for injuries
- Special Therapeutic shoes (which may be covered by Medicare and other insurance)
- Take safety measures to compensate for loss of sensation
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