What Is Sjogren's Syndrome? What Causes Sjogren's Syndrome?

Sjogren's syndrome (Sjögrens Syndrome) is a chronic disorder of the immune system - a long-term autoimmune disease - in which the patient's white blood cells attack the saliva and tear glands, leading to dry mouth and eyes because the body's tear and saliva production is reduced. Sometimes the gland responsible for keeping the vagina moist is also affected, resulting in vaginal dryness. There can also be pain and stiffness in the joints and aching muscles.

An autoimmune disease is one when the healthy tissues and cells are mistakenly attacked by the body's own immune system. The immune system is designed to attack invaders of the body that do us harm - pathogens. A person with an autoimmune disease has abnormal antibodies circulating in the blood that attack healthy tissues as if they were harmful pathogens, such as infectious viruses or bacteria.

Doctors classify Sjogren's syndrome as either primary or secondary Sjogren's syndrome: Primary Sjogren's syndrome - the condition does not develop as a result of another condition, it is not the consequence of another condition.Secondary Sjogren's syndrome - the condition develops because of or alongside another condition, such as lupus or rheumatoid arthritis.Sjogren's syndrome can develop at any age. However, the majority of patients are diagnosed after the age of 40 years. 90% of patients are female. Symptoms commonly subside after some time.

There are approximately 4 million people in the USA and half-a-million in the UK with Sjogren's syndrome.

A symptom is something the patient senses and describes, while a sign can be spotted by other people, such as a doctor. An example of a sign is a rash, while a symptom may be pain.

The most common symptoms associated with Sjogren's syndrome include dry eyes and dry mouth. Females may also report vaginal dryness. Dry eyes and dry mouth can be linked to other symptoms.

Signs and symptoms associated with dry mouth: Tooth decay, and eventual loss of teethPersistent dry coughProblems chewingProblems swallowingVoice becomes hoarseSome people may have difficulty speakingSalivary glands become swollenRecurring oral thrush (fungal infection in the mouth)Signs and symptoms associated with dry eyes: A sensation that there is something in the eye(s), such as sand or gravelEyes become and look tiredItchy eyesMucus discharge from the eyesPhotophobia - sensitivity to lightStinging or burning eyesSwollen eyelidsIrritated eyelidsSmoky, air-conditioned or windy environments can exacerbate the symptoms. Airplane travel can worsen symptoms. In some cases, the patient's immune system may attack other parts of the body, causing the following signs and symptoms: General tirednessAching musclesInflammation of joints, as well as stiffness and painPeripheral neuropathy - numbness and sometimes pain in the arms or legsRaynaud's phenomenon - hands feel painful, cold and numbVasculitis - the blood vessels become inflamedSjogren's syndrome is an autoimmune disease - the patient's immune system attacks healthy cells and tissues, mistaking them for dangerous pathogens, such as infectious bacteria or viruses.

Experts are not sure why Sjogren's syndrome affects some individuals, and not others. Studies have indicated that some viral or bacterial infections can trigger the disease.

Initially, with Sjogren's syndrome the salivary and tear glands are attacked and harmed by the immune system, resulting in less moisture production - less saliva in the mouth and tears in the eyes. The vaginal glands may also be affected, causing vaginal dryness.

The tear, salivary and vaginal glands are collectively known as the exocrine glands. Exocrine glands are glands of external secretion. They secrete a substance out through a duct. Examples include salivary, tear and sweat glands, as well as glands within the gastrointestinal tract.

However, other parts of the body may also be attacked and harmed, including the nerves, skin, joints, lungs, kidneys, and thyroid gland.

Primary Sjogren's syndrome - as mentioned before, experts are not sure what the exact cause of Sjogren's syndrome is. Most believe it is likely to be a combination of environmental and genetic factors. Some people are probably born with certain genes that make them more susceptible to having an abnormal immune system. Sometime during their life, an environmental factor, such as hepatitis C viral infection, or an infection with the Epstein-Barr virus may have triggered the immune system not to work properly.

As the majority of people who develop Sjogren's syndrome are female, and because the menopause is the most common time for a diagnosis to be made, doctors believe that estrogen, a female hormone, plays an important role. Possibly falling levels of estrogen might in some way disrupt the immune system, some experts theorize.

Secondary Sjogren's syndrome - the syndrome can develop as another autoimmune condition progresses, such as lupus or rheumatoid arthritis.

As Sjogren's signs and symptoms are similar to some other health conditions, it can sometimes be hard to diagnose. The patient may be seeing various health professionals, perhaps a dentist for dry mouth, an ob/gyn for dry vagina, and an ophthalmologist for dry eyes.

Some medications can also cause symptoms similar to those in Sjogren's syndrome.

Screening questions - the National Health Service (UK) offers these screening questions for those who are concerned they might have Sjogren's syndrome. If you answer "Yes" to most of the questions below, see your doctor. It does not mean you have the syndrome, but you may: Do you apply eye drops containing tears more than three times a day?Do you feel as if there were gravel or sand in your eyes?Has dry eyes bothered you persistently, every day, for over three months?Do the glands between your jaw and your ears (salivary glands) keep swelling?Do you often need to drink something when you are trying to swallow food?Has dry mouth bothered you continuously for over three months?After reviewing the results of the screening questions, a doctor may order some further tests.

The Rose Bengal and Schirmer tests - usually done by an ophthalmologist. Rose Bengal test - measures the state and function of the tear glands. Rose Bengal, a non-toxic dye, is dropped onto the surface of the eyes. The dye's distinctive color helps the specialist determine how well the tear film is functioning and how long it takes for the tears to evaporate.The Schirmer test - strips of blotting paper are placed under the eyelid for about five minutes. They are removed and analyzed to determine how much liquid the paper absorbed.Lip biopsy - the doctor removes a sample of tissue from the patient's inner lip and examines it under a microscope. If there are clusters of lymphocytes, it could point towards Sjogren's syndrome. Lymphocytes are types of white blood cells.

Blood tests - when the immune system is affected by Sjogren's syndrome, there are special antibodies in the blood, known as SS-A and SS-B (or anti-Ro and anti-La). As these antibodies only show up in about 60% of Sjogren's syndrome patients, a negative result does not necessarily mean the syndrome can be ruled out.

Salivary flow rate - the patient is asked to spit as much as he/she can into a cup for about five minutes. By weighing the saliva, the doctor can determine whether the salivary glands are working properly. If not enough saliva is being produced, it could mean the patient has Sjogren's syndrome.

Sialogram - this is a special X-ray. A dye is injected into the parotid glands (behind the jaw and in front of the years). The aim is to determine how much saliva flows into the patient's mouth.

Salivary scintigraphy - a radioactive isotope is injected and tracked to measure salivary gland function.

Chest X-ray - this is to determine whether there is lung inflammation, which can be caused by Sjogren's syndrome.

Urine sample - the urine is tested to determine whether the kidneys have been affected.

Artificial tears - artificial tears can usually treat moderate cases of dry eye effectively. They can be purchased at a pharmacy OTC (over the counter, no prescription required). If the eyes become severely irritated, the doctor may prescribe a short course of corticosteroid-containing eye drops. Long-term usage raises the risk of undesirable and serious side-effects, such as Cushing's syndrome.

Moisture chamber spectacles - these are special glasses that wrap around the eyes, a bit like goggles. They help keep the moisture in, and also protect the eyes from dust, particles and other irritants.

Surgery - small plugs seal the tear ducts which drain the tears away. If they are sealed tears will stay in the eye longer. This procedure is called punctual occlusion. It is generally only recommended if all else fails. Initially, the doctor will probably place temporary silicone plugs to see whether the procedure was successful. If it was, the silicone plugs are later replaced by permanent ones.

Keeping your mouth lubricated: Consume more liquidsIce cubes - sucking them helps keep the mouth lubricatedMouth rinses - regular mouth washing helps protect against infection and also soothes the mouthOral hygiene - good oral hygiene prevents gum disease and tooth decaySmoking - give up. Smoking speeds up the rate at which saliva evaporates. Smoke irritates the mouth.Sugar free chewing gum - this stimulates the production of salivaSaliva substitutes - these are available as a lozenge, gel, gum or spray. They help lubricate the mouth.

Pilocarpine - a medication for dry eyes and mouth. The drug stimulates the saliva and tear glands to produce more tears and saliva.

Hydroxychloroquine - a medication that slows the immune system's attack on saliva and tear glands. It may also help with symptoms of joint pain and stiffness, and muscle pain. Patients will not notice any effects for several weeks.

Vaginal dryness - lubricants, such as KY Jelly help. HRT (hormone replacement therapy) and using estrogen creams are also options.

Joint and muscle pains - OTC NSAIDs (non-steroidal anti-inflammatory drugs), such as ibuprofen are usually effective. The doctor may prescribe a stronger NSAID if needed.

Patients with Sjogren's syndrome have a 44 times higher risk of developing non-Hodgkin's lymphoma than other people (about 5% of all patients).

People with Sjogren's syndrome have a higher risk of developing yeast infections, dental cavities, and having vision problems. Less commonly, there is also a risk of inflammation that may cause bronchitis, pneumonia, and other lung problems that may lead to kidney function problems, which in turn raise the risk of hepatitis or cirrhosis in the liver. In rare cases a pregnant woman with Sjogren's syndrome may give birth to a baby with heart problems. There is also a higher risk that the baby may develop lupus.

Peripheral neuropathy - Some patients develop a burning, tingling or numbing sensation in their hands and feet.

Summer Travel With Diabetes: 11 Essential Tips

As you probably know all too well, diabetes doesn't take a vacation. So before you set off on a trip--be it a cruise, a week in the mountains with the family, or an international destination--be well-prepared for every possible scenario.

"When people are on vacation, they're just naughty," says Dana Simpler, MD, of Mercy Medical Center in Baltimore, MD.  "They eat more than they should, they may drink too much, and they may either get more or less exercise than usual."

One way to keep track of your blood sugar is to pack your glucose meter, and to use it during travel, Simpler recommends.

"Knowing your blood sugar is very important," Simpler says. "And when you keep track of your blood sugar, you can see what your vacation is doing to your diabetes."

As you're packing your suitcase and readying yourself for travel, you should:

Compose and pack a list of all the medications, as well as a list of all medical conditions that you have. "Consider taking a recent set of lab results and an EKG," Simpler says. "This way, a doctor would know your baseline should an emergency come up while you are traveling." Pack duplicates of all your medications in case something should get lost during travel or left behind at the hotel, advises Gerald Bernstein, MD, FACP, director of the Diabetes Management Program at the Friedman Diabetes Institute at Beth Israel Medical Center in New York City. "Take two or three days' worth of extra blood testing strips, too, in case you are delayed," he says.Pack your medications in your carry-on if you are flying, just in case your luggage gets lost.Be sure to ask your doctor whether you need any extra vaccinations before traveling. Don't wait until the last minute, since some have to be obtained many weeks before you travel. If you'll be immobile for hours at a time sitting on a cramped plane or train, ask your doctor if you should wear compression stockings or take a baby aspirin in order to prevent blood clots, Simpler says. Get up and walk around every hour or so while on the plane, too.Ask your doctor if you should take along an antibiotic just in case you get an infection, Simpler says.If you are abroad and you're not sure of the water quality, stick to bottled water and don't eat fruit or vegetables washed in local water. "When you are diabetic you are more susceptible to infections, and infections tend to be harder on you," Simpler says. Take snacks so that you'll have some shelf-stable foods that you are familiar with. Pack candy or glucose tablets in your carry-on in case of hypoglycemia. "Take a variety of glucose replacements and be prepared for any kind of circumstance," Friedman says. Pack plenty of cotton socks and loose-fitting, comfortable shoes. They'll come in handy if you do a lot of walking, Friedman says. Check your feet often, especially if you are doing a lot of walking on the trip.  Finally, and this is tough to follow when you're in vacation mode, use moderation at mealtime--at least for most of the trip. "After all, you're on a vacation for fun and relaxation, not to make yourself sick," Simpler says.

View the original article here

New Tool Accurately Predicts Kids' Food Allergies

A new tool developed by researchers from University College Cork may be just what the doctor ordered when it comes to diagnosing your child's food allergies.

New Way to Diagnose Food Allergies in Children

The Irish scientists have created a special "calculator" that allows you to input some important data to instantly identify if your child has an allergy to milk, eggs, and peanuts, which are three of the most common food allergies in kids.

Identifying Kids' Food Allergies

According to a study published in the Journal of Allergy & Clinical Immunology in March of 2011, the calculator relies on information on things known to correlate with food allergies to run allergen-specific algorithms to determine whether an allergy exists to each of the three main types of food allergy triggers. The data used includes the patient's age, sex, skin prick test results, IgE blood levels for different allergens, and past history of allergic reactions.

The Benefits

This avoids the need for children to undergo an oral food challenge, which up to now has been the best diagnostic method available, but also poses serious risk for highly-allergic patients and can also be stressful and time-consuming for participants. The calculator's results are 96 percent accurate compared with other common methods of diagnosing food allergies, which are right only between 61 to 81 percent of the time, according to the researchers. It can also be much more cost-effective than other diagnostic methods.

An added benefit is that doctors may also be able to use the calculator's results to determine the best course of action in dealing with each patient's specific food allergy.

A commercial version of this calculator will be released later this year so more children can benefit from its effectiveness.

What This Means For You

If you have a child whom you suspect could have food allergies, it's important to talk to her allergist about this new tool and find out when it will be available in your area. While the Cork scientists focused their research efforts on young children with an average age of about 7 years old, you can also ask the doctor about whether this calculator may also be appropriate to use in the future with younger and older children and adults as well.

Prevent Food Allergies in Children

Remember that food allergies in people of all ages can be quite serious or even life-threatening. Therefore, it's important to know what foods and drinks could trigger an attack and take the appropriate steps to head off any problems well in advance. It's also essential to make sure your child has access to injectable epinephrine at all times in case a food allergy does occur.

Sources:

L.M. Segal, J.O.B. Hourihane, A. Clarke, R. Alizadehfar, J. Lucas, G. Roberts, M. Lajeunesse, A. DunnGalvin. "A Systematic Evaluation of the Cork-Southampton Food Challenge Outcome Calculator in a Canadian Sample." Journal of Allergy and Clinical Immunology (2011): 127. Web. 18 April 2011.

"Predicting Food Allergies." News@ucc. University College Cork, Ireland, 3 March 2011. Web. 20, April 2011.

View the original article here