Phenomena and symptoms
The main symptoms of this disease are dry mouth and dry eyes, which is part of the reason why this disease is called Sjogren's syndrome. In addition, Sjogren's syndrome can also lead to dryness of skin, nasal cavity and * * *. It may also affect other organs of the human body, such as kidneys, blood vessels, lungs, liver, pancreas and brain. Secondary patients usually have symptoms related to rheumatoid disease.
The cause of disease
At present, the specific cause of the disease is not clear, and it is thought to be related to the defect of aquaporin -5(AQP-5) on some cell surfaces. At present, it is known that the disease has a certain genetic basis, that is, people with or without a certain gene are relatively easy to get the disease. These related genes are different among different races. For example, HLA-DR53 is related to Japanese, while Western Europeans are related to HLA-B8. In addition, African lymphovirus (EB virus) has a certain correlation with primary Sjogren's syndrome. In addition, cytomegalovirus and HIV are also considered to be related to Sjogren's syndrome. The disease belongs to autoimmune disease, and the patient's own immune system mistakenly attacks normal cells, causing inflammation.
test
Because Sjogren's syndrome has various symptoms, and these symptoms are similar to some symptoms caused by other reasons, its diagnosis is more complicated. However, the disease can still be detected by combining various detection methods.
Blood examination
By checking the antibody level in blood, such as anti-nuclear antibody (ANA) and rheumatoid factor (because rheumatoid disease usually causes secondary Sjogren's syndrome), it can help to judge whether you have the disease. If the result is too high, you should be suspicious, because these indicators are related to autoimmune diseases. The typical case of antinuclear antibody in patients with Sjogren's syndrome is that anti-Ro antibody (Sjogren's syndrome A antibody, SSA) and anti-La antibody (Sjogren's syndrome B antibody, SSB) are positive. Especially SSB/La is more meaningful, because SSA/Ro is related to many other autoimmune diseases, although this index is usually abnormal in Sjogren's syndrome patients.
Lacrimal gland function test
Tear secretion test can measure the level of tear secretion: put the test paper on the inner side of the lower eyelid for five minutes, then take it out and measure the length of the wet part with a ruler. If the length is less than 5 mm, Sjogren's syndrome is usually considered. But with the increase of age, or the deterioration of lacrimal gland function caused by other diseases, the same result may be obtained. You can also observe the surface of the eyes through the slit lamp to confirm whether the eyes are dry or not.
Salivary gland function test
Like the tear secretion test above, the function of salivary gland can be tested in a similar way. That is, the secreted saliva was collected and measured within five minutes. You can also do a lip biopsy. If you have Sjogren's syndrome, you can find that lymphocytes gather around salivary secretion cells and are seriously damaged by inflammation.
In addition, salivary glands can be examined by ultrasound. Through this examination, it will be found that the gland parenchyma of the patient will have a hypoechoic lesion area with a size of about 2 ~ 6mm, which is an area suffering from lymphatic infiltration. If the examination shows that the terminal duct of salivary gland is punctate dilatation or stones appear, it usually indicates that the disease has entered the advanced stage. The advantage of this examination method is that it is simple and convenient, will not cause invasive harm to human body, and can accurately find the relationship between symptoms. Another advantage of this examination is that related complications can be found. For example, if you have extranodal lymphoma, you can see an intraparenchymal mass with a size of 1 to 4 cm.
Radiographic contrast examination is also an effective and accurate detection method. This examination needs to inject developer into the main duct of parotid duct before filming. Both ends of this duct are located on the oral wall of parotid gland and second maxillary molar respectively. If a large number of scattered contrast media spots are found in parotid gland, it can be differentiated as Sjogren's syndrome.
diagnose
The newly revised diagnostic criteria for Sjogren's syndrome require signs, symptoms and laboratory results before making a diagnosis. Symptoms reported by patients must include pathological phenomena of eyes and mouth at the same time, such as dry eye for more than three months every day, drinking water before swallowing food, etc.
Objective evidence collection includes the above-mentioned tear secretion test and rose staining (or similar other staining methods), and histopathological examination should also show lymphatic infiltration in small salivary gland lesions. The actual situation of salivary gland can be obtained by ultrasonic diagnosis, non-puncture detection of salivary secretion level, parotid gland radiography or salivary gland radiography.
In the diagnosis, it is necessary to exclude the following situations: having received head and neck radiotherapy, being in the early stage of lymphoma, suffering from diseases such as hepatitis C, AIDS, sarcoidosis or organ rejection, and taking anticholinergic drugs, the metabolic time is not more than 4 times.
treat cordially
At present, there is no treatment that can completely cure Sjogren's syndrome, and there is no treatment that can restore the secretory function of secretory glands once and for all. On the contrary, the current treatment is only supportive therapy to relieve symptoms. For example, for the symptoms of dry eyes, artificial tears (eye drops) are used to keep them moist. In addition, the prescription drug cyclosporine (Liyanda eye emulsion, an immunosuppressant) can be used to treat chronic dry eye. Its principle is to inhibit the inflammatory reaction in lacrimal gland, which will weaken the function of lacrimal gland and interfere with its function of secreting tears. There are similar drugs to treat salivary gland problems, such as cevimeline and pilocarpine. Non-steroidal anti-inflammatory drugs can be used to relieve muscle and bone symptoms. For patients with other serious complications, doctors may prescribe corticosteroids or other immunosuppressants. Drugs like methotrexate can also help to relieve rheumatoid diseases. At present, people are studying a variety of monoclonal antibodies related to the disease.
In the late stage of the disease, even with artificial tears, the eyes still feel as dry, itchy and painful as fire. Patients can feel all kinds of torture all the time, especially in the morning and evening. Eye drops are not only often used, but also have not had much effect. At this time, it may be necessary to use special goggles to increase the local humidity, or to plug the lacrimal punctum into the lacrimal canaliculus to prevent the tears from losing from the lacrimal canaliculus and leave more tears in the eyes. This is because there is a lacrimal passage in the upper and lower eyelids, and the amount of tears lost from the upper lacrimal passage accounts for about 40% of the total loss through this passage, and the remaining 60% is discharged through the lower lacrimal passage. In general, patients with dry eye can prolong the stay time of tears in their eyes by blocking the lower lacrimal passage, although punctal plugs can be placed in the upper and lower lacrimal passages. The process of placing the lacrimal punctum plug is quite simple, and it can be completed in the office of an optometrist or ophthalmologist. The whole process only takes a few minutes. Usually, the collagen lacrimal punctum plug is placed for the first time, and this lacrimal punctum plug will dissolve in a few days. This step is to let patients experience whether they can adapt to this therapy, although generally speaking, the condition will get better immediately. If the patient does not feel unwell, a permanent punctal plug can be placed. The so-called permanent only means that it will not be dissolved and can be taken out when necessary.
Many patients neglect preventive dental treatment, which is usually necessary. Due to insufficient saliva secretion, the oral environment will become conducive to the reproduction of many bacteria that cause dental caries. These treatments include topical use of household fluoride products to protect enamel and regular visits to dental clinics to clean teeth. The existing dental caries also need to be treated as soon as possible, because in this specific oral environment, dental caries can easily develop into deep pulp. Once this happens, it will not be treated by simple methods such as cleaning or filling teeth, but may require tooth extraction and/or nerve extraction, which will bring greater pain to patients. Patients with xerostomia caused by other reasons should also be treated similarly. Unfortunately, however, most patients don't understand the necessity of this treatment, so that most teeth can't be saved when problems are found. Most teeth of xerostomia patients can't be treated, so they can only have their nerves removed, which is not uncommon for dentists. At this time, all the teeth can only be pulled out, replaced with dentures, or dental implants.
prognosis
Sjogren's syndrome may damage key organs, and its symptoms may be alleviated or aggravated. Unlike other autoimmune diseases, this disease will not be alleviated. Some people may only feel mild dry eyes and mouth, while others may have serious symptoms. Although many people can relieve symptoms through treatment, some people can only choose to endure blurred vision, persistent eye discomfort, repeated oral infections, parotid gland enlargement, hoarseness and dysphagia. Even some patients may develop renal diseases (autoimmune tubulointerstitial nephritis) and lead to proteinuria, diabetes insipidus and distal tubular acidosis.
Patients with Sjogren's syndrome are more likely to suffer from non-Hodgkin's lymphoma than patients with other types of autoimmune diseases and normal people, and about 5% patients with Sjogren's syndrome will develop into some kind of malignant lymphoma. Especially in patients with severe symptoms, the probability of lymphoma is higher than that in patients with mild and moderate symptoms. Among them, the most common are B-cell lymphoma (mucosa-associated lymphoid tissue lymphoma of salivary gland) and diffuse large-cell B-cell lymphoma.
complication
In addition to the complications mentioned above, if a woman with Sjogren's syndrome is pregnant, the probability of neonatal lupus erythematosus with congenital heart block (requiring pacemaker) is relatively high.
Topic: xerosis.