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Clinical Practice Guidelines for Ocular Management in Sjögren’s

Posted on Wed, Jul 20, 2016

July is Dry Eye Awareness Month! During July, the Sjögren’s Syndrome Foundation works to help educate the public about dry eye symptoms, treatment options, and the possible cause being Sjögren’s. We hope you enjoy our July blogs aimed to promote dry eye education and encourage you to share this post.

The Sjögren’s Syndrome Foundation (SSF) has developed the first-ever U.S. Clinical Practice Guidelines for Ocular Management in Sjögren’s to ensure quality and consistency of care for the assessment and management of patients.

The SSF Clinical Practice Guidelines for Ocular Management in Sjögren’s established that, in a given patient, the clinician must determine whether the dry eye is due to inadequate production of tears, excess evaporation, or a combination of both mechanisms. The success of a treatment option depends upon proper recognition and approach to therapy.

Click here to view the SSF Clinical Practice Guidelines for Ocular Management in Sjögren’s and its recommendations.

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The SSF Sjögren’s Clinical Practice Guidelines initiative is funded fully by the SSF with no corporate or pharmaceutical industry support. The SSF would like to thank our committee chairmen and members of the ocular working group for volunteering their time and expertise to develop these guidelines. We would also like to thank all SSF members and our generous supporters for helping to make the dream of Sjögren’s Clinical Practice Guidelines start to become a reality! 

Click here to view the U.S. Clinical Practice Guidelines  for Ocular Management in Sjögren’s    

Topics: Sicca, Dry Eyes, Sjogren's, Treatment, coping with sjogren's, Punctal Plugs, Clinical Practice Guidelines for Ocular Management, Clinical Practice Guidelines

Natural Herbs & Spices That Alleviate Dry Eye Symptoms

Posted on Fri, Aug 28, 2015

spices-1Could alleviating dry eye pain be as simple as spicing up your life a little bit? (No, don’t cue Victoria Beckham- we mean that in a literal sense!) There are plenty of natural herbs and spices that are full of dry eye fighting antioxidants. In fact, you might even find dry eye relief in your own spice cabinet! Intrigued yet? We thought so. Behold, some of the best natural herbs and spices to help prevent your peepers from drying out:

Turmeric
This wonder spice was a hit with our dry eye prone friends. Sometimes known as curcumin, turmeric is an Asian spice that is protective against a number of diseases (including dry eye!). However, there’s a catch: turmeric is not always easily absorbed. Experiment with this natural anti-inflammatory anyway- it may help reduce oxidative stress. (P.S. One of our Facebook friends shared her go-to hot beverage for dry eyes a few months back. Try Janice’s recipe: Warm up some almond milk, sprinkle a tsp of turmeric, ½ tsp cinnamon and 1/8 tsp cloves. Finish with a dollop of raw honey. Whisk together and voila, an inventive {and delicious} way to incorporate turmeric into your diet!)

Paprika
Paprika has an extremely high concentration of vitamin A, which is great for warding off dry eye symptoms. Other good news about paprika, it’s an extremely versatile ingredient- and just about everyone has it sitting in the spice cabinet. Try using paprika next time you cook. It’s awesome for boosting flavor- and nutrition! Get a dose of paprika by sprinkling it on potato salads, fish, chicken and eggs. 

Bilberry
You may have already heard that bilberry, a shrub closely related to the blueberry, is great for overall eye health and retinal diseases like macular degeneration. Well, it’s also particularly beneficial for dry, itchy eyes. Extracts from the bilberry fruit help to improve blood circulation, oxygen supply and tear gland function. Additionally, bilberries contain vitamin P and citrin, both of which help to decrease swelling and inflammation in the body; a common dry eye trigger. Experiment with bilberry supplements or tea made from bilberry leaves. However, be careful not to over indulge. Ingest no more than 220 mg of bilberry per day.

Mint
Next time you’re tempted to rub those itchy, stinging eyes, try a spearmint eyewash instead. Simply boil about 10-12 leaves of spearmint in some water. Wait until the solution cools (at least 20 minutes!) and then use a clean face cloth to apply the wash to your eyes. Menthol, the active ingredient in mint, actually stimulates tear production and will leave your eyes feeling energized and refreshed. Plus, it smells amazing! Win-win.

Chamomile
Chamomile is known for its cooling and anti-inflammatory properties. It soothes tired eyes and can help restore moisture. Another bonus? Drinking chamomile tea makes you feel sleepy and prepares you for rest, so it’s the perfect drink to sip on after a long day.

So, there you have it; options for natural dry eye relief. Of course, the above mentioned are merely a few of the wondrous herbs and spices that can alleviate dry eye pain.  Other potential dry eye fighters include thyme, fennel, marigold and calendula.

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This article is a reprint from AllAboutDryEye.com, which is sponsored by TearLab Corporation and first shown by the SSF in “The Moisture Seekers,” SSF’s patient newsletter.

Topics: Sicca, Dry Eyes, Sjogren's, Treatment

Ask the SSF Staff: Treating Primary vs. Secondary Sjögren’s

Posted on Wed, Dec 10, 2014

describe the imagedescribe the image Should I treat my Sjögren’s differently if I have primary vs secondary Sjögren’s? 

Thedescribe the image terms "Primary and "Secondary" were first used in the 1960s and were devised by researchers who wanted to distinguish between those Sjögren’s patients whose disease was not "complicated" by other major rheumatic or autoimmune disorders. When carrying out research, the investigators wanted to make sure they were looking at purely Sjögren’s  patients and not looking at outcomes for patients who had, for example, both Sjögren’s  and rheumatoid arthritis (RA). They thought that could confuse clinical trials looking at how well a specific therapy worked.  As such things usually happen, though, the terms began to carry over to general clinical diagnosis and medical discussions and thought patterns, and that's where everything became complicated and not helpful for patients and not even helpful for the clinicians treating them. It didn't always make a major difference for the research, either.

So, first, what do the terms mean? "Primary" has been defined as a Sjögren’s patient who does not have another major rheumatic and/or autoimmune disease and "Secondary" as a Sjögren’s patient who does. But as you can imagine, it's not always simple or easily apparent. If a patient has another major rheumatic, autoimmune disease such as lupus, RA, scleroderma or the autoimmune disease multiple sclerosis, they would have traditionally been categorized as have "Secondary Sjögren’s." The term "Secondary" has not been applied to the prevalent autoimmune thyroid diseases, however, which are common in Sjögren’s, and so the terms are somewhat tricky.

Also, investigators have confronted a dilemma when a patient has had Sjögren’s for many years and been labeled as "Primary" and then is diagnosed with another major rheumatic and/or autoimmune disease and automatically being re-labeled as "Secondary Sjögren’s."  And to complicate matters more, some clinicians have now started saying their patient has "Primary Sjögren’s” and "Secondary lupus"(for example) while others undiagnosed the patient from having "Primary Sjögren’s” and changed the diagnosis to "Secondary Sjögren’s." How confusing!

Does it really matter? NO - It certainly doesn't matter to the patient or the clinician treating a patient. It doesn't alter treatment, since treatment for these diseases is based largely on the clinical manifestations and symptoms. All patients should be treated on a case-by-case basis. 

Does the label mean your disease is more or less severe? ABSOLUTELY NOT.  If someone has labeled you as having "Secondary Sjögren’s," it does not mean that your Sjögren’s is less severe or secondary in importance to the other condition. It also doesn't mean that symptoms that were labeled as Sjögren’s symptoms previously are now symptoms of the other disease. Autoimmune diseases often overlap, and sometimes it's difficult to tell if a symptom is Sjögren’s or, say, lupus. In fact, Sjögren’s is the most frequent disorder that occurs in conjunction with other autoimmune and rheumatic diseases, so, again, your signs and symptoms must guide the treatment.

Does the label make a difference as to whether patients are monitored for specific complications or not? NO. Again, your management and treatment should depend on your manifestations of autoimmune disease. You might be labeled as having lupus AND Sjögren’s or rheumatoid arthritis AND Sjögren’s, and then your symptoms and diseases should be managed according to your specific case and with complications specific to each in mind.  

Traditionally, it has mattered to an investigator running clinical trials, but even that is now being called into question. First, diagnosis and pigeon-holing these diseases is not always easy or an exact science. Second, investigators didn't mind if patients with RA or lupus who entered clinical trials also had Sjögren’s  and thought it did not muddy the results of trying a new therapeutic. Why? Because, again, like clinical treatment, the trials were primarily targeted toward clinical manifestations - for example, joint pain, which can occur in several rheumatic diseases including Sjögren’s. While a few manifestations might be distinctive of one disease versus another, such as the joint damage that occurs only in rheumatoid arthritis, the results still were based on the manifestation.

The Sjögren’s Syndrome Foundation is trying to move the medical and scientific community away from these terms, because they usually are NOT helpful or necessary. In fact, they are most often used out of habit, and while we recognize that habits can be hard to change and it can take a long time for a majority to start using different terminology, the SSF is on a mission to accomplish this. Simply put, someone either has Sjögren’s or does not have Sjögren’s. Having another identifiable disease doesn't change the fact that the patient has Sjögren’s, and a somewhat arbitrary decision about which additional diseases and conditions might change a patient between "Primary" and "Secondary" no longer makes sense.
 
-Katherine Hammitt, SSF Vice President of Research

This article was first published in The Moisture Seekers, SSF's member newsletter.

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Topics: Diagnosing Sjogren's, Sicca, Sjogren's, Joint Pain, Treatment, Advocacy, Primary v Secondary Sjogrens

Sjogren's & The Importance of Saliva

Posted on Tue, Oct 28, 2014

Dryness from Sjögren’s may affect any organ in the body that secretes moisture, because the body’s immune system is mistakenly attacking its own moisture-producing glands. Almost every Sjögren’s patient experiences some degree of dry mouth, which is caused by a decrease in both the quantity and quality of saliva.

Saliva plays an immensely important role in the oral cavity, which is why proper dry mouth care and attention is critical for a person’s overall oral health. If dry mouth persists for months or years, the decreased salivation can lead to many oral complications such as severe and progressive tooth decay, oral infections (particularly fungal), difficulty swallowing, or a combinations of these. Dr. Rhodus explains more below about the importance of saliva:

Saliva

"A human being normally produces approximately 1.5 liters of saliva per day. There is a typical diurnal circadian rhythm in the production of that saliva with one peak in the mid-morning followed by a relative decrease until the second peak occurs around early evening.

Saliva flow normally is decreased at night. Saliva is produced by several glands: the submandibular glands (which lie bilaterally just under the posterior jaw) produce most of the quantity of saliva (45%) and it is a mixed fluid with both mucous (thick, stringy fluid) and water but containing most of the proteins; the paired parotid glands (which are in the mid-face just in front of the ears) produce primarily serous (or watery) fluid and accounts for about 35% of the total quantity; the sublingual glands (again in a pair just beneath the anterior tongue) are much smaller and contribute only about 10% of the total volume; and finally there are hundreds of small minor salivary glands in the lips, palate and throat which contribute a relatively small, but important portion of natural salivary flow.

The normal quantity of saliva naturally provides necessary oral lubrication and moisture to assure comfort and function for the individual, but saliva does much more than that. At least equally as important as this volume of saliva, if not more so, is the composition of saliva, which is rich in constituents which have potent digestive, coating, protective, antimicrobial, antiacid, lubricative and homeostatic properties. Saliva is much more than water. In fact, saliva contains approximately 60 important, protective constituents including: immunoglobulins,electrolytes, buffers, antimicrobial enzymes, digestive enzymes and many others, all of which make saliva an essential contributor to the health and homeostasis of the oral cavity. This is the reason that water or artificial salivas are a poor substitute; none of them have the rich composition of ones own natural saliva."

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This post is the introduction from "The Importance of Silvia" article written by Nelson L. Rhodus, DMD, MPH, FICD, that was first published in The Moisture Seekers, SSF's member newsletterSSF members can click here to read the full article on the members section of the website.

Topics: Sinuses, Sicca, Dry Mouth, Symptoms, Sjogren's, Saliva, Burning mouth

Sjogren's Vs. Sicca Syndrome

Posted on Thu, Aug 21, 2014

Sicca is a word derived from the Latin siccus, meaning “dry.” Dryness of the exocrine glands, particularly the eyes and mouth, is referred to as “sicca syndrome” or “sicca complex” when there is no evidence of autoimmune disease present.  While sicca symptoms occur in the vast majority of Sjögren’s patients, not everyone with these symptoms has Sjögren’s. Because of this, it is important to establish an autoimmune cause for the dryness.  Sometimes other causes may be found, such as radiation therapy to the head, certain medications, or Hepatitis C or HIV infections. If no cause is found, the patient should be followed carefully for possible Sjögren’s because it sometimes takes years for the diagnosis to become clear. 

tms cover 2014 April

Dryness from Sjögren’s may affect any organ in the body that secretes moisture. In addition to changing the quantity and quality of saliva and tears, dryness may manifest in the airways, nasal passages, sinuses, throat, skin, and in women, the vagina. Some Sjögren’s patients initially present with recurrent sinus infections, severe vaginal dryness, chronic dry cough, and so on. All types of specialists, not just eye doctors and dentists, need to keep Sjögren’s in mind as a diagnostic possibility, especially when dryness is severe, persistent, or accompanied by systemic symptoms such as fatigue and widespread muscle and joint pain. Dryness can be quite serious, causing dental disease, eye pain and even visual impairment.  However, these issues should not detract from the often missed point that Sjögren’s is much more than sicca syndrome.  Sjögren’s is a serious systemic autoimmune disease that can affect almost any organ in the body. 

-Sarah Schafer, MD

This information was first printed in the April issue of The Moisture Seeker, SSF's patient newsletter for members. 

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Topics: Diagnosing Sjogren's, Dry Nose, Sinuses, Sicca, Dry Mouth, Dry Eyes, Symptoms, Sjogren's, Fatigue, Vaginal Dryness, Chronic Cough

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