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Yoga and Sjögren's: There's a pose for that!

Posted on Thu, Sep 12, 2019

As finding alternatives to overall wellness, mind and body, continue to evolve in present day, many holistic health techniques have stood the test of time, proving to offer benefits that heal the body from the inside out. Yoga is one of these holistic healers. Many centuries ago, when yoga was said to be created, ancient peoples made yoga their daily routine to treat and ward off disease and to become peaceful in the mind. The body would react to this practice over- time, ceasing illness and spiritual negativity from the body. As I continue on my journey into offering yoga for therapeutic purposes as a registered yoga teacher, I witness what these ancient yogis were onto. Yoga is a practice that benefits the body in many ways. Different yoga poses promote healing for different body parts. Here are some poses that have exponential benefits:

Energize & Open Your Heart with Camel Pose

Sanskrit Name: Ustrasana

Boost your energy and open your heart with camel pose. This pose is known for eliminating the
feeling of sluggishness or fatigue and promoting energy through the body while creating more oxygen
to the brain. Come to your knees on the floor with knees hip-distance apart. Allow your toes to untuck and stabilize through the legs. Bring your hands to your lower back with palms facing in and finger tips facing down. Push the pelvis forward to create space for the spine to keep alignment. Inhale and lift your heart higher by letting the shoulder blades relax down the back. Exhale and allow your back to release down, energy through the crown of the head as you lean back. Let your neck relax, tensing up here will be counteractive. Breathe deeply for 5 to 10 breaths or until you find comfort in the pose. Inhale to slowly rise back up to a straight spine. Release with a few trunk twists or any movement that will feel good to your body after this pose.

Take a Chill Pill & Relieve Anxiety with Bridge Pose

Sankrit Name: Setu Bandha Sarvangasana

Feeling anxious and nervous about something? Alleviate stress, worry, and anxiety with bridge pose, a beginner’s inversion.

Lie flat on your back with knees bent parallel, feet flat on the ground, arms down by your sides. On your inhale, rise your pelvis toward the sky and keep pushing down through the feet and hands to balance the weight. Take this a step further by placing a block or study pillow under the back to stay with your pelvis elevated. Stay here for about 5 breath cycles. On a slow exhale, lower back down slowly to your mat and repeat.

Ease S.I. Joint Discomfort with Triangle Pose

Sanskirt Name: Trikonosana 

Experiencing aches and pains in your lower back area? It could be something deeper caused by your sacroiliac joint, the pelvis joint formed by the sacrum and ilium. Its main function is to manage stability and weight transfer. While many experience this pain, so few actually know it
is connected with their sacroiliac joint. Visiting a chiropractor if you are unsure is highly recommended, however, spending some time on your yoga mat may be the best way to relieve the pain. Standing poses, like Triangle Pose (Trikonosana), can increase strength in the glutes and rotator muscles, which help support the S.I. joint.

Stand up against a wall and step feet apart with a wide stance, feet should be wider than shoulder-width and toes facing forward. Turn your left toes to face
the side, so that your left foot is now parallel against the wall. Press into both feet, pull up in the knees, and keep the legs straight. Push into the right hip and bring the arms into a T, with finger tips reaching away. Begin to reach your left hand down toward your toes, 
and continue to bring your right arm up and back. Continue to reach until the shoulders are stacked vertically and you reach your shin, toes, or the ground inside your left foot. Engage your core and try to keep your bottom from touching the wall without leaning forward. Breathe deeply 5 to 10 breath cycles. Inhale to rise back up to standing. Reverse the feet and re-peat on other side.

About the Author

Lee-Ann has a deep–rooted, therapeutic connection with yoga, and aspires to create opportunities for others that foster personal growth and well-being. She completed her RYT 200 at Bombay Yoga Company in 2016 and teaches at Mellow Yoga Studio in Philadelphia, PA. Lee-Ann recently created Two Hearts Dance & Yoga.

This information was first printed in The Moisture Seeker, SSF's member newsletter.

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Topics: Sjogren's, Joint Pain, Fatigue, coping with sjogren's, Chronic Pain, Flare,, Natural Treatments, Yoga

Get the Inside Scoop & Receive the SSF Newsletter!

Posted on Thu, Aug 29, 2019

Summer TMS CoverFor $3 a month, you can become a member of the Sjögren's Syndrome Foundation (SSF) and receive great resources, while also supporting the vital work being done to conquer this complex disease.

Join now with thousands of others who subscribe to our newsletter and receive discounts on Sjögren's resources. 

Member benefits include:

  • The Moisture Seekers newsletter: This 10 issues a year print newsletter contains the latest information on Sjögren's, practical tips for daily living, and answers to medical questions from the experts.

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  • Members-only discounts on a variety of products and services such as The Sjögren's Syndrome Handbook and registration for our educational conferences.

  • Providing the Foundation with one more voice to increase awareness, educate others, and encourage research – all of which help in the fight to conquer Sjögren's.

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Topics: Pulmonary manifestation, Dry Mouth, Dry Eyes, Sjogren's, Joint Pain, Fatigue, coping with sjogren's, Gastroesophageal Reflux, Advocacy, Sjögren’s, Heart disease

Pain and Sjögren's

Posted on Thu, Aug 15, 2019

Pain and Sjögrens Chronic pain is one of the most common symptoms associated with Sjögren’s. I have the interesting position of working as a healthcare provider in the field of comprehensive pain medicine as well as being a Sjögren’s sufferer. My role working as a Physician Assistant and Chiropractor is to help patients manage their pain. In our practice, we treat a variety of diverse conditions with a continuum ranging from carpal tunnel syndrome to abdominal pain and everything in between. While this can be a challenging area of medicine to practice, it is also quite rewarding to assist others in living a more enhanced quality of life.

Prior to being diagnosed with Sjögren’s, I rarely experienced pain. Recently, I was reminiscing back to a time not many years ago in which I only used ibuprofen once or twice over several years’ time. My own personal struggle with Sjögren’s causes me to endure discomfort in various areas of my body every day. I experience joint pain, especially in my knees and fingers. The nerve sensations in my muscles are also very discomforting. Additionally, only since the development of Sjögren’s, I suffer from debilitating pelvic pain. Non-steroidal anti-inflammatory medications ibuprofen and Celebrex seem to help the greatest for my pain. Heat is also quite effective. When I make more anti-inflammatory diet choices, my pain is absolutely better. This includes avoiding excessive sugars, flour, dairy, red meat as well as processed and fried substances. When I regularly take vitamin D and eat fresh cherries the pain also improves. If I have poor stress management and sleeping habits, my pain worsens. Finding motivation for regular exercise can be difficult as I also fight significant fatigue, but I know that movement is necessary to keep my joints and muscles mobile. I also use a TENS unit from time to time as well as over the counter lidocaine products.

It is fulfilling to assist in improving the quality of life of others that suffer from chronic pain. This is especially meaningful being that I endure pain daily. I encourage anyone experiencing chronic pain to seek out a comprehensive pain management specialist for evaluation.

by Rebecca Hosey, DC, MSPAS, PA-C

Dr. Rebecca Hosey is a Board Certified Physician Assistant and Chiropractor. She has practiced interventional pain medicine for many years and was diagnosed with Sjögren’s in 2015.

This information was first printed in The Moisture Seeker, SSF's member newsletter.

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Topics: Symptoms, Sjogren's, coping with sjogren's, Chronic Pain, Vitamin D, Natural Treatments

Acupuncture for Dry Eye

Posted on Mon, Jul 15, 2019

acupuncture July is Dry Eye Awareness Month!  We hope you enjoy this blog post aimed to promote dry eye awareness and education.

The “Living with Sjögren’s” patient survey, conducted by Harris Poll on behalf of the Sjögren’s Syndrome Foundation, SSF, showed that 92% of Sjögren’s patients suffer from dry eye. Chronic dry eye has two main causes: decreased secretion of tears by the lacrimal (tear-producing) glands and loss of tears due to excess evaporation. Both can lead to ocular surface discomfort, often described as feeling of dryness, burning, a sandy/gritting sensation, itchiness, visual fatigue, sensitivity to light and blurred vision. In Sjögren’s, a person’s white blood cells mistakenly invade moisture-producing glands and affects the entire body, including the lacrimal glands, causing inflammation and reducing secretion, which causes dry eye to be one primary symptoms of the disease.

Chronic dry eye does not typically get better on its own, and often times it will get worse. Acupuncture is a very safe treatment, and apart from occasional bruising, its side effects typically include improved sleep quality, relaxation of tense muscles, and a sense of wellbeing.

Question_and_AnswerCan acupuncture increase moisture with dry eyes?

The beauty of acupuncture is that it does not build a dependency and in fact builds independence by helping to rebuild and restore function to various body systems.

A study published in the Chinese Journal of Practical Ophthalmology “found that patients receiving acupuncture plus lubricant eye drops had a 76.92% improvement in rate of dry eye symptoms. Patients receiving only lubricant eye drops had a 53.85% improvement. Tear film stability improved significantly with acupuncture. Patients receiving acupuncture plus eye drops had a tear film break-up time of 4.03 seconds compared with 2.11 seconds for the eye drop only group.” This means that acupuncture resulted in increased tear production and slower tear evaporation, so tears last longer.

Another study, published in Ophthalmology Times, found that acupuncture “significantly improved patients’ subjective assessment of dry eye symptoms, was associated with significant reduction in use of artificial tears at six months, and its benefits lasted for 9-12 months.”

Having an autoimmune disease, like Sjögren’s, can be stressful and overwhelming at times, often leading to poor sleep quality. All of these work against creating and maintaining healthy levels of serotonin, which is fundamental to healthy tear production.

Receiving regular acupuncture helps maintain healthy serotonin levels, as well as to decrease inflammation, increase circulation, and stimulate the nervous system to focus on a specific region, such as the eyes.

What does this mean for Sjögren’s patients?

It means that although you have Sjögren’s and may always have to work to maintain a reasonable number of tears, a combination of diet, stress management, and acupuncture may be able to minimize and help keep your symptoms at bay.

Dr. Townsend, adjunct professor at the University of Houston College of Optometry, says that “the potential patient benefits of acupuncture suggests that, at the very least, we should consider contacting an acupuncturist and explore working together as a possibility.”

Acupuncture has become so popular in the past few years that everyone is adding it to their list of services. Look for a National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM®) board certified acupuncturist who has a minimum of four years of formal training and countless hours of clinical experience to ensure the best possible experience.

by Chris Leininger, DACM (c), Dipl. Ac. & ABT (NCCAOM), L.Ac., Founder and Director of Pure Health Acupuncture, LLC in Brazil, IN.

This information was first printed in The Moisture Seeker, SSF's member newsletter.

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Topics: Dry Eyes, Sjogren's, Treatment, coping with sjogren's, Natural Treatments, Acupuncture Treatment

Hair Loss and Sjögren’s

Posted on Mon, Aug 20, 2018

SSF logo Q. “I am starting to experience hair loss. Can this be connected with my Sjögren’s and what can I do about it?” 

A. Hair loss can be caused by a number of conditions including hormonal or genetic causes, medications, inflammatory conditions of the scalp, autoimmune disorders, or shedding of the hair that can occur after a change in health status. Patients with Sjögren’s can have hair loss, but their underlying Sjögren’s is not always to blame. A thorough history and physical exam by a dermatologist can help to elucidate the underlying cause of the patient’s hair loss and will guide treatment.

As Sjögren’s patients often have a concurrent autoimmune disorder it is important to confirm entities like cutaneous or systemic lupus are not the cause of the hair loss. Control of the underlying autoimmune disease is the priority in this case to improve the hair loss. If cutaneous lupus is present, topical medications, injectable medications, and sometimes-internal medications are needed. Significant illness or major life events, which can affect Sjögren’s patients, can produce a shedding of the hair called telogen effluvium that fortunately is self-resolving. Androgenetic alopecia, a type of hair loss that can be caused by genetic or hormonal factors, and is not related to Sjögren’s, can begin with a widening of the midline part of the hair. Topical minoxidil (Rogaine) 5% foam or solution is usually the first line treatment.

As a number of other conditions can also produce hair loss, I would encourage you to see your dermatologist to diagnose your type of hair loss and formulate a treatment plan.

Natalie Wright, MD, FAAD
Texas

This article was first printed in The Moisture Seekers, SSF's patient newsletter for members.

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Topics: Treatment, coping with sjogren's, Lupus, Sjögren’s, Hair Loss

Sjögren’s Top 5: What Your Rheumatologist Should be Monitoring For

Posted on Tue, Oct 31, 2017


Daniel Wallace.pngPatients with Sjögren’s usually see their autoimmune treating physician several times a year. Mostly, they are rheumatologists, but can also be primary physicians, internists or subspecialists such as interested pulmonary or hematology doctors. In addition to taking a history, performing a physical examination, or drawing blood tests, are there things that should be specifically looked at or monitored for? This article reviews the top five items.

1. Is there evidence for extraglandular Sjögren’s?

Some people with extraglandular Sjögren’s may have interstitial lung disease, renal tubular acidosis, swollen lymph glands, or inflammatory scarring of the bile ducts (biliary cirrhosis). Being identified with extraglandular Sjögren’s usually warrants systemic immune suppressive therapy with agents such as azathioprine, methotrexate, cyclophosphamide or rituximab. The treating physician should use their tools to screen for the spread of Sjögren’s to new areas with imaging or laboratory testing, which allows one to be proactive and treat the disease early.

2. Screening for lymphoma

Over a 15-20 year period of observation, 8-15% of Sjögren’s patients develop a lymphoma. Screening for symptoms of early lymphoma include asking a patient about swollen glands, fevers, weight loss and new onset of fatigue. A physical examination can detect lymph nodes, evidence for a “wasted” appearance, or an enlarged spleen. I perform a serum protein electrophoresis (a $30 blood test) on my Sjögren’s patients every 6 months. Often, early lymphomas can be detected with the development of an extra protein on this determination, which is known as a “MGUS” or monoclonal gammopathy of uncertain significance. Most Sjögren’s associated lymphomas are of a specific variety known as “MALT” that, if identified early, responds well to treatment.

3. Looking for overlapping Sjögren’s

Sjögren’s patients can have features of other autoimmune conditions such as rheumatoid arthritis, inflammatory myositis, biliary cirrhosis, scleroderma, Hashimoto’s thyroiditis or lupus, while still being “mostly” Sjögren’s. These features may warrant certain anti-inflammatory interventions. This would include corticosteroids for inflamed muscles, drugs that promote more oxygen to dilate the vessels of the hands for individuals with Raynaud’s (often seen with scleroderma or lupus), approaches that halt the development of erosions (bone destruction) with rheumatoid arthritis (e.g., anti-TNFs), ursodiol for biliary cirrhosis, antimalarials for subacute cutaneous lupus rashes in anti-SSA positive patients or thyroid. Identification of a secondary autoimmune overlap can often explain symptoms that may be profound but are not a part of Sjögren’s.

4. Don’t unnecessarily treat Sjögren’s for symptoms that are not related

SSF Top 5 .png

Sjögren’s patients may have high blood pressure, depression and diabetes, as does 25% of the United States. Medications given for these conditions can make dry eye or dry mouth symptoms more severe. Treating such patients with anti-inflammatory medications or diuretics (water pills) is not advisable. Before altering one’s Sjögren’s medications or their environment, the physician should strive to rule out co-morbidities or co-existing circumstances that may seemingly worsen Sjögren’s symptoms. 

5. Screening for head and neck emergencies or ares associated with non-extraglandular Sjögren’s

Patients with Sjögren’s whose disease is confined to the salivary glands, eye, head and neck areas occasionally develop complications, which may mandate emergent treatment. These include acute inflammation of the parotid gland (parotitis, or Mikulicz’s syndrome, with either a stone or focus of inflammation, treated with corticosteroids), corneal ulcerations, blocked salivary ducts (affecting the mouth), and dental caries or abscesses. Most Sjögren’s patients see a dentist 2-3 times a year to get their teeth cleaned, and are often frequent return visitors to their otolaryngologist (ENT doctor). 

In summary, screening for the five features reviewed above, can prevent or promote early treatment of the overwhelming complications with Sjögren’s.

This information was first printed in The Moisture Seekers, SSF's patient  
newsletter for members. 

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Topics: Depression, Treatment, Top 5 Tips, coping with sjogren's, Raynauds, Lupus, Lymphoma, Ask the Expert, Methotrexate

Headaches and Sjögren’s

Posted on Thu, Aug 31, 2017

Headaches and Sjogren's.png

Sjögren’s is a systemic autoimmune disease often characterized by dryness of the eyes and mouth and accompanied by chronic fatigue and musculoskeletal pain. Over half of Sjögren’s patients experience systemic symptoms, some of which can involve the nervous system. One of the most common symptoms involving the nervous system is headache. Headaches are a common complaint in healthy people who do not have an autoimmune disease. Some of the most common types of headaches include tension type headaches, migraines (with and without aura), and cluster headaches. Headaches are common in Sjögren’s, estimated to occur in roughly 50 to 75% of patients.

headaches .png

Many Sjögren’s patients may wonder whether or not their underlying autoimmune disease is causing the headaches. Although the answer to this question is largely unknown, some research comparing Sjögren’s patients with healthy controls show that tension-type headaches and migraine headaches, the most common headache subtypes found in Sjögren’s, are more common in those with Sjögren’s than in the general population. Other data demonstrate headaches are more severe in those with Sjögren’s than in those of the general population with depression as a significant influence on headache severity.

Sjögren’s patients may also develop a rare and particularly severe type of headache caused by inflammation of the outer lining of the brain (the leptomeninges) called aseptic meningitis. Although meningitis in general is typically caused by infectious agents like viruses and bacteria, in aseptic meningitis, the inflammation is not caused by infection but rather by other causes such as a reaction to a medication or autoimmune activity. In addition to headaches, aseptic meningitis may also be associated with fever, neck stiffness, and other neurologic symptoms such as double vision. 

In general, treatment for routine headaches is the same in those with Sjögren’s as it is for anyone else including medications such as acetaminophen or ibuprofen. Treatment for aseptic meningitis may also involve glucocorticoids such as prednisone. For those Sjögren’s who suffer from headaches, it is important to discuss this symptom with the primary care practitioner and rheumatologist to see if further evaluation is warranted.

This information was first printed in The Moisture Seekers, SSF's patient  
newsletter for members. 

Click Here to Receive our Newsletter  by Becoming an SSF Member

Topics: Depression, Symptoms, Sjogren's, Treatment, coping with sjogren's, Headaches

April is Sjögren’s Awareness Month!

Posted on Sat, Apr 01, 2017

SSF This Is Sjogren's.pngApril is Sjögren’s Awareness Month! To portray the entire patient experience, in our This Is Sjögren’s Awareness Campaign, the Sjögren’s Syndrome Foundation (SSF) is drawing facts and figures from our recent “Living with Sjögren’s survey findings. This survey, which was conducted by Harris Poll on behalf of the SSF, gave the Foundation amazing data about how patients’ lives are affected by Sjögren’s, what symptoms and complications patients live with and how the disease affects their emotional and financial well-being. 

The independent nationwide survey, designed by Harris Poll along with the SSF and a volunteer committee of patients and healthcare providers, was mailed to Foundation members in the spring of 2016. Nearly 3,000 adults shared their experiences with the disease and its physical, financial and emotional effects on their lives.

With the support of our members, this survey was developed to help the SSF:

  • Educate regulatory agencies and pharmaceutical companies about a need for a therapeutic drug for Sjögren’s
  • Support the need for additional SSF Clinical Practice Guidelines (CPGs) for how to treat and manage Sjögren’s
  • Provide researchers with information about the variety and severity of experiences patients have with Sjögren’s
  • Create greater awareness of this disease among consumers and healthcare professionals

Every day the SSF is sharing a fact from these survey findings or other information about the disease on our social media accounts to show: This is Sjögren’s (#ThisIsSjögrens)! While the daily post give a small glimpse into Sjögren’s, by the end of April, we hope these 30 posts will show the complexity and seriousness of the disease. SSF_17114.03-4-2.png

How Can You Get Involved:

We encourage you to use April Awareness month and our #ThisIsSjögrens social media campaign, as a way to talk about Sjögren’s with your family and friends. Every post is an opportunity to start a conversation about living with Sjögren’s and how it affects you. The more others understand, the more support you can find. And know that we at the Sjögren’s Syndrome Foundation are here for you! We are committed to accelerating the development of better diagnostic, management and therapeutics that will have the greatest potential impact on improving the quality of life for Sjögren’s patients. Together, we will transform the future of Sjögren’s!

SSF This Is Sjogren's April 2017.jpg

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Topics: coping with sjogren's, Advocacy, Men with Sjogren's,, Children with Sjogren's,, April Awareness Month, #ThisIsSjögrens

Sjögren's Awareness Month is Almost Here!

Posted on Mon, Mar 20, 2017


ATT00002.pngApril is Sjögren's Awareness Month and we hope you will join us in educating the public about this complex disease and how it affects those who are living with it.

Sjögren's is often described as an invisible illness because many of the disease’s debilitating symptoms cannot be physically seen. This can lead to a misunderstanding about the seriousness of the disease and be extremely isolating for those living with Sjögren's. 

This April, the SSF is going to build upon our This Is Sjögren’s campaign from last year! Our goal is to help others visualize the disease from a patient’s perspective, and close the gap between the reality of Sjögren’s and the perception that many non-patients have with Sjögren’s! 

To better portray the entire patient experience, in our #ThisIsSjögrens 2017 April Awareness campaign, the SSF will be drawing facts and figures from our recent national patient survey. This survey, which was conducted last year, has given the SSF amazing data about how our patients lives are affected by Sjögren’s, what symptoms and complications patients live with and how the disease affects their emotional and financial well-being!  

Each day, throughout April, the Foundation will post a different #ThisIsSjögrens factoid or patient phrase on social media – so stay tuned! And while the daily post will give a small glimpse into living with Sjögren’s, by the end of April, we hope these 30 posts will show the complexity and seriousness of the disease.

Let Your Voice Be Heard!

SSF This Is Sjogren's.png

As the voice of the SSF, we want to hear form you! Please comment below and share with us one phrase that represents what it’s like to live with Sjögren’s. Thank you for your support; together we will transform the future of Sjögren’s.                                             

Example: Sjögren’s means choosing a medication that will help with my fatigue and joint pain but knowing it will make my eyes drier and more painful. #ThisIsSjögrens!

Topics: coping with sjogren's, Advocacy, April Awareness Month

Why doesn’t my doctor understand Sjögren’s?

Posted on Mon, Jan 30, 2017

Why Doesn't my doctor understand Sjogren's .pngLike many Sjögren’s patients, I find it disheartening that most doctors remain unfamiliar with the disease. First diagnosed with dry eyes and corneal abrasions at age 18, I had no idea that something bigger was brewing. Over the next three decades, not one of my multiple eye specialists asked about other symptoms that could have led to a timely Sjögren’s diagnosis. By my thirties, I had a classic Sjögren’s picture of dry eyes and mouth, flu-like fatigue, multiple gastrointestinal problems, chronic sinusitis and widespread musculoskeletal pain. Yet no one put the pieces of the puzzle together, and it wasn’t until I experienced incapacitating symptoms that Sjögren’s was even considered.

Lack of provider awareness would be understandable if Sjögren’s was a rare disease. But Sjögren’s is extremely common, affecting approximately 1% of the US population, mostly adult women.1 This is similar to the number of women living with breast cancer.2 I like to call Sjögren’s “the most common disease no one has ever heard of.”

Sarah Schafer.pngSjögren’s can be debilitating. Despite a high disease burden and increased rates of infection and heart disease, Sjögren’s still tends to be “missed and dismissed.” While direct complications such as lymphoma and organ involvement are often successfully treated, these conditions lead to death in approximately 10% of Sjögren’s patients.3,4

After years of advocating for my own care, I am now using my unique vantage point as a physician-patient to teach primary care providers (PCPs) about Sjögren’s. From discussions with recent medical school graduates, I have discovered that Sjögren’s continues to be glossed over as a mild disease, mostly about managing dryness. Medical students are rarely taught these basics: Sjögren’s is common, serious and always systemic.

The following ten points help to explain why “Sjögren’s neglect” persists in medicine. By understanding what is behind the problem, you can better advocate for yourself as a patient.

  1. Sjögren’s is a complicated disease. It takes a high index of suspicion to recognize that scattered and mostly invisible symptoms may all be related. Most Sjögren’s patients experience the triad of pain, fatigue and dryness. While only the dryness can be measured, doctors must take patient reports of pain and fatigue seriously in order to see the bigger picture. 
  1. Sicca (dryness) symptoms are often overlooked in the primary care setting. Sicca is often the best clue to diagnosis. Yet many patients do not mention dryness to their providers, thinking it unimportant or unrelated to their other symptoms. Physicians and patients alike may not recognize that burning, gritty eyes or difficulty swallowing food without liquids are dryness symptoms. 
  1. Sjögren’s patients usually look well, even when they are quite ill. There are no blood tests that correlate with the severity of the disease. This makes it easy for providers to write off patients as complaining or malingering.
  1. Misdiagnosis is common. Symptoms often overlap with more familiar conditions such as depression, fibromyalgia, hypothyroidism and irritable bowel syndrome. Menopause often unmasks Sjögren’s symptoms that have been brewing for years. While these conditions may co-occur with Sjögren’s, PCPs often fail to consider the possibility of Sjögren’s as the major culprit.
  1. Delayed diagnosis. The typical Sjögren’s patient has a delay of nearly three years until diagnosis. True delays are even longer: many patients describe decades of symptoms before things got bad enough to seek diagnosis. Clearly this needs to change. PCPs need to be taught how to recognize Sjögren’s and take the first steps to diagnosis.
  1. Diagnosis can be difficult. Better tests are needed. There is no one test or group of tests that diagnoses Sjögren’s early and accurately. Many patients who do not have Sjögren’s antibodies (“seronegative”) are told they do not have Sjögren’s. Yet 30% of Sjögren’s patients are in this seronegative group. These patients typically experience even greater delays in diagnosis, because the confirming minor salivary gland biopsy is not always done, and it may take years to turn positive. Normal blood tests do not rule out Sjögren’s!
  2. Patients with serious organ system complications are often misclassified as other autoimmune diseases. This happens largely due to the ongoing misperception of Sjögren’s as a mild disease. These patients may never get properly diagnosed, perpetuating the “Sjögren’s is mild” mythology.
  1. Research neglect. Clinical studies of Sjögren’s lag far behind other connective tissue diseases. While this is changing, this lack of research keeps Sjögren’s under the radar of awareness as an important health issue.  
  1. Until 2016, no standard of care existed for Sjögren’s management. Doctors tend to be highly motivated to practice medicine within the standard of practice in their community. The recently published clinical practice guidelines (CPGs) will be a good first step in providing consistent treatment standards for rheumatologists, ophthalmologists and dentists.
  1. Rheumatologists are not always up to date on Sjögren’s management. There are still some rheumatologists- the very specialists who treat Sjögren’s- who do not consider Sjögren’s to be serious enough to warrant treatment. There are too many present day stories of patients with debilitating fatigue and pain who are refused treatment because the rheumatologist told them that “their Sjögren’s was not bad enough.” Hopefully the CPGs will provide incentive for these rheumatologists to treat Sjögren’s patients sooner. Most Sjögren’s experts with extensive clinical experience believe that treatment slows progression and prevents serious complications.  

As a Sjögren’s patient, what can you do?

  1. Make sure you are being followed by a rheumatologist, ophthalmologist and dentist who are familiar with Sjögren’s and its complications. Take a copy of the new clinical practice guidelines to your next appointment.

  2. Understand that PCPs are unlikely to be well educated about Sjögren’s, due to the many reasons listed above. However, if they are caring for you, it is their job to learn about Sjögren’s. I encourage you to refer your physicians and their office team to the SSF and sjogrens.org. The SSF will provide medical professionals with free materials to help them diagnose and manage Sjögren’s.

This information was first printed in The Moisture Seeker, SSF's member newsletter.

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REFERENCES:

  1. Helmick CG, Felson DT, Lawrence RC, et al. National Arthritis Data Workgroup. Estimates of prevalence of arthritis and other rheumatic conditions in the United States, Part I. Arthritis Rheum. 2008;58:15-25
  2. http://seer.cancer.gov/statfacts/html/breast.htm
  3. Brito-Zeron P, Ramos-Casals M, et al. Predicting adverse outcomes in primary Sjögren’s syndrome: identification of prognostic factors. Rheumatology 2007;46:1359-136
  4. Brito-Zeron, P, Ramos-Casals M. Systemic Sjögren’s: More than a sicca disease. http://www.the-rheumatologist.org/article/systemic-sjogrens-more-than-a-sicca-disease

 

Topics: Diagnosing Sjogren's, Sjogren's, Treatment, coping with sjogren's, Clinical Practice Guidelines

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