What happens in the glands
Lymphocytes penetrate into the salivary and lacrimal glands and gradually replace the working tissue. The glands stop coping, and the mucous membranes lose their protective film. Saliva not only moisturizes: it washes away bacteria, neutralizes acids and contains substances that protect enamel. Therefore, if there is a lack of it, caries, fungal infections and inflammation of the tongue quickly develop. The tear film protects the cornea, and if it is deficient, irritation, erosion, and the risk of eye damage occur. Similar changes affect the glands of the respiratory tract, stomach, skin and genital organs.
- Primary syndrome is an independent disease
- Secondary - against the background of another rheumatic disease
- Damage to the salivary and lacrimal glands
- Dry airways and vagina
- Possible systemic manifestations in other organs
Symptoms
Complaints grow gradually, sometimes over years. Dry mouth makes you drink dry food and wake up at night to drink; the tongue becomes bright red and painful, the lips become cracked. The eyes turn red, get tired quickly, have a hard time with wind, air conditioning and working behind a screen, and instead of tears, very little liquid is released when crying. The parotid glands are often enlarged - the face appears swollen at the corners of the jaw. More than half of patients complain of severe fatigue and joint and muscle pain, which can be even worse than dryness.
- Dry mouth, difficulty swallowing dry food
- Multiple caries, inflammation of the tongue, seizures
- Pain and feeling of sand in the eyes, redness
- Swelling of the parotid and submandibular glands
- Severe fatigue
- Pain in joints and muscles
- Dry skin and vaginal mucosa
Diagnostics
The doctor assesses the severity of dryness and necessarily excludes other causes: medication, diabetes, radiation therapy, viral infections. The ophthalmologist measures tear production with a Schirmer test and evaluates the coloration of the ocular surface. The dentist evaluates salivation and the condition of the teeth. The blood is searched for antinuclear antibodies, specific antibodies to the Ro and La antigens, rheumatoid factor, ESR, general blood count and protein fractions are assessed. If the picture is unclear, an ultrasound of the salivary glands and a biopsy of the minor salivary gland on the inside of the lip are performed.
- Schirmer test and ocular surface staining
- Salivation assessment
- Antinuclear antibodies and antibodies to Ro and La
- Rheumatoid factor, ESR, complete blood count
- Ultrasound of the salivary glands
- Minor salivary gland biopsy
- Exclusion of drug dryness and other causes
Treatment of dryness
It is impossible to completely restore the functioning of the glands, but the quality of life improves with consistent care. For the eyes, artificial tear preparations without preservatives are used, gels at night, and, if necessary, procedures that retain tears in the eye. Saliva substitutes, frequent drinking in small sips, chewing gum without sugar to stimulate salivation are suitable for the mouth; sometimes the doctor prescribes drugs that enhance secretion. Dental prevention is extremely important: fluoridation, regular examinations, treatment of fungal infections. Smoking and dry air aggravate symptoms.
- Artificial tears without preservatives, night gels
- Saliva substitutes, frequent small sips
- Chewing gum without sugar
- Drugs that stimulate secretion, as prescribed by a doctor
- Fluoridation and regular dental checkups
- Air humidification, smoking cessation
- Treatment of oral candidiasis
Systemic therapy and observation
If the joints, skin, lungs, kidneys or nervous system are affected, the rheumatologist uses basic drugs and, with high activity, glucocorticoids or genetically engineered drugs. Dryness itself responds poorly to these drugs, so they are prescribed specifically for systemic indications. Patients with this diagnosis need regular monitoring and monitoring of tests, since the disease increases the risk of lymphoma. Alarming signs are persistent enlargement of the salivary glands and lymph nodes, fever and weight loss; they should be reported to your doctor immediately.
- Basic therapy for systemic manifestations
- Short course glucocorticoids during exacerbation
- Genetically engineered drugs in selected cases
- Regular monitoring of blood tests
- Oncological vigilance and monitoring of glands
- Treatment of concomitant autoimmune diseases
- Routine examinations by an ophthalmologist and dentist