Do you feel so exhausted that even combing your hair or brushing your teeth seems like climbing Everest? If you do feel this way and also keep coming down with skin allergies and joint pain, then it's time to seek a specialist's help. There's a debilitating syndrome that's silently creeping upon urban Indians, but is little known and often misdiagnosed. Known as Sjogren's Syndrome (ss) and pronounced 'show grins', it is an autoimmune disease wherein the body's immune system mistakenly attacks its own moisture-producing glands.
Genetic and environmental factors are one of the several causes of this syndrome but not much is known about the exact triggers. It is more prevalent in people where there is a family history of autoimmune illnesses like hypothyroidism and type I diabetes. Low-levels of SS-B (La) antibodies in the blood could activate the syndrome while physical and mental stress can make a person more susceptible to it. Pollution is also cited as one of the causes of SS; however, no research has been carried out to determine the exact pollutants. Women above the age of 35 have reason to worry as 90 per cent of ss patients belong to this category. It progresses slowly and takes over five to six years to get diagnosed.
"Sjogren's Syndrome cases are on the rise in India. At least four to five patients visit my clinic every month."Dr Reena Sharma, Ahmedabad
"I have been living with this syndrome for over five years now. I always carry a bottle of water and eye drops with me."Kirtida Oza, Ahmedabad
As Sjogren's is a syndrome, it is a combination of several signs and symptoms. Patients affected by SS are more prone to pneumonia, liver failure, kidney failure and other internal organ damage. A small percentage of patients could even develop cancer of the lymph glands. "The probability of a SS patient getting cancer has increased by over 30 times as compared to the general population," says Dr Amita Aggarwal, vice-president of the Indian Rheumatology Association and assistant professor, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow. Sjogren's is classified into two types-primary and secondary. In primary syndrome, the tear and salivary glands are affected which results in the dryness of the eyes and mouth; secondary SS occurs with another disease like rheumatic arthritis, lupus or scleroderma. According to Dr Aggarwal, "Doctors are finding it difficult to spot the primary syndrome compared to the secondary one."
Like it happened with Pratibha Gupta, a 50-year-old housewife from Lucknow, who went to the doctor following joint pain. It was diagnosed as rheumatoid arthritis. Meanwhile, she lost five teeth due to caries and her dentist had advised filling. These tell-tale symptoms were accompanied by a gritty sensation in her eyes and oral dryness. Further, she had two episodes of parotid swelling that were treated with antibiotics and painkillers. But her doctors had missed out completely on suspecting Sjogren's Syndrome.
Some of the major manifestations of the ss include hypokalemic periodic paralysis in which excessive dehydration leads to low level of potassium in the blood leading to the paralysis and renal tubular acidosis in which the kidneys fail to excrete acids into urine. In some cases, SS patients might also develop parotid swelling, the swelling of the largest salivary gland in the mouth. In India, people are unaware of the existence of ss. For almost five years, Ahmedabad-based Kirtida Oza, 47, made several rounds to the doctor's clinic until she was diagnosed with SS. "I didn't know what was happening to me and even the doctors failed to diagnose it," she says. However, such cases are on the rise. Dr Reena Sharma, rheumatologist at Shalby Hospital, Ahmedabad, says at least four to five patients suffering from SS visit her in a month.
Besides general blood tests, a number of simple diagnostic tests like the Schirmer eye test, lip biopsy, salivary scintigraphy and parotid scans can be performed to determine whether a person is suffering from Sjogren's or not. Though there is no specific cure, SS can be kept under control with medication and precautions. Treatment depends on the organ that is affected in the syndrome. Currently, research to find a concrete cure is underway at the Christian Medical College and Hospital (CMC), Vellore. "We are working on the use of Omega-3 fatty acid (fish oil) to treat SS. However, it is still at an observational stage," says Dr Debashish Danda, professor and head, clinical immunology and rheumatology, CMC. But SS leads to alterations in the lifestyle as performing hectic activities becomes difficult as these patients tend to get exhausted easily. Other symptoms like breathlessness or dryness of the eyes also need care. "You will never see me without eye drops and a water bottle. They are the two most indispensable things of my life now," Oza says.
Dr Ramani Atkuri, 46, who lives near Bilaspur in Chhattisgarh, was diagnosed with primary SS five years ago. "I am a doctor and so is my husband but even then we couldn't diagnose it initially," says Atkuri. Severe phases of exhaustion would take her by surprise but she didn't pay much heed. Her ophthalmologist referred her to a rheumatologist and it was then SS was detected. Atkuri's work requires her to travel a lot but now she has cut down on it considerably. "After a day at work, I can't do anything. I just reach home and fall asleep," she says, adding that it takes her a couple of days to regain her lost energy. The message is clear. Ignoring those subtle signs of dryness, exhaustion and joint pains can lead to serious complications and a little known syndrome called Sjogren's.
Related AilmentsMajor manifestations of Sjogren's Syndrome
- Autoimmune thyroiditis can lead to abnormal thyroid hormone levels.
- Gastroesophageal reflux disease can cause heartburn and difficulty in swallowing.
- Primary biliary cirrhosis, an autoimmune disease of the liver, can lead to scarring of liver tissues.
- Cancer of the lymph glands.
- Hypokalemic periodic paralysis in which excessive dehydration leads to low level of potassium in the blood leading to paralysis.
- Renal tubular acidosis in which the kidneys fail to excrete acids into urine.
Preventive MeasuresPrecautions that keep this syndrome under control
- Moisture replacement therapy to ease dryness.
- Eye drops to reduce inflammation of the tear glands.
- Drinking plenty of fluids to treat oral dryness.
- Proper dental hygiene to avoid dental decay.
- Sucking sugarless lemon drops or glycerin swabs to help stimulate salivary glands.
