Sjogren syndrome is an autoimmune condition characterized by dry eye and dry mouth. A recent medical journal article suggests that Sjogren “disease” should be defined by the presence of specific anti-Ro/La antibodies, while Sjogren “syndrome” has similar symptoms without these antibodies. Other authors report progress in diagnosis and treatment.
Biopsy of the salivary gland has been commonly used as a diagnostic tool. However, an article from the University of Chicago reports that biopsy is usually not necessary. A Japanese research team reports that ultrasound imaging is an effective diagnostic tool. It has the advantages that it is non-invasive and easy to use.
Treatment includes anti-inflammatory and immune-modulating drugs. A review article in the Journal of the American Medical Association has this to say about the most commonly used drugs:
1. Pilocarpine and cevimeline (Evoxac) are beneficial, based on evidence from controlled trials.
2. Cyclosporine eye drops are beneficial for dry eye.
3. Anti-tumor necrosis factor drugs have not shown clinical efficacy for Sjogren syndrome. These drugs include infliximab (Remicade) and etanercept (Enbrel). This is important because these drugs have serious side effects, must be administered by injection, and are expensive.
4. Rituximab demonstrated significant results in some secondary outcomes in two small trials. Larger controlled trials are suggested for this drug. It is also an expensive option with serious side effects, and must be injected.
I reported last year on clinical trials for dietary supplements being tested for Sjogren's syndrome. I found two: DHEA and EPA (and omega-3 fatty acid). The DHEA studies are now reported as complete, and the EPA study terminated with the data being analyzed. I hope to see results published soon. Other clinical trials are in progress for a variety of drug options, as well as mesenchymal stem cell transplants.
References:
1. Ramos-Casals M et al, “Sjogren syndrome or sjogren disease? The histological and immunological bias caused by the 2002 critieria”, Clin Rev Allergy Immunol. 2010 Apr; 38(2-3): 178-85.
2. Bamba R et al, “The minor salivary gland biopsy as a diagnostic tool for Sjogren syndrome”, Laryngoscope. 2009 Oct; 119(10): 1922-6.
3. Obinata K et al, “A comparison of diagnostic tools for Sjohren syndrome, with emphasis on sialography, histopathology, and ultrasonography”, Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010 Jan; 109(1): 129-34.
4. Ramos-Casals M et al, “Treatment of primary Sjogren syndrome: a systematic review”, JAMA 2010 Jul 28; 304(4): 452-60.
5. Clinical trials:
http://clinicaltrials.gov/ct2/results?term=sjogren
Linda Fugate is a scientist and writer in Austin, Texas. She has a Ph.D. in Physics and an M.S. in Macromolecular Science and Engineering. Her background includes academic and industrial research in materials science. She currently writes song lyrics and health articles.