disease (syndrome) S
In this article, the reader learns that a Sjogren's syndrome, why it arises, as shown, as well as get acquainted with the principles of diagnosis and treatment of this condition.So ... Content
As mentioned above, the disease (syndrome) Sjogren - a condition which is characterized by a triad of symptoms: dry eyes (keratoconjunctivitis sicca), dry mucous membranes of the mouth (xerostomia) and any autoimmune disease.Interestingly, for the production of this diagnosis is enough even the first 2 characters.If a patient is determined keratoconjunctivitis and xerostomia, Sjögren's syndrome is called the primary, and some authors consider it a separate disease entities, and was referred to as Sjogren's disease.If these symptoms along with chronic inflammation of the joints is determined autoimmune nature, called secondary Sjogren's syndrome.
suffer this pathology persons of all ages, but 90% of the patients are women of middle and old age.
To date, no reason, no mechanisms of this disease is not completely understood.It is believed that the main role in the development of autoimmune disease belongs factors.Undoubtedly, there is also a genetic predisposition to Sjogren's syndrome: it can be diagnosed at the same time in several close relatives, usually the mother and daughter.
Under the influence of unknown factors in the body fails, resulting in the lacrimal and salivary gland infiltrated B- and T-lymphocytes.The blood thus detect antibodies to epithelial cells of affected glands, and rheumatoid factor and other immunological phenomena.
main morphological feature is the infiltration of the exocrine glands and lymph plasmocytes.The first to suffer the tear and salivary glands, a little less - cancer of the bronchi, the digestive tract and vagina. amazing and large and small glands.First, at an early stage of the disease, the process involved only a small ducts;the progression of her infiltration extends further, to actual breast tissue, resulting in glandular tissue atrophy and replaced by connective.In some cases described above infiltrates not only occur in the exocrine (exocrine) glands, but also in other organs and body systems, in particular, muscle, lung and kidney.This ultimately leads to dysfunction of the affected organ.
in 30-40% of patients in the material, taken by biopsy of the salivary glands, determined metaplasia (transformation) of the cells lining the ducts: there myoepithelial islands.
Slices affected glands are destroyed in some patients, while others preserved lobular structure.Glands or increased in size, or are in the normal range.
Interestingly, even in the absence of clinical symptoms bright Sjogren's syndrome, a patient in any connective tissue disease likely to show up histological signs of inflammation of the salivary glands.
As mentioned earlier in this article, the most common symptoms of this disease are xerostomia, xerophthalmia, and chronic inflammation of the joints.
In xerostomia, or dryness of the oral mucosa, the patient complained of a Sjögren's syndrome.Dryness in the early stages of the disease occurs frequently, with the progression of it - worries constantly, increasing by prolonged conversation or background disturbances.In addition to directly dry the patient noted a burning sensation and pain in the mouth, it becomes difficult to swallow food - you have to moisten your mouth before swallowing the liquid, but sometimes even that does not help, and swallow dry food the patient can not.The voice hoarse patient, appears suddenly and progresses rapidly caries - in a short time previously healthy teeth deteriorate and fall.
On examination, the doctor draws attention to the reddened, dry mucous membranes of the mouth, many teeth decay, cracks in the corners of the mouth (in medicine this phenomenon is called - cheilitis), and the almost complete lack of saliva in the frenum.In severe cases of illness oral mucosa hyperemic clearly defined stomatitis, gingivitis, teeth missing, buds atrophied, withered lips, they visualized peeling areas.Such a severe course of the disease, as a rule, it is disease, Sjogren's syndrome, or when, develop on the background of systemic lupus erythematosus or rheumatoid arthritis.
often determined by a one- or two-sided increase in submandibular and / or parotid salivary glands.
Very often, persons suffering from the syndrome (disease), Sjogren also suffer acute inflammation of the parotid gland: mumps.This gland increases in size, it becomes swollen, from the salivary duct is allocated purulent secret sick notes increase in body temperature to febrile digits (39-40 ° C), and he is having difficulty opening the mouth.
Dry eye, or xerophthalmia, is celebrated in most patients, but mostly it is expressed precisely in the case of Sjogren's syndrome, or syndrome when combined with rheumatoid arthritis.The patient complained of dry, cutting pain in the eyes, the feeling of being in sand or any foreign body.Eyelids bloodshot and itchy.The eyes get tired quickly when there is undue stress their pain.Rarely - in severe cases - reduced visual acuity and photophobia develops.
the purpose of recognizing the reduced separation tears using Schirmer's test: in the lower eyelid lay a strip of filter paper and make sure that when it gets wet.Norma is getting wet for more than 15 mm in 5 minutes.When Sjogren's syndrome for the same time - 5 minutes - the wet filter paper is much less.At low by simple tests you can perform a forced Schirmer sample: to breathe examinee 10% ammonium chloride (sal ammoniac).
most common systemic manifestations of Sjögren's syndrome are a recurring joint pain or arthralgia.Also, it may be arthritis of the interphalangeal joints of the hands: they are swollen, sore, range of motion in their sharply reduced.May be affected knee and elbow joints.As a rule, it proceeds non-severe arthritis, the symptoms of it after a while regress, erosion not typical.
skin of persons suffering from Sjogren's syndrome, dry, scaly, these changes are particularly pronounced in the area of upper and lower extremities.With the defeat of the sweat glands is reduced sweating.
50% of patients complained of typical of Raynaud's syndrome: this is a high sensitivity to cold, coldness, numbness distal extremities - hands and feet.
Approximately 15% of patients diagnosed with the so-called giperglobulinemicheskuyu purple - the skin of the lower third lower legs, sometimes in the hips and / or abdomen, visualized petechial hemorrhages;It can be determined by increased pigmentation of the skin in these areas.
Sjogren Very often proceeds with the increase of regional lymph nodes.Typically, the process involves the neck, submandibular and supraclavicular lymph nodes, the degree of increase varies from mild to severe: in the latter case, has the form of lymph node pseudolymphoma.Often, when a given pathology and malignant lymphoma: probability of developing a human suffering from dry syndrome are higher than in healthy, 44 times.
If dry syndrome affects internal organs, it is clinically manifested symptoms of their functions: developing dry bronchitis, interstitial pneumonia, polymyositis, glomerulonephritis, tubular acidosis.With the defeat of the nasal mucosa is determined by its dryness, the formation of solid crust, often occur nosebleeds.Olfactory and / or taste deteriorates.At the close of the opening of the nasopharynx dry crusts develop serous otitis media, which is manifested by pain in the ear, hearing loss with a groan of defeat.
should also be said about the complaints of patients from genital cancer which is often involved in the process with the Sjögren's syndrome.Patients worried about dryness in the vaginal area, burning it, pain during sexual intercourse.Histologically determined atrophic changes in the vaginal mucosa, as well as nonspecific vaginitis.Often these changes are wrongly regarded as age-related changes in the woman's body during menopause, and often on the contrary, are a consequence of it was his, and sicca syndrome is not to blame.
With the defeat of vessels located in the central nervous system, neurological symptoms occur: meningoencephalitis, hemiparesis, nystagmus, symptoms of traumatic brain more often - trigeminal nerve.
often described us in the background pathology in patients develop enhanced individual sensitivity to certain drugs, in particular to non-steroidal anti-inflammatory medicines, certain antibiotics (penicillin), a drug so-called basic therapy, cytostatics.
Based on patient complaints, anamnesis of the illness and life, taking into account the results of physical examination, the doctor suspects the presence of the patient Sjogren's syndrome, and assign a number of additional studies to clarify the diagnosis:
targeted therapy of dry syndrome are relieved itself of its symptoms in a parallel treatmentBackground of autoimmune disease.
can be used drugs of the following groups:
apply and efferent methods of treatment: hemosorbtion, plasmapheresis, as a rule, combined with pulse therapy with prednisolone or methylprednisolone.
as replacement therapy may be used the following methods:
When inflammation of the salivary glands used applications Dimexidum hydrocortisone, heparin and 5% solution of ascorbic acid, and injected directly into the ducts metipred.
criteria for the quality of treatment is the normalization of the clinical manifestations of the disease, laboratory parameters, histological improvement salivary gland biopsy, negative results of tests of eye damage.
About Sjogren's disease say the program "Living healthy»: