Introduction To The Nervous System
The nervous system is divided into two anatomic compartments:
Sjögrens syndrome can cause inflammation and damage to both the CNS and PNS.
Risks Of Oab And Bps/ic
Compared with the comparison cohort, pSS patients exhibited significantly increased risks of OAB and BPS/IC . shows the disease-free survival curves of OAB and BPS/IC using the KaplanMeier method. The five-year OAB and BPS/IC-free survival rates for the pSS cohort were significantly lower compared to the control cohort .
Comparisons of probabilities of OAB and BPS/IC-free, OAB-free, BPS/IC-free survival between pSS and comparison cohorts. pSS: Primary Sjögren syndrome OAB: overactive bladder BPS: bladder pain syndrome IC: interstitial cystitis.
What Is Sjgrens Syndrome
Sjögrens syndrome is an autoimmune condition. This means that the immune system, which is the bodys natural self-defence system, gets confused and starts to attack your bodys healthy tissues.
Inflammation is your bodys normal reaction to injury or infection. You might notice inflammation if you have a cut or a wound. It causes the affected area to hurt and turn red. It may also become hot, as fluid rushes to the area and causes swelling.
The inflammation seen in Sjögrens syndrome particularly affects the glands in your body that produce tears and saliva. This causes your eyes and mouth to become dry. Other parts of the body can also be affected, leading to dryness of the:
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Most Common Sjgrens Syndrome Symptoms
When a person has Sjögrens syndrome, their immune system is attacking the glands that keep the eyes, mouth and other body parts moist. The severity of the disease can vary widely, but the most common symptoms are dry eyes and dry mouth.
- Dry eyes. Due to decreased tear production, your eyes may feel extremely dry. They may also itch or burn, leading to excessive blinking. It may feel like grains of sand are lodged in your eyes. Or they may be red or watery, and you may have blurred vision or be sensitive to bright or fluorescent lights.
- Dry mouth. Because your body cant produce saliva readily, it might be difficult to swallow or speak, or to taste food. Your mouth may feel chalky or cottonlike, you might wake up at night and need a drink because of the dryness, or you may find yourself drinking more during the day to help swallow food.
Because Sjögrens syndrome primarily involves the eyes and mouth, you may have cavities and infections of the mouth such as oral thrush and vision problems including corneal ulcers.
Sjögrens syndrome can often be difficult to diagnose, as these symptoms are very general and can indicate a range of conditions.
Managing Gastric Reflux When You Have Sjogrens Syndrome
Sjogrens syndrome is an autoimmune disease characterized by a decreased production of saliva, tears, and other secretions.
A common symptom of Sjogrens syndrome is acid reflux, also known as gastric reflux or heartburn. Sometimes, gastric reflux may progress into a more serious condition called gastroesophageal reflux disease.
Saliva is known to neutralize the effect of stomach acid that is refluxed into the upper digestive tract. Therefore, because Sjogrens syndrome patients have decreased salivary production, they may experience episodes of gastric reflux.
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Peripheral Neuropathy Of Sjgrens Syndrome
What is neuropathy?
Neuropathy, which means inflammation and/or damage to the peripheral nerves, can be affect patients with Sjögrens syndrome. Neuropathy can cause various symptoms, from numbness, to coldness in its most severe, neuropathy has been described as burning, lancinating, or feeling like my skin is on fire. Neuropathy can also cause weakness and clumsiness.
How does my doctor diagnose neuropathy?
The first step is to take a careful history and perform a physical examination. The pattern and description of symptoms, which may include pain and weakness, could suggest damage to the peripheral nerves. A neurological examination is crucial in providing objective evidence of peripheral neuropathy. Weakness may be present, which is typically greater in the toes and fingers than in the larger muscle groups of the arms and legs. Your physician may test your reflexes. Typically, a reflex hammer should elicit emphatic lurches of arms and legs. However, patients with neuropathy may not have any reflexes. Your physician may also test your ability to appreciate temperature, a sharp pin, and vibration. If the neurological examination confirms a peripheral neuropathy, then you may have a nerve-conduction test, looking at the integrity of nerves and muscles.
Neuromuscular Manifestations Of Sjogren’s Syndrome
Patients suffering from Sjogren’s syndrome may develop a whole variety of neuromuscular complications. Let us begin with myalgia. This is an inflammation of muscle tissue accompanied by spontaneous pain or pain induced by palpation . Patients affected usually report difficulty climbing stairs because of the accompanying muscle weakness. Inflammation of muscle tissue may also be completely asymptomatic. The disease tends to progress over time and even cause muscle fiber necrosis which is confirmed with an elevated sedimentation rate and muscle enzymes, electromyography as well as muscle biopsy.
Furthermore, patients may additionally develop neuropathy of different kinds. This condition is characterized by paresthesia, an abnormal sensation occurring in the form of tingling, burning, pricking, or numbness of a person’s skin with no obvious long-term physical effect. Neuropathies associated with Sjogren’s syndrome predominantly affect the legs.
Depending on whether the neuropathy affects sensorineural or motor neuron patients develop different symptoms. If many nerves in the body get inflamed and damaged, the condition is known under the name multiple mononeuropathy. Polyradiculoneuropathy is characterized by the inflammation of various nerves and nerve roots and is actually the most severe form of the disease.
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Comorbidities And Pharmacological Treatment
Hypertension , coronary artery disease , type 2 diabetes mellitus , chronic pelvic pain , chronic fatigue syndrome , depression , anxiety , migraine , fibromyalgia , irritable bowel syndrome , asthma , sleep apnea , and hyperthyroidism were identified as comorbid medical disorders. Comorbidities were categorized if these diagnostic codes were found in 2 outpatient claims six months before and after the index date. Pharmacologic treatment for pSS was also included. Pilocarpine, cevimeline and saliva substitute were defined as treatment for dry mouth, while artificial tears were categorized as treatment for dry eyes.
Risk Of Autoimmune Diseases In Patients With Interstitial Cystitis/bladder Pain Syndrome: A Nationwide Population
- 1Department of Medical Education, Chung Shan Medical University Hospital, Taichung, Taiwan
- 2Institute of Medicine, College of Medicine, Chung Shan Medical University, Taichung, Taiwan
- 3Department of Urology, Chung Shan Medical University Hospital, Taichung, Taiwan
- 4Department of Medical Research, Center for Health Data Science, Chung Shan Medical University Hospital, Taichung, Taiwan
- 5Department of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan
- 6Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
Objective: The association between autoimmune diseases and interstitial cystitis/bladder pain syndrome has long been investigated. However, the lack of comprehensive descriptions of patients in the literature has made comparison and evaluation impossible. We aim to investigate the risk of systemic ADs in patients with IC/BPS in Taiwan using a population-based administrative database.
Results: The adjusted Hazard Ratio of ADs for IC/BPS patients was 1.409 . The subgroup analysis indicated that female or 4560 years of age had a greater risk of ADs. Furthermore, the subgroup analysis of primary outcomes indicated that IC/BPS had greater incidence with Hashimoto’s thyroiditis , ankylosing spondylitis , rheumatoid arthritis , and Sjogren’s syndrome .
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Other Chronic Hepatitis Viral Infections
No cases of association between other hepatitis viral infections and SS have been reported. In 1998, we reviewed the prevalence and clinical significance of hepatitis G virus infection in 100 Spanish patients with primary SS. Four patients and six volunteer blood donors were found to have HGV-RNA sequences in serum. HGV infection was associated with biochemical signs of liver involvement in only two of the patients with primary SS. When compared with patients without HGV infection, no significant differences were found in terms of clinical or immunological features. HCV co-infection occurred in one of the four SS patients with HGV infection. We concluded that HGV infection alone was not a significant cause of chronic liver involvement in patients with primary SS.
Comparison Of Risks Of Oab And Bps/ic By Pss
To investigate whether pSS-specific treatments may be associated with bladder symptoms, we further analyzed risks of OAB and BPS/IC by various therapeutic strategies . Interestingly, we found that pSS subjects with either treatment for dry eye or both treatment for dry eye and dry mouth had higher risks of bladder irritation symptoms. However, treatment of dry mouth alone was not significantly associated with risks of OAB and BPS/IC.
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What Are The Medications For Interstitial Cystitis
Drugs should be considered after conservative measures have failed to provide substantial improvement in symptoms.
Bladder Drug Instillation
- Dimethyl sulfoxide is the only drug approved by the FDA for use in bladder instillation. Using a catheter, the bladder is filled with DMSO, which is retained in the bladder for 15-20 minutes before being emptied. The technique does not require anesthesia, hospitalization, or the use of an operating room. This treatment is given every week or two weeks for six to eight weeks. DMSO is believed to work as an antiinflammatory agent and therefore reduces pain. It may also prevent contractions that cause pain, frequency, and urgency. By the end of the sessions, complete relief of symptoms is often obtained.
If symptoms recur, more treatments can be given. People who are willing to catheterize themselves may be able to self-administer treatments at home. Side effects include a garlic-like body odor in some people. For some people, DMSO instillations can be painful. This can often be relieved by first instilling a local anesthetic into the bladder through a catheter or by mixing the local anesthetic with DMSO. Some clinicians substitute intravesical heparin for DMSO. Other agents can be added to DMSO making an IC “cocktail.” These include corticosteroids, heparin, normal saline , and lidocaine.
What Other Neuropathies Can Occur With Sjgrens Syndrome
1. Autonomic Neuropathy
Sjögrens syndrome can cause nerve damage which regulates the coordination of heartbeat, respiration, and gastric motility. This is called an autonomic neuropathy. Examples of symptoms include lightheadedness when standing, decreased or increased sweating, and feeling full despite eating small meals. The diagnosis of autonomic neuropathy should be made by a neuromuscular specialist.
2. Trigeminal Neuralgia and Glossopharyngeal Neuralgia
Sjögrens syndrome can cause a numbness or burning of the face, called trigeminal neuralgia. Pain in the back of the throat, which may worsen while swallowing, is called glossopharyngeal neuralgia. Patients with trigeminal or glossopharyngeal neuralgia can have agonizing mouth and facial pain. These neuropathies may co-exist with other neuropathies in different parts of the body. For example, up to 20% of patients with a small-fiber neuropathy may also have trigeminal neuropathy.
3. Mononeuritis Multiplex
The pace of recovery from mononeuritis multiplex can be frustratingly slow. In some cases, it may be difficult to determine whether the slow pace of recovery is a manifestation of the slow process of healing and rewiring, or is due to ongoing and ineffectively treated inflammation. In such cases, repeat nerve-conduction tests may be important. Immunosuppressant medications which may be used in the pattern of mononeuritis multiplex includes cyclophosphamide, azathioprine, as well as prednisone.
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Central Nervous System Complications Of Sjogren’s Syndrome
In rare instances, patients living with Sjogren’s syndrome additionally develop abnormalities within the central nervous system. There may be changes affecting solely the brain or the spinal cord, or both organs get damaged.
Focal deficit disorders are typical for this form of the disease. They may precipitate motor or sensory loss along with hemiparesis , aphasia , dysarthria and movement disorders. Seizures and cerebellar syndrome may occur as well.
Diffuse disorders develop in the form of encephalopathy and aseptic meningitis, dementia, impaired cognitive function or even psychiatric abnormalities.
When the spinal cord gets damaged, patients with Sjogren’s syndrome may develop transverse or chronic progressive myelitis. They are also susceptible to neurogenic bladder or end up with Brown-Séquard syndrome or lower motor neuron disease.
Psychological and behavioral changes that might occur along with the basic symptoms and signs of Sjogren’s syndrome include a lack of concentration and attention, a subcortical dementia, hysteria, hypochondriasis, depression, dysphoria and sometimes anxiety or panic attacks.
Sex Fertility And Pregnancy
Women with Sjögrens syndrome can sometimes have a dry vagina, which can make sex painful. Lubricants and creams made from the female sex hormone, oestrogen, can help with this. Treatments for infections such as thrush are available from chemists.
The condition doesnt affect fertility in men or women. However, there may be a higher risk of miscarriage in women who have anti-Ro or anti-La antibodies. Your doctor might suggest low-dose aspirin in the early stages of pregnancy to reduce this risk.
There arent usually any problems during or after pregnancy, and you may be able to carry on with some treatments, such as hydroxychloroquine, during pregnancy.
However, a very small number of women may pass anti-Ro or anti-La antibodies on to their baby during pregnancy. The baby could then develop symptoms, such as rashes and abnormal blood tests after birth.
These will clear up once the mothers antibodies have been lost from the babys blood. This can take anything from a couple of weeks to a few months.
In some cases, the antibodies affect the babys heart, causing it to beat slowly. If you have these antibodies, you should tell your obstetrician, as your babys heartbeat will need additional monitoring in the womb.
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Blood And Urine Tests
The following tests are routinely performed in the evaluation of a patient with suspected Sjogrens syndrome:
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Can Sjogren’s Syndrome Cause Kidney Disease
I received a letter from a reader who recently discovered that a specific test for her kidney function: the GFR – glomerular filtration rate – was abnormal and that her kidneys were only functioning at 50% of their capabilities. She wanted to know if Sjogren’s syndrome could be the cause, and if so, what other sjoggies would have to say about their experience with kidney failure and Sjogren’s syndrome.Excellent questions.I wrote a post back in 2008 in which I briefly discussed Sjogren’s syndrome and kidney disease in generalities however this question requires a more thorough answer. As always, I feel more comfortable describing an organ’s abnormalities only after we establish some understanding of normalcy. The following sections of simplified information about normal kidney structure and function were found here: .
The kidneys are bean-shaped organs, each about the size of a fist. They are located near the middle of the back, just below the rib cage, one on each side of the spine. The kidneys are sophisticated reprocessing machines. Every day, a person’s kidneys process about 200 quarts of blood to sift out about 2 quarts of waste products and extra water. The wastes and extra water become urine, which flows to the bladder through tubes called ureters. The bladder stores urine until releasing it through urination.
- Complement levels
- Blood potassium
How Many People With Sjogrens Syndrome Suffer Memory Problems
Sjogrens syndrome indeed can cause memory problems, even though this autoimmune condition is associated with dry mouth and dry eyes.
Because Sjogrens syndrome is potentially systemic, the entire body can be affected, including organs, and this can mean the brain.
Patients with Sjogrens syndrome may suffer from a number of different neurologic abnormalities, says Ali D. Askari, MD, Professor of Medicine Case Western Reserve University Chief, Division of Rheumatology University Hospitals Case Medical Center Director, Rheumatology University Hospitals Case Medical Center.
Rheumatologists often deal with Sjogrens syndrome patients, since the disease often initially manifests with joint pain or stiffness.
Dr. Askari continues, Unlike lupus , which has more of central nervous system involvement, Sjogrens syndrome has peripheral nerve involvement more commonly.
Neurological problems affect as many as 20 percent of patients. However, Dr. Askari says that dementia is a rare complication of Sjogrens syndrome.
In our own study reported to the international SS conference in Japan, we found 14 of 200 patients having neurological abnormality.
Six had variety of central nervous system involvement only one had dementia. Dementia therefore is rare and can happen at any time.
Though Sjogrens syndrome is most associated with dry eyes and dry mouth, these arent necessarily the first presenting symptoms.