Tuesday, April 26, 2005

Thirst For Knowledge

A friend recently told me that her mouth is constantly dry, leading her to drink water nonstop. When I suggested that she might want to be tested for Sjogren's Syndrome (SS), pronounced Show-grins, she gave me a blank look and said she had never heard of it. My friend is hardly alone -- the vast majority of people, including some health-care professionals, have never heard of SS even though it affects about four million Americans and is second only to rheumatoid arthritis (RA) as the most common autoimmune rheumatic disorder.
SS causes lymphocytes (white blood cells) to attack the body's moisture-producing glands. The first and most common symptoms are dry eyes and dry mouth, as well as vaginal dryness and extreme fatigue. Nine out of 10 patients are female and generally between ages 40 and 55. Because of the age profile of patients, many doctors often assume menopause is the culprit -- not an autoimmune disorder. (Though rare, men and children also can develop SS.) Eventually, the deficiencies in the moisture-producing glands can lead to a wide range of problems in other areas of the body. Because the symptoms of SS masquerade as "normal aging problems," it typically takes about six years for patients to obtain a proper diagnosis. They often go from doctor to doctor, only to be told they are depressed or being hypochondriacs. As a result, they suffer longer than need be. Even worse: Left untreated, the attacking lymphocytes continue to invade the glands and over time destroy healthy tissue, which the body replaces with scar and fat tissue. The result is that patients become ever drier, to the point that they might produce no moisture at all. Rheumatologist Frederick Vivino, MD, is director of the Sjogren's Syndrome Center at the University of Pennsylvania Medical Center-Presbyterian. He tells me that, as a rule, people greatly underestimate the importance of saliva in the body's functioning, and this may be one reason that SS has received so little attention in general. In the mouth alone, saliva protects against diseases of both the teeth and mouth, and it starts the digestive process for the gastrointestinal (GI) tract. Internally, virtually every organ needs moisture to do its work. The cause of SS is thought to be varied and poorly understood. Once it appears, SS can progress in a steady fashion or it may ebb and flow. About 20% of patients diagnosed with SS develop life-threatening internal organ manifestations, among them interstitial lung disease (when the walls of the air sacs in the lungs become inflamed).
To diagnose SS, doctors consider six criteria, including an evaluation of eye and mouth dryness and several blood tests, including anti-SSA and anti-SSB. SS is confirmed if a patient meets at least four of six criteria. Once diagnosed, patients can secure care through a number of SS centers around the country staffed by a rheumatologist, an ophthalmologist and a dentist, each of whom specializes in treating SS. Treatment generally addresses dry eyes and dry mouth. Patients are often prescribed the drugs pilocarpine hydrochloride (Salagen) and cevimeline (Evoxac), which stimulate tear and saliva production. Dr. Vivino adds that data suggests these drugs also address dryness problems in other parts of the body.
Although it is good to know that drugs are available to increase moisture production, autoimmune diseases such as SS often are a result of a whole system breakdown. About half of SS cases are secondary to other connective-tissue autoimmune diseases, such as RA or lupus. Eugene Zampieron, ND, has worked with many patients with such disease, for many years, and is coauthor of a number of books on autoimmune rheumatic disorders, including Arthritis: Alternative Medicine Definitive Guide (Ten Speed). I spoke with him to discuss the naturopathic approaches to SS. He stresses a three-prong approach to all rheumatic disorders, including SS...
*Identify the stressors on the immune system.
*Remove them.
*Reestablish a healthy balance in the body.
High on the stressor list, he says, are food allergies and environmental toxins, which can be eliminated by following a proper diet rich in fruits, vegetables, quality proteins and whole grains -- but diets must be individualized to eliminate foods or chemicals that are allergy triggers. In addition, he recommends certain natural supplements prescribed on an individual basis. In the short run, he advises SS patients to be sure they are getting plenty of omega-3 fish oils and antioxidants, including vitamins E and C, and the minerals manganese, selenium and germanium. The doses should be individualized to the patient's condition and needs. To help increase saliva production, he frequently advises an herb called prickly ash that he says is generally safe, though should always be used with professional guidance. SS is tricky to diagnose and tricky to combat. The good news is that just having the symptoms does not mean you have the disease. However, if you do have the symptoms, it is wise to be tested for SS and then to work with trained professionals on the best treatment options. Even over-the-counter supplements such as those listed above should be used with professional guidance. You can learn more at the Sjogren's Syndrome Foundation Web site at www.sjogrens.org. If you are interested in naturopathic therapy, you can find a naturopathic physician in your area at www.naturopathic.org. Treatment of Sjorgren's Syndrome is complex and time consuming and can take several years to accomplish -- but it is worth the effort in the long run.


At 12:10 PM, Anonymous Anonymous said...

This has been extremely helpful. Thank you.

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