The Early Warning Signs and Symptoms of Sjogren's Syndrome
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The Early Warning Signs and Symptoms of Sjogren's Syndrome

Sjogren's Syndrome is one of more than 100 known autoimmune diseases. It affects between two and three per cent of the general population. Women are nine times more likely to be affected than men. The main targets of this miserable condition are the secretary glands. The most commonly affected are the salivary or parotid glands and the tear ducts. With a mean time to diagnosis of nine years, it is natural to wonder if there are any early warning signs. The answer is very surprising.

Autoimmune conditions

The human immune system evolved to protect us from invasion by foreign organisms such as bacteria, viruses and other microscopic parasites. Sometimes it mistakes host tissue for a pathogen, ramping into overdrive to attack the body’s own cells. When the body turns against itself, this is called autoimmunity (AI). Sjögren’s Syndrome (SS) is one of more than a hundred known AI conditions. Others include Rheumatoid Arthritis, Fibromyalgia, Systemic Lupus Erythematosis. All present with neuropsychiatric symptoms, usually long before they are correctly diagnosed.

The incidence of Sjogren's Syndrome (SS) is approximately 2% to 3% of the general population, with women nine times more likely than men to be affected. Here, the secretory glands are the target of immune system attack. This is particularly true for the tear ducts and salivary glands, although other organs including the pancreas may become involved. This is a systemic disease, affecting every aspect of life. Nearly all individuals who have SS report overwhelming fatigue and muscle pain and weakness. The average time to diagnosis is nine years.

Psychiatric symptoms often precede a diagnosis of AI

Evidence associating autoimmune pathology with neuropsychiatric illness among this population comes from autoantibody expression, infarcts (stroke) and seizure activity.  Central Nervous System (CNS) manifestations of SS present most frequently as atypical mood disorder, although psychosis, dementia, dissociation, personality disorders and panic have also been described. 

Systemic Lupus Erythematosis (SLE) is a multisystem autoimmune disease affecting half a million Americans. Nearly all individuals with SLE experience joint and muscle pain, often as the first symptom. Roughly half of those who develop organ-threatening conditions of the heart, lungs, liver, kidneys or central nervous system do not survive for more than 20 years after they have been diagnosed. This condition mainly afflicts women of childbearing age. Neuropsychiatric illness, including psychosis, schizophrenia and erotomania are common afflictions in this population. Disorders of cognition and mood and hypergraphia have also been reported.

A simple solution?

In many autoimmune conditions, psychiatric symptoms frequently appear long before the development of defining physical symptoms and signs. There are actually more reports of central SS in the rheumatology and neurology literature than there are in psychiatric journals. This suggests that when patients present with neuropsychiatric symptoms that do not respond to standard therapies, general practitioners and psychiatrists should consider looking for an underlying autoimmune disorder.

Determining the presence of an inflammatory condition is neither difficult nor expensive. If simple blood tests for erythrocyte sedimentation rate (ESR) and C-Reactive Protein (CRP) were incorporated as part of a routine work-up for patients presenting with these complaints, it could point clinicians in the right direction for corrective therapy. Years of suffering could be circumvented.

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Comments (1)

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