Sjogren's syndrome, also known as Mikulicz disease and Sicca syndrome, is an autoimmune disorder. This means that the immune system attacks parts of the body. The most common symptoms include dry mouth and eyes; it can also effect other organ systems and lead to elevated levels of enzymes in the blood such as alkaline phosphatase. It is important to consult with a physician for the diagnosis and treatment of all health conditions.
Characteristics
In Sjogren's syndrome, cells of the immune system attack glands in the body called exocrine glands. These are glands that secrete their products, such as fluids or hormones, into ducts such as the salivary glands and tear ducts. The damage from the immune system causes the glands to stop functioning. The lack of saliva and tears causes a dry mouth and eyes. Sjogren's syndrome is more common in women; two general types exist. The first type, called primary Sjogren's, develops alone, while the second type, called secondary Sjogren's syndrome, develops in patients with another autoimmune disorder such as lupus or rheumatoid arthritis.
Organ Involvement
While the eyes and mouth are the most commonly affected areas of the body, Sjogren's syndrome can affect other organs as well including the lungs, liver, kidneys, bile ducts, skin, nose, genital tract, blood vessels, pancreas and nervous system. The cells of these organs, especially the bile ducts, contain the enzyme alkaline phosphatase. When the immune system destroys these cells, they break open and release their contents into the blood. This causes the alkaline phosphatase levels to rise in the blood. If the bile ducts are destroyed by the immune system, it is likely from a condition called primary biliary cirrhosis, which can occur with Sjogren's syndrome.
Diagnosis
Elevated alkaline phosphatase is not specific for Sjogren's syndrome because it can rise in many other conditions as well. However, along with the symptoms of dry eyes and mouth, and other characteristics of the syndrome, elevated alkaline phosphatase can suggest the presence of Sjogren's syndrome and primary biliary cirrhosis. Blood tests for autoimmune factors can also be helpful, as can the measurement of tearing, called the Schirmer test. Imaging of the salivary glands may also be useful. If needed, a doctor can perform a biopsy of a salivary gland or liver, which is then examined with special studies such as microscopy.
Treatment
The treatment of Sjogren's syndrome is supportive. It addresses the symptoms since there is no cure for the underlying cause. Minor symptoms of dry mouth and eyes can be addressed by sipping water and using eye drops. Drugs that suppress the immune system are also used in some cases.
References
- "Harrison's Principles of Internal Medicine"; Anthony S Fauci, et al.; 17th Ed 2008
- "Henry's Clinical Diagnosis and Management by Laboratory Methods"; Richard A. McPherson, et al.; 21st Ed 2006
