Monday, November 21, 2011

Sjogren's Syndrome

Sjogren's syndrome, more than just a dry mouth and dry eyes, is an autoimmune disease. In people with an autoimmune disease, the person's white blood cells attack healthy tissue. In the case of Sjogren's, the white cells attack the moisture producing glands.

In addition to dry mouth and eyes, Sjogren's can also affect other organs, blood vessels, the central nervous system and even increases the risk of developing lymphoma.

The symptoms of Sjogren's may include dry mouth, increased cavities, gum disease, swallowing difficulty, dry eyes with a gritty sensation leading  possible eye infections, inflammation of the airways leading to infection and even vaginal dryness and infections.

Sjogren's symptoms are not isolated to the moisture producing glands. This disease also causes extreme fatigue, joint pain, Raynaud's syndrome and an increased risk of developing lymphoma.

Since many of the symptoms of Sjogren's can mimic those of many other diseases, diagnosis is often delayed. To complicate matters, Sjogren's may occur alone, known as primary Sjogren's or in conjunction with other autoimmune disease like Rheumatoid Arthritis or Lupus.

Diagnosis involves observing clinical features of dry eyes and mouth and possibly Schirmer tear test strips to confirm reduced tear production. Salivary glands may become enlarged and feel firmer on palpation than normal glands. Salivary gland scans may also be done to detect inflammation. A salivary gland biopsy may also be done under local anesthesia.

Lab work may reveal a positive ANA (antinuclear antibodies), SS-A and SS-B antibodies (Sjogren's syndrome A and B antibodies), rheumatoid factor, thyroid antibodies and others. The sufferer may also have anemia and abnormal inflammation markers. 

Most treatment is directed at managing symptoms. Artificial tears, Restasis, lacrimal plugs are all ways to manage dry eyes. Dry mouth may be managed by increasing fluid intake, Biotene sprays and mouthwashes, and Salagen are all ways to manage oral dryness. Nasal dryness may be helped by using nasal saline sprays. If vaginal dryness is a problem, a lubricant should be used during sexual intercourse.

Additionally, hydroxychloroquine (Plaquenil) may help with fatigue, muscle and joint pains. If the patient develops vasculitis, the patient may require immunosuppressive drugs like prednisone, azathioprine or cyclophosphamide.

Prognosis for the patient with Sjogren's is usually very good but the patient must work closely with the ophthalmologist and dentist. Exceptional oral hygiene is imperative to prevent dental issues and prevention of corneal abrasions is important to promote eye health and prevent vision problems.

Thursday, November 17, 2011

Raynaud's Syndrome

People with Rheumatoid Arthritis frequently have Raynaud's syndrome. This syndrome is characterized by painful extremities when exposed to cold temperatures. 

Raynaud's, named for the identifying French physician, Maurice Raynaud, causes an interruption in blood flow to fingers and toes. Ears and nose may also be involved. When the extremity is exposed to cold or the sufferer is under stress, the blood vessels spasm. This causes the extremity to turn white then blue then bright red over the course of the attack. 

Tingling, swelling and painful throbbing are associated with the Raynaud's spasm. The attack may last from minutes to hours and in the most severe cases ulcerations may develop which can lead to infections and gangrene in the extremity.

RA sufferers develop what is known as secondary Raynaud's syndrome. Meaning, the syndrome is secondary to the Rheumatoid Arthritis.

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There is no cure for this condition and in fact, the cause of Raynaud's is unknown. While there is no cure, there are some treatments that may help with the symptoms. 

Avoiding cold temperatures, wearing gloves in cold weather and when accessing freezers, reducing stress, regular exercise, relaxation techniques and a type of medication called calcium channel blockers (frequently used for high blood pressure) may all help reduce the severity of Raynaud's spasms.

Development of ulcerations from Raynaud's can lead to gangrene in the extremity so the importance of seeking medical attention upon development of an ulceration must be stressed.

Sunday, November 6, 2011

Rheumatoid Arthritis Basics

The name, Rheumatoid arthritis, is in many ways a misnomer. RA is so much more than arthritis. It is a disease that affects the every aspect of the person who suffers from it.

RA is a chronic, autoimmune disease characterized by severe fatigue, fever, morning stiffness, swelling and pain in the joints. It can result in loss of function of the joints.
Autoimmune diseases are characterized by the body's immune system attacking healthy tissue. This results in a variety of symptoms such as flu-like symptoms including overall aching, muscle aches, loss of appetite, and weight loss in addition to the joint pain, stiffness and swelling.

The causes of RA are unknown but there is a genetic predisposition to developing this disease. Simply stated, it is not a directly inherited disease but the tendency to develop the disease may be inherited.

Those between the ages of thirty and fifty years old are most likely to develop RA though it can occur at any age, even in early childhood. RA affects women more often than men.

Early detection and aggressive, early treatment are key to lessening long-term joint damage. RA can begin damaging the bones within a year from the onset of symptoms.

Almost all joints of the body may be affected. RA may present differently in different people. For example, one person may present with knee involvement while another may present with hand involvement. Others, may present with a migratory arthritis. In other words, the arthritis may move from joint to joint.

RA usually develops symmetrically. If the sufferer has arthritis in one hand, the other hand will develop arthritis. In addition to arthritis, the person with RA may develop tendon involvement.

Systemic manifestations of RA are common. These include rheumatoid nodules, cardiovascular disease, anemia, chonic leg ulcers, non-Hodgkin's lymphoma, osteoporosis, Sjogren's syndrome, pulmonary complications including pleurisy and rheumatoid lung nodules, pericarditis, Raynaud's syndrome. 

1) "Genetic Basis for Rheumatoid Arthritis." PubMed. December, 2005.

Wednesday, November 2, 2011

Faces of Rheumatoid Arthritis

Meet Peggy Piscapo - Here is her story. You can also find her story on her blog -

My life was a normal one.. Wife, Mother, Sister, Daughter and Friend.    I had a fork in the road called RA.  On July 26th I was officially diagnosed with RA.  I had been having a lot of pain and swelling for several months and couldn't figure out why... I am only 42 and "I didn't Look Sick".   I had my husband come to this visit, so he could grasp the fact that I was sick.

Sitting in the doctor's office, I saw people in wheel chairs and have "old people" shoes on.  They were all much older than me.  We were in shock when the doctor handed me 9 prescriptions.  Tons of brochures on RA drugs.  I needed a backpack to carry all the info out of the doctor's office.  My husband and I went to the car and drove to Sonic Burger... where we sat in shock...and drank cherry lime-aids.   I had to make the call to my mother to confirm that YES,  I do have RA.    Next stop was the pharmacy:

The first time I picked up my medicine from the pharmacy... nine bottles all RA drugs.  I was in shock.  I couldn't even read the labels.  I forgot to ask for easy to open caps, not child safe ones.  I had to get two pill box's to hold all the pills.  I had to have my husband write it all down on the calender.  All the drugs are very powerful.  I used to just take Advil.   Now I take cancer drugs.

Methotrexate is the first treatment doctors try to treat RA.  I heard it was an awful drug.  It causes you to be sick to your stomach and it can cause hair loss.  I was terrified to take it.  I am on my third week now, and so far so good.  I am one of the lucky ones.  Many people who take this drug get sick and lose their hair... (I am not out of the woods with the hair thing yet).

I see my life changing every moment and in every way.  I work with horses, and its physically demanding a lot of the time.  My hands hurt and swell up at any given moment.  Heck... it all hurts.  I have a handicap placard now.  I can't have my kids hold my hands any hurts to much.  My husband is afraid to hug me...due to the pain.  There is so much change, which I will share along the way..which is why I am writing this blog.  To help myself and others.  

It is not all doom and gloom.  I have found a wonderful support group online.  I have found who my closest friends are.  I look at life in a much different way now.  I am not in a hurry to get it all done now.  I have taken time to slow down and see my life and family.  I don't get as angry anymore... I let things slide off my back now.  So join me on my journey of the positives and not so positives. 

I'm Marcy Dyer. When I first got ill, I was very active. I had just obtained my black-belt in Tae Kwon Do and as a single woman, I had quite a few friends who liked to play volleyball and softball on the weekends. 

I was the type of person who couldn't sit still. My first symptom was fatigue. Severe fatigue. I remember complaining over and over to my gynecologist. He recommended several different diets but nothing helped. I saw an internist who diagnosed me with asthma and put me on steroids. 

I felt great on the steroids but after a while I starting having knee problems. A friend recommended that I see a specialist in Dallas. The specialist drew labs on me and called me a few days later. My RF was positive and he wanted me to see a rheumatologist. He referred me to Dr. Alan Duby in Dallas. Dr. Duby diagnosed me with polyinflammatory arthritis and started me on plaquenil. Over time, with multiple flares, he added medications. In addition to RA, I developed Sjogren's Syndrome which causes very dry mouth and eyes and Raynaud's Syndrome which causes spasms of the blood vessels in the hands and feet when exposed to the cold.

Thanks to my insurance changing, I had to change rheumatologists - twice. My third and current rheumatologist is the one who finally decided this was seronegative RA. My RA titer went negative after starting treatment. All of my rheumatologists have treated me aggressively and as a result, I don't have a severe joint damage as I might otherwise.

My goal is to bring awareness to RA and to educate people on this disease while living my life to the fullest. There are many things I can no longer do but I have faith that God will use me and this illness for His glory.