Sjogren’s Syndrome and its Homoeopathic Management

Dr. Chirag Mishra 1, Dr.Seema Meena1, Dr. Shipra Singh 1

1 PG Scholar Department of Repertory, Dr. MPK Homoeopathic Medical College Hospital & Research Centre (Under Homoeopathy University), Saipura,  Sanganer , Jaipur. (Raj.)

ABSTRACT: Autoimmune diseases arise from an overactive immune response of the body against substances and tissues normally present in the body. This may be restricted to certain organs or involve a particular tissue in different places. Sjogren’s syndrome (SS) is one of them, in this regards homeopathy has a prospective role of treatment in the auto immune disease, the disease is studied at the level of bacteria/virus and also factors like any mental/ physical stressors that could predispose the individual to this illness.

Keywords:  Sjogren’s syndrome (SS), Hompeopathic Management. 

INTRODUCTION

Sjogren’s syndrome (SS) is a chronic inflammatory autoimmune disease characterized by mixed cellular infiltration of exocrine glands, specifically the lachrymal glands and salivary glands.1 

Sjögren’s (pronounced SHOW-grins), discovered by Swedish physician Henrik Sjögren in 1933, is a chronic autoimmune disorder in which the body attacks the exocrine glands – the glands that produce moisture needed in the mouth, skin, eyes, vaginal area, gastrointestinal tract and respiratory tract.2

The inflammation of exocrine glands causes dryness of the eyes, (xerophthalmia), dryness of mouth (xerostomia) and very frequently dryness of nose, throat and vagina. The combination of dry eyes and dry mouth is often referred to as sicca syndrome. In many cases, these clinical features are associated with other autoimmune diseases.1

Sjögren’s Syndrome takes an average of approximately five years to properly diagnose from the time when initial symptoms appear.2

EPIDEMOLOGY

Sjogren’s syndrome is estimated to affect 1-3% of the general population.3 A cautious but realistic estimate from the studies presented so far will be that primary Sjögren’s Syndrome is a disease with a prevalence not exceeding 0.6% of the general population (6/1000).4 Sjögren’s Syndrome , although a common disorder in Western countries with an estimated prevalence of 3 in 100 to 1 in 1000, has rarely been reported from India.5 Although patients of all ages and both sexes may be affected ,this disorder mostly affects women ( 9:1 female to male ratio) .6

PRELIMINARY CRITERIA FOR THE CLASSIFICATION OF

SJÖGREN’S SYNDROME:7,8

1. Ocular symptoms

A positive response to at least one of the following questions.

  1. Have you had daily, persistent, troublesome dry eyes for more than three months?
  2. Do you have recurrent sensation of sandy or gravel feeling in the eyes?
  3. Do you use tear substitutes more than three times a day?

2. Oral Symptoms

A positive response to at least one fifth following questions

  1. Have you had daily feeling of drug month for more than three months?
  2. Have you had recurrent or persistently swollen salivary glands as an adult?
  3. Do you frequently drink liquids to aid in swallowing dry foods?

3. Ocular signs

Objective evidence of ocular involvement determined on the basis of a positive result on at least one of the following two tests.

  1. Schirmer – one test (≤ 5mm in 5 minutes)
  2. Rose Bengal score (≥ according to the van Bijsterveld scoring system)

4. Histopathalogical findings

Focus score ≥ 1 on minor salivary gland biopsy (focus defined as an agglomeration of at least 50 mononuclear cells; focus score defined as the number of foci/4mm2 of glandular tissue).

5. Salivary gland involvement

Objective evidence of ocular involvement determined on the basis of a positive result on at least one of the following three tests.

  1. Salivary scintigraphy
  2. Parotid sialography
  3. Unstimulated salivary flow (≤ 1.5 ml in 15 minutes)

6. Autoantibodies

Presence of at least one of the following autoantibodies in the serum. Antibodies to Ro/SS-A or La/SS-B or anti-nuclear antibodies or rheumatoid factor. A patient is considered as having probable SS if three of the sixcriteria are present and definite SS if four of six are present.

Clinical features2

Investigations:2

It can be difficult to diagnose Sjögren’s syndrome. No single test will confirm the diagnosis and, Sjögren’s syndrome may appear in many different forms in different patients. The diagnosis criteria consider dryness symptoms, changes in salivary (mouth) and lacrimal (eye) gland function, and systemic (whole body) findings.

Blood Tests may include:

1. ANA (Anti-Nuclear Antibody): Found in 70% of Sjögren’s patients and people with other autoimmune diseases.

2. RF (Rheumatoid Factor): Antibody found in 60-70% of Sjögren’s patients and people with rheumatoid arthritis.

3. SS-A (or Ro) and SS-B (or La): Marker antibodies for Sjögren’s. 70% of Sjögren’s patients are positive for SS-A and 40% are positive for SS-B. Also found in lupus patients.

4. ESR (Erythrocyte Sedimentation Rate): Measures inflammation. An elevated ESR can indicate an inflammatory disorder,including Sjögren’s syndrome.

5. IGs (Immunoglobulins): Normal blood proteins, usually elevated in Sjögren’s syndrome.

The Eye Test Includes:

l. Schirmer test: Measures tear production.

2.Rose Bengal and Lissamine Green: Use dyes to examine the surface of the eye for dry spots.

The Dental Tests Include :

l. Salivary flow: Measures the amount of saliva produced over a certain period of time.

2. Salivary scintigraphy: A nuclear medicine test that measures salivary gland function.

3. Salivary gland biopsy (usually in the lower lip): Confirms lymphocytic infiltration of the minor salivary glands.

General Management

AUXILLARY MEASURES 

  • Alcohol and smoking should be avoided and thorough oral hygiene is essential.9,10 
  • Xeropthalmia can be managed with preservative-free teardrops and ocular lubricating ointments.11
  • Patients with xerostomia can manage the dry mouth by doing gustatory stimulation (chewing gum) and moisture replacement.11
  • Regular exercises and physiotherapy can help increase strength and flexibility of the muscles.

Depending on patient’s symptoms, Sjögren’s syndrome can lead to other health problems or even serious complications. Here are tips to help prevent these:12

  • Get regular dental check-ups to prevent tooth decay, cavities and tooth loss.
  • Stick to good oral hygiene habits.
  • Get regular eye exams with an ophthalmologist to check for cornea damage.
  • For severe eye redness or irritation, get checked for infections.

HOMOEOPATHIC MANAGEMENT:13

Homeopathy treatment finds the thread of root cause of the triggers factors and treat accordingly, thus helps to bring back the equilibrium of the body’s immune system in a natural way to normal state thus may help to cure the auto immune diseases. 

Homoeopathy treats the person as a whole, it means that the homoeopathic treatment focusses on the person and pathological conditions. This includes a detailed medical history of the patient, family and causative factors. Any underlying predisposition/susceptibility is considered. Constitutional medicines work wonders in such cases.

These are the some homoeopathic medicines which can be helpful in Sjögren’s syndrome-

Alumina: A very general condition corresponding to this drug is dryness of mucous membranes and skin,

Throat – Dry, sore; food cannot pass, oesophagus contracted.  – Feels as if splinter or plug were in throat.  – Irritable, and relaxed throat.  – Looks parched and glazed.  – Clergyman’s sore throat in thin subjects.  – Thick, tenacious mucus drops from posterior nares.  – Constant inclination to clear the throat.

Mouth – Sore.  – Bad odor from it.  – Teeth covered with sordes.  – Gums sore, bleeding.  – Tensive pain in articulation of jaw when opening mouth or chewing.

Antimonium crudum

Eyes – Dull, sunken, red, itch, inflamed, agglutinated.  – Canthi raw and fissured.  – Chronic blepharitis.  – Pustules on cornea and lids.

Mouth – Cracks in corners of mouth.  – Dry lips.  – Saltish saliva.  – Much slimy mucus.  – Tongue coated thick white, as if whitewashed.  – Gums detach from teeth; bleed easily.  – Toothache in hollow teeth.  – Rawness of palate, with expectoration of much mucus.  – Canker sores.  – Pappy taste.  – No thirst.  – Subacute eczema about mouth.

  Throat  – Much thick yellowish mucus from posterior nares.  – Hawking in open air.  – Laryngitis.  – Rough voice from over use.

Bryonia alba

Mucous membranes are all dry.

Mouth – Lips parched, dry, cracked. Dryness of mouth, tongue, and throat, with excessive thirst.  – Tongue coated yellowish, dark brown; heavily white in gastric derangement.  – Bitter taste. [Nux; Col.]  – Burning in lower lip in old smokers.  – Lip swollen, dry, black, and cracked.  Throat  – Dryness, sticking on swallowing, scraped and constricted. [Bell.]  – Tough mucus in larynx and trachea, loosened only after much hawking; worse coming into warm room.

Pulsatilla

Eyes

Thick, profuse, yellow, bland discharges. Itching and burning in eyes. Profuse lachrymation and secretion of mucus. Lids inflamed, agglutinated. Styes. Veins of fundus oculi greatly enlarged. Ophthalmia neonatorum. Subacute conjunctivitis, with dyspepsia; worse, in warm room.

Mouth

Greasy taste. Dry mouth, without thirst; wants it washed frequently. Frequently licks the dry lips. Crack in middle of lower lip. Yellow or white tongue, covered with a tenacious mucus. Toothache; relieved by holding cold water in mouth (Coff). Offensive odor from mouth (Merc; Aur). Food, especially bread, tastes bitter. Much sweet saliva. Alternations of taste, bitter, bilious, greasy, salty, foul. Loss of taste. Desire for tonics.

Belladonna

Mouth

Dry Throbbing pain in teeth. Gumboil. Tongue red on edges. Strawberry tongue. Grinding of teeth. Tongue swollen and painful. Stammering.

Throat

Dry, as if glazed; angry-looking congestion (Ginseng); red, worse on right side. Tonsils enlarged; throat feels constricted; difficult deglutition; worse, liquids. Sensation of a lump. Œsophagus dry; feels contracted. Spasms in throat. Continual inclination to swallow. Scraping sensation. Muscles of deglutition very sensitive. Hypertrophy of mucous membrane

Ammonium carb

Eyes

Burning of eyes with aversion to light. Eye-strain (Nat mur). Asthenopia. Sore canthi.

Mouth

Great dryness of mouth and throat. Toothache. Pressing teeth together sends shocks through head, eyes, and ears. Vesicles on tongue. Taste sour; metallic. Cracking of jaw on chewing.

PROGNOSIS: Overall, the prognosis of Sjögren’s syndrome is favorable.The life expectancy of pSS patients is comparable with that of the general population. 14 In patients with sSS, life expectancy is determined by the primary disease.15

CONCLUSION:

People with Sjögren’s syndrome may be more susceptible to drug allergies and care is needed to monitor patient’s condition if medication is required. Although Sjögren’s syndrome is not life threatening, careful attention to the problems it causes can help minimize the “nuisance” aspect of this condition and assist in a more relaxed way. Individually prescribed homeopathic medicine could be a valuable adjunct to the management of Sjögren’s syndrome. Every individual has its own trigger factors either in his psychological level or emotional level or physical level or genetic level.

So there are not same set of medicines for a particular disease which can be repeated for every patient. But at the same time the general management therapy whatever is required for the patient should be kept continued along with homeopathy treatment.

REFERENCES:

  1. KM Mahendranath. Sjogren’s Syndrome – Diagnosis and Management. © suppliment to japi. 2006;54:54-57.
  2. Sjögren’s Syndrome Foundation. Sjögren’s Syndrome. 2011.
  3. Hammi A, Al-Hashimi I, Nunn M, Zipp M. Assessment of SS-A and SS-B in parotid saliva of patients with Sjögren’s syndrome. J Oral Pathol Med 2005;34:198-203.
  4. Jonsson R, Moen K, Vesterheim D, Szodoray P. Current issues in Sjogren’s syndrome. Oral Dis 2002;8:130-40.
  5. Malaviya AN, Singh RR, Kapoor SK, Sharma A, Kumar A, Singh YN. Prevalence of rheumatic diseases in India. Results of a population survey. J Indian Rheum Assoc 1994;2:13-7.
  6. Stefanski AL, Tomiak C, Pleyer U, Dietrich T, Burmester GR, Dörner T: The diagnosis and treatment of Sjögren’s syndrome. Dtsch Arztebl Int 2017;114: 354–61.
  7. Vitali C, Bombardieri S, Moutsopoulos HM, et al. Preliminary criteria for the classification of Sjögren’s syndrome: Results of a prospective concerted action supported by the European Community. Arthritis Rheum 1993;36:340-7.
  1. Vitali C, Bombardieri S, Moutsopoulos H, et al. Assessment of the European classification criteria for Sjögren’s syndrome is a series of clinically defined cases: Results of a prospective multicentre Study. Ann Rheum Dis 1996;55:116-21.
  2. Kassan SS, Moutsopoulos HM. Clinical manifestations and early diagnosis of Sjogren syndrome. Arch Intern Med. 2004; 164: 1275-84.
  3. Ramos-Casals M, Tzioufas AG, Font J. Primary Sjogren’s syndrome: new clinical and therapeutic concepts. Ann Rheum Dis. 2005; 64: 347-54.
  4. T Both,V Dalm, P. Hagen, P Daele. Reviewing primary Sjögren’s syndrome: beyond the dryness – From pathophysiology to diagnosis and treatment. Int. J. Med. Sci. 2017;14(3): 191-200.
  5. E Ruderman, S Tambar. Patient Fact Sheet- Sjogren’s Syndrome.American College of Rheumatology. 2013.
  6. W Boericke. Pocket Manual of Homoeopathic Materia And Repertory. Santa Rosa, CA: Boericke & Tafel; 1927.
  7. Singh AG, Singh S, Matteson EL: Rate, risk factors and causes of mortality in patients with Sjögren’s syndrome: a systematic review and meta-analysis of cohort studies. Rheumatology (Oxford) 2016; 55: 450–60.
  8. AL Stefanski, C Tomiak, U Pleyer, T Dietrich, GR Burmester, T Dörner. The Diagnosis and Treatment of Sjögren’s Syndrome. Dtsch Arztebl Int 2017; 114: 354–61)

3 Comments

  1. My Wife has diagnose Sjogren Syndrome. I am looking for treatment.
    Please guide me how can I start the treatment and which is best.

  2. Hi, My wife diagnose sjogren Syndrome. I am looking treatment in Homeopathy. Please guide me from where I can get the appointment

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