Primary dry syndrome chapter
Primary dry syndrome is a systemic autoimmune disease characterized by dry mouth and dry eyes due to damage of exocrine glands. The cause of this disease is not known, and it may be related to genetic and immune function disorder.
Early and regular treatment can make most of the patients’ disease can be effectively controlled, although it cannot be cured, but the current treatment methods and strategies can completely achieve the purpose of no symptoms and survival with disease.
Treatment goals
1.Disease control (no symptoms, no evidence of organ damage and normal inflammatory index)
2. Basic disease control (asymptomatic, basic normal or stable organ damage indicators, normal inflammatory indicators)
I. Induction of remission (to achieve the above treatment goals in the shortest possible time)
1. Hormones Prednisone, dexamethasone, methylprednisolone, etc.
Features: as a bridge treatment is a necessary means to rapidly improve symptoms and control the disease, but to bear more side effects, high dose use for as short a time as possible, as early as possible to reduce the drug.
2.Intravenous gammaglobulin
Features: Immunosuppression is fast-acting and has the effect of increasing the patient’s ability to resist disease. It is often used in critically ill patients, such as those with important organ damage, low immune function and significantly reduced platelets.
3.Immunosorbent and plasma exchange
Characteristics: Fast onset of action, but easy to rebound and expensive. It is an alternative for critically ill patients, such as those with important organ damage, organism immunocompromised and significantly reduced platelets, and often plays a crucial role.
4.Biological agent Meroval
Characteristics: Rapid relief and small side effects are its outstanding advantages, and it is an alternate choice in treatment, but it is more expensive and may be ineffective in a small number of patients, and can be chosen if economic conditions allow.
Second, maintenance treatment (is to prevent recurrence to achieve long-term survival guarantee)
1.Hormone Prednisone, methylprednisolone, etc.
Characteristics: After 1 to 2 months of induction of remission, the drug can be reduced under the guidance of the doctor until it is maintained in small doses, and most patients can stop the drug.
2.Immunosuppressants Cyclophosphamide, vincristine, leflunomide, mycophenolate, methotrexate, azathioprine, hydroxychloroquine sulfate, tacrolimus and cyclomycin, etc.
Features: slow onset of action, requires cycles of combined long-term medication, but the dose and interval of medication can be adjusted according to the changes in disease and immune function, in principle, the smallest dose and the least number of times to maintain remission. Most patients can discontinue the drug, but long-term follow-up observation is required.
Follow-up plan: Close follow-up is the key to the treatment of primary dry syndrome, and in principle, patients must be followed up once “three weeks”. The follow-up period can be extended appropriately according to the condition after 1 year of treatment.
Follow-up period
Examination items
Remarks
Every 3 weeks
Blood count, blood sedimentation, urine routine
Every 3-4 months
Liver and kidney function
Every 6 months
Immune function, CD4+ Th cell subpopulation
Every 1 year
Comprehensive autoantibody review
Precautions.
I. Functional exercise
1.Increase the level of biological hormones in the patient’s body, which plays a certain therapeutic role and can reduce the amount of medication.
2.Prevent osteoporosis
3.Maintain and improve joint function
4.Pleasant mood, enhance physical fitness
Exercise method: choose one of the ways
1.Swimming 1000 meters per day (can be progressive)
2.Walking 1 hour per day (continuous)
3, running 30 minutes a day (continuous)
Second, keep the mouth and eyes locally clean.
Third, no special dietary contraindications, but should avoid taking immunity-enhancing health products or proprietary Chinese medicine.
Fourth, female patients with fertility needs should stop taking immunosuppressive drugs for six months before pregnancy, and the whole process of pregnancy should be closely followed.