Dry syndrome is a chronic autoimmune connective tissue disease, which can occur at any age, but the onset of the disease is mostly after middle age, and women account for more than 90%. At present, modern medicine at home and abroad has no effective treatment drugs, public can symptomatic treatment, such as dry eyes with artificial tears, dry mouth with artificial saliva, etc..
Patients suddenly manifest as dry eyes, dry mouth and nose, in severe cases no tears, no saliva, eating with water to send, some female patients vaginal dryness, pain abnormal.
The lesions often involve the lung, liver, kidney, gastrointestinal, skin, joints and lymph, etc. It often develops secondary to rheumatoid arthritis, lupus erythematosus, polymyositis, nodular arteritis, etc. It can also be complicated by chronic active hepatitis, malignant lymphoma such as reticulocytoma and allergic vasculitis. This disease can be diagnosed by the presence of two items in the triad of oral, ocular dryness and rheumatoid arthritis. Laboratory tests often show fluid and cellular immune abnormalities, such as increased sedimentation, significantly elevated serum gammaglobulin and immunoglobulin G, and low complement, etc. The disease is easily ignored at the early stage, but early treatment is crucial. Dry syndrome belongs to the category of “dryness” in Chinese medicine, and the symptoms are mainly internal dryness, but also external dryness. It is mostly caused by internal heat and fluid injury, or internal deficiency of essence and blood in long term illness, or excessive blood loss, or injury to fluid after sweating, vomiting, or downward movement. Therefore, we take nourishing Yin and clearing heat, nourishing blood and moistening dryness as the main treatment rule, that is, “Gu Zheng is seemingly but not need to nourish the stomach and store fluid, transforming evil but need to moisten the lung and dryness. In clinical treatment, according to the patient’s physical condition and complications, the treatment is flexible according to the symptoms.
I. General remarks
Sjogren syndrome (SS) is a chronic inflammatory autoimmune disease involving exocrine glands (such as lacrimal glands and salivary glands) throughout the body, with common symptoms such as dry eyes, dry mouth, no sweating, dry stools, etc. It can also involve multiple systems throughout the body. The disease was reported in detail by Henrik Sjogren as early as 1933. Because its performance is mainly dry, it is named as dry syndrome.
The incidence of the population
The incidence rate of dry syndrome is as high as 0.4-0.7%, and it can be as high as 3-4% in the elderly, but it is more common in middle-aged and elderly women. If the disease has systemic damage, such as improper treatment, the internal environment can be disturbed, causing serious consequences.
Causes
The onset of the disease is related to genetics, and viral infection may be the cause. People with this disease have a series of autoimmune phenomena after being infected by viruses, producing excessive autoantibodies, which specifically erode their own glands, causing inflammation of the glands and loss of secretion function and occurrence of the disease.
IV. Main symptoms
1. Oral cavity
Many patients with mild disease have no obvious oral manifestations, that is, they have mild dry mouth, which is often ignored.
2. Eye
Dry eyes, itching and pain, no tears, photophobia, blurred vision, visible red eyes, ulcers in the eyes, some can appear protruding eyes, etc.
3.Respiratory tract
Dry nose, little secretion in the nose, dry crust; dry throat, reluctance to vocalize; sticky phlegm, may have bronchitis, interstitial pneumonia, pulmonary atelectasis, etc.
4.Digestive tract
Difficulty in swallowing, atrophy of gastric glands, formation of atrophic gastritis, there can also be pancreatitis and hepatosplenomegaly.
5.Urinary tract
Kidney damage can be formed, forming interstitial nephritis, tubular acidosis, renal diabetes, glomerulonephritis, etc.
6.Nervous system
The central nerve is involved in 25% of cases and the peripheral nerve in 10-43%, manifesting as mental disorders, convulsions, hemianopia, aphasia, hemiplegia, paraplegia, ataxia, etc.
7.Muscle and joint
There can be muscle pain, joint pain, and some can have periodic paralysis.
8.Skin mucosa and lymph
Dryness like ichthyosis, nodular erythema, purpura, Raynaud’s phenomenon, skin ulcers, vaginal dryness and atrophy, lymph node enlargement, etc.
9.Pseudolymphoma and malignant lymphoma
10.Laboratory examination
There may be anemia, decreased white blood cells, thrombocytopenia, increased eosinophilia, accelerated sedimentation, increased immunoglobulin IgG IgM, increased circulating immune complexes, positive antinuclear antibody (ANA), positive anti-SSA and anti-SSB, positive rheumatoid factor (RF), etc.
V. Diagnostic criteria
1.Dry keratitis
2.Dry mouth syndrome
3.Serum is positive for one of the following antibodies: anti-SS-A, anti-SS-B, ANA>1:20, RF>1:20, and the diagnosis can be confirmed if the above three items are present and other diseases are excluded.
VI. Conventional treatment
At present, there are no specific drugs in Western medicine, 0.5% methylcellulose eye drops and coated oral cavity can be used to improve the symptoms, without systemic damage or combined with other autoimmune diseases to apply corticosteroids (hormones), can also apply immunosuppressive drugs, plasma exchange and other methods.
Side effects of hormonal drugs.
1.Body fattening;
2.It can cause osteoporosis and femoral head necrosis;
3. The body’s resistance decreases; etc.
Both hormones and immunosuppressants have a certain effect on sexual function. Long-term, high-dose use of corticosteroids such as prednisone can aggravate the degree of sexual dysfunction. Almost all immune agents can make testicular atrophy, ovarian damage, resulting in the reduction or disappearance of spermatogenic function, loss of libido, impotence.
Seven, regulation and care
1, pay attention to oral and eye hygiene, reduce friction and avoid infection
2.Prevent colds and other viral infections
3, mental well-being, establish confidence in longer treatment
4, do not eat irritating and “fire” food
5.Make friends with doctors and get health care guidance.
General treatment of dry syndrome
1.Treatment of dry keratitis
Use 0.5% hydroxymethylcellulose (artificial tear) drops to reduce the damage of cornea. Local use of hormone can relieve symptoms, but it can relapse rapidly after stopping the drug, and long-term application can induce glaucoma and secondary eye infection. Diuretics, certain anti-hypertensives and antidepressants have inhibitory effects on the lacrimal and salivary glands and should be used with caution.
2.Treatment of dry mouth
It is quite difficult to reduce the symptoms of dry mouth, and the mouth should be moistened with liquid frequently. Attention must be paid to oral cleaning to prevent dental caries and other oral infections. Avoid taking drugs containing cholinergic effect.
3.Treatment of dryness of other parts
Dry skin generally does not need to be treated. Dry nasal cavity can be treated with saline drops, avoid using oily lubricant to avoid lipid-like pneumonia caused by inhalation. If vaginal dryness hinders sex life, lubricant can be used.
4. Systemic treatment
Corticosteroids can be used for severe vasculitis, lung and kidney disorders, liver damage, blood cell reduction and other serious lesions. Prednisone is commonly used, with the first dose of 30-40mg daily, and the dose is reduced after the symptoms are relieved, and the hormone is withdrawn at the right time. Although the immunosuppressants azathioprine and cyclophosphamide have many side effects, they should be used in combination with glucocorticoids for those with rapidly progressing disease.
The dose of cyclophosphamide is 2-4 mg/kg/day, and the white blood cells should be monitored during the treatment period, and should be discontinued if the white blood cells are less than 4X109/L. Patients with arthralgia can take NSAIDs such as ibuprofen, anti-inflammatory pain, etc. Those who appear to have malignant lymphoma should actively and timely carry out combined chemotherapy for lymphoma.
Diet regulation of dry syndrome
Patients with dry syndrome are characterized by deficiency of yin and fluids as the root and dryness and heat and fire as the symptoms, thus manifesting as signs of dryness and heat and fluids injury in both eyes, mouth, skin and vagina.
Therefore, the diet of patients with dry syndrome should favor sweet-cooling and moistening, and eat more foods that nourish Yin and clear heat and produce fluid, such as edamame, loofah, celery, red stalked cabbage, yellow cauliflower, wolfberry head, celery, tamari and turtle. Fruits such as watermelon, sweet orange, fresh pear, fresh lotus root, etc., can also be sweet and cold to produce Jin. Those who have dry mouth and tongue can often contain plums, Tibetan green fruit, or often drink lime juice, lemon juice and other thirst-quenching drinks.
Should avoid eating spicy and hot drinks and food, to prevent dryness and injury, aggravating the disease. Avoid eating spicy, dry and warm products, such as wine, tea, coffee, all kinds of fried food, mutton, dog meat, venison, as well as ginger, onion, garlic, chili, pepper, pepper, fennel, etc., and smoking is strictly prohibited. However, due to the long duration of dry syndrome patients, while treating the dietary taboos correctly, we should not be too strict with the taboos, for if the taboos are too strict, it will affect the absorption of nutrition for years and years, which is unfavorable to the disease. In short, food should be fresh, meat and vegetables should be matched, less and more meals should be eaten, diet should be suitable for taste, and sufficient nutrition should be ensured.