I. Overview
1. It is a systemic autoimmune exocrine gland disease characterized by dryness of the mouth and eyes, mainly involving the lacrimal and major and minor salivary glands.
2. It is divided into primary and secondary, the latter is seen in RA, SLE, MS, PM (or DM), CHV, etc.
3. It is more common in middle-aged women, 1:9~10 in men and women.
4. characterized by positive anti-SSA and SSB antibodies.
5. pathological features: chronic lymphocyte and plasma cell infiltration, glandular tissue destruction.
The main pathological mechanism of this disease is lung and stomach yin deficiency in the first place, liver and kidney yin deficiency in the second place, yin deficiency is not restored, dryness and heat from within, the key to the pathology is yin deficiency and dryness and heat, the lighter the lung and stomach yin injury, the heavier the liver and kidney yin deficiency, all because of yin deficiency in the first place, dryness and heat from within. Therefore, nourishing yin medicine is the primary medicine to improve the pathology. By nourishing yin, the key to improve the imbalance of yin and yang in the body, increase the source of fluid, which is the basis of the substance in the body, improve the secretion of the glands of the mouth, nose and eyes, and increase the body’s resistance to disease.
Etiology and pathology
1. the etiology is unknown, probably related to genetics, infection, and sex hormone level
2. pathogenesis: multi-causal, abnormal cellular and immune function of the body, highly reactive proliferation of B lymphocytes producing a large number of cytokines, hyperglobulinemia and a variety of autoantibodies, resulting in local tissue inflammatory damage
3. pathological features: salivary glands, lacrimal glands and any tissue in the body are infiltrated by a large number of lymphocytes, called pseudolymphoma.
III. Clinical manifestations
(a) Exocrine gland manifestations
1. Dry mouth signs: a. Dry mouth, frequent water intake for speech and solid food; b. Smooth, dry or ulcerated tongue; c. Rampant teeth – blackened teeth, flaky loss, only residual roots; d. Parotid and/or submandibular glands with transient or chronic, recurrent enlargement, one or bilateral enlargement, accompanied by pain and pressure pain
2. dry eyes (dry conjunctivitis), dry eyes, foreign body sensation, few tears, photophobia, easy eye fatigue, decreased vision, etc.
3. Dryness of respiratory tract, digestive tract, vagina, skin and other parts of the symptom
(II) Systemic manifestations
1. skin and mucous membrane lesions, purpura-like rash on both lower limbs, erythema nodosum-like rash, oral ulcers and Raynaud’s phenomenon
2. joint and muscle lesions, joint pain, myalgia, muscle weakness, normal muscle enzymes
3. digestive system lesions hepatomegaly, splenomegaly, jaundice, increased GPT, obstructive cholangitis and autoimmune cholangitis, acute and chronic pancreatitis and pancreatic exocrine hypoplasia, atrophic gastritis, dysphagia
4. renal lesions distal tubular lesions cause decreased renal reabsorption, which can lead to hypokalemic periodic paralysis, renal tubular acidosis, nephrogenic uropathy, nephrogenic chondromalacia and urinary tract stones
5. peripheral neurological lesions: sensory neuropathy – lower limb numbness, pain central: seizures, impaired consciousness, psychiatric symptoms
6. Respiratory lesions respiratory dryness, interstitial fibrosis —- dry cough, progressive dyspnea, respiratory failure
7. cardiovascular pathology pulmonary heart disease, pericardial effusion, heart failure
8. lymphoid tissue hyperplasia enlargement of multiple lymph nodes throughout the body, pathology suggests benign hyperplasia, called pseudolymphoma, which may turn into malignant lymphoma in time
9. Hematologic lesions with reduced whole blood cells, but normal bone marrow examination
IV. Laboratory tests
1. ANA antibody, anti-SSA antibody, anti-SSB antibody, anti-ds-DNA antibody, anti-RNP antibody, ACL antibody may be positive, and RF may be positive in high titer.
2. Anti-SSA and anti-SSB antibodies were positive in 70% and 40% of SS respectively
3. High diagnostic specificity of anti-SSB antibody
4. Anti-SSA and anti-SSB antibodies are not associated with disease activity
V. Diagnostic criteria refer to European diagnostic criteria
1. Having dry eyes for more than 3 months or gritty eyes, requiring artificial tears more than 3 times a day. Any one of them is positive
2. Have dry mouth for more than 3 months, or need to be brought down with water when eating dry food, or have recurrent or persistent parotid gland enlargement. With which filter paper test 5mm/5min or corneal staining index 4 is positive
3. mononuclear cell infiltrate foci of 1/4mm2 on lower lip mucosal biopsy
4. parotid gland imaging, salivary gland isotope scan, salivary flow rate with any 1 of the positive
5. Positive serum anti-SSA antibody and anti-SSB antibody
If at least 4 of the above 6 items are present, the diagnosis of primary SS can be confirmed; if there is a definite connective tissue disease with 1 or 2 of the above, and 2 of 3, 4 or 5 are positive, the diagnosis of secondary SS can be made.
VI. Differential diagnosis
SLE
RA
Other diseases with symptoms of dry mouth and eyes
VII. Treatment principles
1. symptomatic treatment for those without multi-system damage
2. Symptomatic treatment + systemic treatment for those with multi-system damage
How should the diet of dry syndrome patients be regulated?
Diet should be cool and nourishing, and eat more foods that nourish Yin and clear heat and produce body fluid, such as edamame, loofah, celery, red stemmed vegetables, yellow flowering vegetables, wolfberry head, celery, light vegetables, snapper and other cool foods. Fruits such as watermelon, sweet orange, fresh pear, fresh lotus root, etc., can also be sweet and cold to produce Jin. Dry mouth and tongue can often contain plums, Tibetan green fruit, or often drink lime juice, lemon juice and other thirst-quenching drinks.
Avoid eating spicy, fragrant, dry, warm products to prevent dryness and injury, aggravating the disease. 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 relatively long duration of dry syndrome patients, while treating the dietary taboos correctly, we should not be too strict in avoiding food.
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.