Sjogren’s Syndrome

Posted by ATMAJA'Z


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s a chronic inflammatory autoimmune process of unknown cause that affects the lacrimal and salivary glands.
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It is thought that antibodies directed at exocrine glands are produced, causing lymphocytic infiltration and impairing function of involved tissue.

* The syndrome may cause variety of complications such as corneal disease, tooth loss, pulmonary fibrosis or hypertension, obstructive airway disease, chronic atrophic gastritis, chronic pancreatitis, abnormal liver or kidney function, and dementia.

Assessment:

1. Decreased tear production leading to keratoconjunctivitis, photophobia.
2. Dry mouth (xerostomia), mucosal ulcers, stomatitis, salivary gland enlargement (unilateral or bilateral), dysphagia.
3. Nasal dryness, epistaxis, nasal ulcers.
4. Dryness of bronchial tree, hoarseness, recurrent otitis media, pneumonia, and bronchitis.
5. Skin dryness (xeroderma), urticaria, purpura.
6. Pancreatitis, hypochlorhydria or achlorhydria, autoimmune liver disease.
7. Renal tubular acidosis, nephrogenic diabetes insipidus.
8. Trigeminal neuropathy (Bell’s Palsy), polymyopathy, sensory and motor neuropathy, seizures, multiple sclerosis like syndrome.
9. Autoimmune thyroiditis.
10. Raynaud’s phenomenon, vasculitis infants born to mothers with Sjogen’s syndrome may have congenital heart block.
11. Vaginal dryness, dyspareunia.
12. Nonerosive polyarthritis.

Diagnostic Evaluation:

1. Complete blood count shows mild anemia, leukopenia present in 30% of patients.
2. Erythrocyte sedimentation rate is elevated in 90% of patients.
3. Rheumatoid factor is positive in 75% to 90% of patients.
4. Antinuclear antibody is positive in 70% of patients; speckled and nucleolar patterns are most common.
5. Antobodies to SSA or SSB detect antibodies to specific nuclear proteins.
6. Salivary scintigraphy evaluates salivary gland function.
7. X-rays of affected joints rule out erosive arthritis.
8. Salivary gland biopsy may be done to determine lymphocytic infiltration of tissue.

Pharmacologic Interventions:

1. Corticosteroids and immunosuppressants such as cyclophosphamide are used in severe cases.
2. Antifungal agents therapeutically or prophylactically for superimposed fungal infections of mouth or vagina.
3. Cevimeline 30 mg t.i.d., a cholinergic agonist for treatment of dry mouth.

Nursing Interventions:

1. Inspect oral mucosa for oral Candida infection, ulcers, saliva pools, and dental hygiene.
2. Instruct or assist patient in proper oral hygiene.
3. Encourage frequent intake of non-caffeinated, non-sugar liquids. Keep pitcher filled with cool water.
4. Instruct or assist patient in daily inspection of skin for areas of trauma or potential breakdown.
5. Apply lubricants to skin daily.
6. Avoid shearing forces and encourage or perform frequent position changes.
7. Increase liquid intake with meals.
8. Assist or instruct patient to avoid choosing spicy or dry foods from menu choices.
9. Suggest smaller, more frequent meals.
10. Weigh patients weekly and review diet history for basic nutrient deficiencies.
11. Advise patient on proper use of water-soluble vaginal lubrication.
12. Suggest alternate positioning and practices to prevent dyspareunia.
13. Teach the patient to recognize and report symptoms of vaginitis because infection may result from altered mucosal barrier.
14. Advise patient of commercially available artificial saliva preparations, artificial tears, moisturizing nasal spray, and artificial vaginal moisturizers.
15. Encourage frequent dental visits. Dental cavities are more frequent in patients with Sjogren’s syndrome.
16. Advice patient to check with health care provider before using any medications because many cause mouth dryness (eg, diuretics, tricyclic antidepressants, antihistamines).
17. Advice patient to wear protective eyewear while outdoors.