In situ studies did not show increased apoptosis among glandular epithelial cells, but did show reduced apoptosis among infiltrating mononuclear cells. Reduced apoptosis was also implicated in the accumulation of autoreactive B-cells found in the glands. The relationship of autoantibodies expressed in Sjögrens syndrome with apoptosis is still being researched. Hormonal factors
Sex hormones seem to influence humoral and cell-mediated immune response, with estrogen being considered one of the biggest factors responsible for sex-immunologic dimorphism. Estrogen deficiency appears to play a role in development of Sjögrens syndrome. It has been hypothesized that androgen administration to the ocular surface may serve as an effective therapy for dry eyes. Diagnosis
Diagnosing Sjögrens syndrome (SS) is complicated by the range of symptoms that a patient may manifest, and the similarity between symptoms of Sjögrens syndrome and those of other conditions. Also, patients with SS symptoms approach different specialities for treatment, which can make diagnosis difficult. Since dry eyes and dry mouth are very common symptoms, and frequently occur in people over 40, affected people may believe that the symptoms are age-related, so ignore them. Some medications can cause symptoms similar to those of Sjögrens syndrome. The combination of several tests, which can be done in a series, can eventually diagnose Sjögrens syndrome.Blood tests can be done to determine if a patient has high levels of antibodies that are indicative of the condition, such as antinuclear antibody (ANA) and rheumatoid factor (because Sjögrens syndrome frequently occurs secondary to rheumatoid arthritis), which are associated with autoimmune diseases.
Some people may experience only the mild symptoms of dry eyes and mouth, while others have symptoms of severe disease. Many patients can treat problems symptomatically. Others experience blurred vision, constant eye discomfort, recurrent mouth infections, swollen parotid glands, dysphonia (vocal disorders including hoarseness), and difficulty in swallowing and eating. Debilitating fatigue and joint pain can seriously impair quality of life. Some patients can develop kidney involvement (autoimmune tubulointerstitial nephritis) leading to proteinuria (excess protein in urine), urinary concentrating defect, and distal renal tubular acidosis.Hypokalemic paralysis due to primary Sjögren syndrome was rarely reported in the literature. Complications
Among the complications discussed above, women with anti-Ro/SS-A and anti-La/SS-B antibodies who become pregnant have an increased rate of neonatal lupus erythematosus with congenital heart block requiring a pacemaker. Type I cryoglobulinemia is a known complication of Sjögrens syndrome.Sjögrens syndrome can affect such organs as the liver, pancreas, kidneys, lungs, and central nervous system. Associated conditions
Sjögrens syndrome is associated with a number of other medical conditions, many of which are autoimmune or rheumatic disorders, such as celiac disease, fibromyalgia, SLE (lupus), autoimmune thyroiditis, multiple sclerosis and spondyloarthropathy, and several malignancies, principally non-Hodgkin lymphoma. Causes
The cause of Sjögrens syndrome is unknown, but it may be the influence of a combination of genetic, environmental, and other factors, as is the case with many other autoimmune disorders. Around 20 autoantibodies could be involved. Genetics
The observation of high rates of autoimmune disorders in families with a history of Sjögrens syndrome is linked with a genetic predisposition to the syndrome.