Sjogren’s Syndrome And Fatigue

Vagus Nerve And Cns Inflammation

Two mechanisms whereby peripheral inflammation can enhance CNS inflammation are through leaky areas in the blood-brain-barrier and the vagus nerve . The vagus nerve, the tenth cranial nerve, is the longest nerve in the autonomic nervous system. This nerve has parasympathetic control of numerous organs that are involved in respirationincluding the lungs, heart, and diaphragmto mediate oxygen demand , which could contribute to fatigue. The vagal nerve afferents tend to relay pro-inflammatory responses cells from organs in the periphery to the CNS . These vagal efferents tend to induce anti-inflammatory responses in peripheral tissue from CNS signals.

The DMN and NTS are major sources of efferent motor vagal input. Longer preganglionic cholinergic neurons communicate with postganglionic neurons in closer proximity and within tissues of the viscera to induce anti-inflammatory signals . Acetylcholine released from neurons interacts with muscarinic acetylcholine receptors and utilizes the DMN, NTS, nucleus ambiguus , and the vagal efferent nerve to alter heart rate, gluconeogenesis, and bronchial constriction . Consequently, these physiological effects could potentially affect fatigue-like behaviors.

Instrument For Fatigue Assessment In Pss

A perfect instrument for measuring fatigue should be reliable, sensitive to change and easy to administer. The use of a 10-cm visual analogue scale with the anchor points being No fatigue and Worst possible fatigue is one of the simplest methods of measuring the severity of fatigue. As a single item instrument, however, it does not measure individual dimensions of fatigue. Data from studies of patients with RA suggest that the VAS is useful in clinical research as well as in assessing response to treatment . Furthermore, the simplicity of the VAS makes it one of the most popular instruments used in the assessment of fatigue, either alone or alongside other multi-item instruments.

What Causes Sjgrens Syndrome

Sjögrens syndrome is an autoimmune disease, which means something triggers your immune system to attack healthy cells. This attack damages the tear system in your eyes and the salivary glands in your mouth.

Exactly what causes this abnormal immune system response is not clear. These factors may play a role:

• Environmental factors.
• Sex hormones .
• Viral infections.

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What Should I Eat If I Have Sjgrens Syndrome What Foods Should I Avoid

An estimated 90% of people with Sjögrens syndrome have problems related to eating. In some cases, these problems can be enough to cause malnutrition. Troubles can be related to dryness and swelling of the throat, as well as intestinal tract or nerve damage. There also seems to be a significant number of people who have both Sjögrens syndrome and celiac disease and/or symptoms of irritable bowel syndrome .

If you have gastrointestinal symptoms, you can work with a registered dietitian to find out what food sensitivities you have. An RD can then also help you to create a food plan that works well for you and provides the nutrients you need.

Problems with gastroesophageal reflux are also common among people in general and among people with Sjögrens syndrome in particular. Your care team can provide you with tips for dealing with GERD. These might include not eating two to three hours before you lie down to sleep and avoiding greasy foods.

There are some recommendations that people who have autoimmune disorders like Sjögrens syndrome should follow an anti-inflammatory diet to help with joint pain and other symptoms. Some people have found relief from a completely plant-based diet.

Here are some tips that might help you manage other types of eating issues:

Clinical Variables And Outcomes

Fatigue severity was measured using the Profile of Fatigue Questionnaire, which is validated for use in pSS. Physical fatigue was scored on a scale of 07 to classify patients into minimal , mild , moderate and severe fatigue groups based on quartile scores. People from the healthy control group were screened for the presence of fatigue using a self-completed questionnaire. None of the controls reported the presence of fatigue, sicca symptoms or other autoimmune conditions. Anxiety and depression were measured using the Hospital Anxiety and Depression Score.

Other clinical parameters included systemic disease activity using the EULAR Sjögren’s Syndrome Disease Activity Index and EULAR Sjögren’s Syndrome Patient Reported Index , as well as glandular manifestations using Schirmer’s test, unstimulated oral salivary flow test and EULAR Sicca Scorea measure of overall dryness experienced by the patient.,

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How To Utilize Team Care

• SS is a chronic disease with a wide spectrum of clinical manifestations, and therefore optimal management of SS patients requires a multi-disciplinary approach among all the specialists.

• Patients should be followed regularly by their internist or rheumatologist for any significant decline, development of concerning symptoms of malignancy, and signs of disease complications.

• Coordination with a team of specialists, including ophthalmologists, dentists, otolaryngologists, and rheumatologists is crucial in the management of this chronic disease.

• Treatments that are initially effective may become less effective over time as the disease progresses and/or complications arise.

  Artificial tear substitution may be effective initially, however may not be sufficient as tear production become insufficient in which case punctal plugging or use of secretagogues may be indicated.

• Frequent monitoring by a dentist, at least twice yearly, for cleaning and flouride therapy is also critical as increased dental caries may be complicated by oral candidiasis.

• Systemic features of the disease, such as polyarthralgia, myalgia, fatigue, and more severe features such as vasculitis, glomerulonephritis, or neuropathies require management by a rheumatologist with use of immunosuppressive drugs.

• Appropriate referrals and a multi-disciplinary approach are required for care of patients with SS.

Five Ideas For Combating Fatigue When You Have Sjogrens Syndrome

Sjogrens Syndrome is a chronic autoimmune disorder that causes inflammation in various areas of the body, but most often affects the exocrine glands that produce tears and salvia.

Patients with this disorder often complain of dry eyes and mouth, but unfortunately, there is much more to this disease than dryness. Because it is an autoimmune disorder, the immune system mistakenly attacks the bodys cells and tissues. This causes damage to parts of the body, such as joints, thyroids, kidneys, lungs, skin, and nerves.

In addition to dry tissue and damage to organs, patients also have to fight severe fatigue. This fatigue can be divided into two categories physical and mental. Studies indicate that Sjogrens patients experience more physical fatigue than mental fatigue. These patients also report intense daytime sleepiness, an indicator of physical exhaustion. Some who suffer may experience severe symptoms, while others have mild symptoms. Regardless of the varying degrees, patients must be able to manage their symptoms and live a comfortable life. Here are five ideas for combatting the severe fatigue that often accompanies Sjogrens Syndrome.

Stay hydrated.

• Watermelon
• Oranges

Eat well.

Get physically active.

Light exercise can help in maintaining weight, managing stress, and beating fatigue. Studies show that physical activity can improve strength, diminish fatigue, and reduce pain and depression that accompany most autoimmune rheumatic diseases.

Get mentally active.

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If You Think You May Have Sjgrens Syndrome

If these symptoms sound like ones youre experiencing, you could have Sjögrens syndrome. Its important to share this information with your general practitioner, eye doctor or dentist. If Sjögrens syndrome isnt treated appropriately, significant, long-term complications could result that affect your eyes, mouth, lungs, kidneys, liver or lymph nodes complications including blindness, significant dental destruction and non-Hodgkin lymphoma.

Your doctor will discuss your symptoms in greater detail and determine if you should see a specialist, such as a rheumatologist, for a diagnosis.

Identify The Type Of Fatigue

There are 13 types of fatigue that Sjogrens syndrome patients usually experience. Identifying the type of fatigue you have is essential before taking appropriate measures to mitigate the effects.

For example, if you are experiencing the so-called tired-wired fatigue, which occurs due to taking certain medications such as prednisone or consuming excess caffeine, decreasing their intake may reduce the severity of this type of fatigue.

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How Will Sjgren’s Syndrome Affect Me

Though the symptoms can be uncomfortable and last quite a long time, you should be able to lead the life you want if the condition is treated properly. For most people, the condition only affects the tear and saliva glands, but some people may experience other symptoms, such as fatigue and joint inflammation.

If dryness of the eyes isnt treated, the front of your eye could become damaged and cause permanent sight problems. Seeing an optician regularly and using treatments for dry eyes can help stop this.

People with Sjögrens syndrome might be more likely to develop:

• hypothyroidism, when the thyroid gland is underactive
• Raynauds phenomenon, which causes the fingers to feel cold and turn blue
• inflamed blood vessels, known as vasculitis, which can cause reduced blood flow
• loss of feeling in the hands and feet, known as peripheral neuropathy
• IBS, causing tummy pain, diarrhoea and constipation
• kidney problems

You Might Think Of Dry Eyes Or A Parched Mouth But There Are Other Subtle Signs Of Sjogrens You May Be Ignoring

A hoarse voice. Itchy eyes. Wanting to crawl back into bed in the morning because youre still tired. These symptoms might sound like allergies or a cold, but in some people, they could indicate that you have a chronic autoimmune disease: Sjögrens syndrome.

An autoimmune disease occurs when your immune system starts attacking your bodys own healthy cells by mistake. In the case of Sjögrens syndrome, the immune cells mainly target saliva- and tear-making glands, but Sjögrens is a systemic disease that can affect the entire body. Symptoms usually first show up in adults over the age of 40, especially women.

Sjögrens can occur on its own , but it more commonly overlaps with a pre-existing autoimmune disease like rheumatoid arthritis or lupus .

In fact, studies show that up to 31 percent of people with rheumatoid arthritis have Sjögrens. Studies suggest that certain genetic factors increase the risk of producing antibodies that lead to autoimmune conditions Sjögrens included but they havent figured out why certain people develop them, says Sara McCoy, MD, a board-certified rheumatologist with UW Health in Madison, Wisconsin.

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Cns Or Central Nervous System Complications Of Sjgrens Syndrome

Myelitis

Patients with Sjögrens syndrome may have myelitis, which is inflammation of the spinal cord. Myelitis can cause weakness, numbness, and difficulty with urination and/or defecation. Myelitis can present quickly . However, symptoms due to inflammation of the spinal cord may evolve more slowly, progressing over weeks or months. This slower progression may be difficult to distinguish from Multiple Sclerosis . Unfortunately, patients with myelitis and Sjögrens syndrome can be misdiagnosed with MS. Appropriate tests, which may include spinal tap and MRI of the brain/spinal cord, can lead to diagnostic clarity. The importance of accurately distinguishing between Multiple Sclerosis and Sjögrens syndrome is of paramount importance. MS and Sjögrens have completely different treatments. The approved treatments for MS are ineffective for Sjögrens syndrome, and may actually lead to flares or worsening of Sjögrens syndrome.

Patients with Sjögrens syndrome may have another autoimmune disorder called Devics syndrome, or Neuromyelitis Optica. Neuromyelitis Optica causes inflammation of the nerves connecting the eye to the brain, or optic neuritis, as well as myelitis. The pattern of myelitis which can occur in Neuromyelitis Optica is much different than Multiple Sclerosis. Typically, the myelitis in Neuromyelitis Optica is more severe, causing severe weakness, and may cause future relapses.

Red flags for a Diagnosis of Neuromyelitis Optica

Does Sjgrens Syndrome Cause Hair Loss

If you have Sjögrens syndrome, you might see some hair loss, and it might be as a result of the condition. There is a condition known as frontal fibrosing alopecia that is being found in higher numbers in people with autoimmune diseases. This condition causes slow hair loss at the front hairline and sometimes the eyebrows.

However, hair loss can be triggered by many things, including stressful life events and medications. You should ask your dermatologist about problems with hair loss.

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Pathogenesis Of Fatigue In Pss

Despite an increasing interest among clinicians and scientists, the underlying physiological basis of fatigue in pSS, or indeed in other conditions, remains poorly defined. Several non-mutually exclusive mechanisms have been proposed. A useful model to study fatigue is to consider the inter-relationships of biological, psychological and social factors on the feeling of fatigue. It should be emphasized, however, that the categorization of these factors into psychological, social and physiological is somewhat arbitrary and such categorization is mainly intended for facilitating discussion.

Physiological Factors Of Pss

Disease activity

Although fatigue is very common among pSS patients, the link between biological disease activity and fatigue remains to be fully defined. While several studies have shown correlations between the levels of fatigue and various surrogate disease activity markers such as serum levels of immunoglobulins, ANA, lymphocyte counts and anti-Ro antibodies . The results from these studies, however, were inconsistent and sometimes conflicting. Furthermore, it remains unclear whether these markers faithfully reflect disease activity in pSS. Indeed, there has been no standardized tool for measuring disease activity until recently. It would be interesting to re-evaluate the relationship between fatigue and disease activity using the recently devised instruments of disease activity such as the EULAR SS Disease Activity Index .

Cytokines

Other cytokines that have been implicated in fatigue include TNF- and IL-10. Of note, Hartkamp et al. compared the serum levels of IL-1, IL-2, IL-6, IL-10 and TNF- of 60 pSS patients and 139 healthy controls and found no correlation between the levels of fatigue and the levels of these cytokines.

Neuroendocrine disturbances

Autonomic dysfunction

Sleep disturbance

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Sleep And Circadian Rhythms

Sleepiness, often referred to as drowsiness, can be loosely defined as the inability to remain awake or the enhanced occurrence or compulsion to sleep. Sleep disorders and disturbed sleep are associated with sleepiness . Sleepiness can impact vigilance, cognition, mood, and attention as well as induce fatigue . Many sleep-related pathologies, including insomnia and sleep apnea, are associated with impairments in vigilance, cognition, mood, motivation, and attention . Sleepiness can be induced by acutely staying awake for extended periods of time or by the fragmented sleep that occurs chronically with many health conditions including sleep apnea and autoimmune diseases . Evidence suggests that there is a dose-dependent impact whereby greater amounts of sleep loss correlate with enhanced sleepiness and poor performance . Nevertheless, sleepiness varies over the time of day , which can impair an individual’s ability to sleep or the effectiveness of naps in preventing detriments of sleepiness in functional tasks such as cognition . Individuals experiencing fatigue often experience waves of periods of times when their fatigue is worse . Furthermore, individuals with multiple sclerosis may experience increased incidence of fatigue in the morning while others do so in the evening . Although speculative, prior sleep or circadian factors are likely contributors to these time-of-day fluctuations.

Variations Of Fatigue Pain And Dryness Intensity Between Seasons

A total of 632 patients were analysed. We collected and analysed a total of 2858 VASs observations through the four studies .

Table shows the number of VASs for fatigue pain and dryness recorded in spring, summer, fall and winter and the variation of the ESSPRI score according to the season.

Table 1 Pain, fatigue and dryness by season for all spring, summer, fall and winter visits in 632 patients

Moreover, multivariate analyses were performed in the ASSESS cohort to address the influence on objective assessments of dryness of potential confounding factors, such as age of patients, symptomatic treatments of dryness and systemic immunomodulatory treatments. Adjusted odds ratios on age and treatment regimens did not detect any statistically significant seasonal effect on Schirmer test, with aOR of having a pathological Schirmer test of 0.93 CI 95% , 0.95 CI 95% and 0.75 CI 95% in spring, summer and winter, respectively, in comparison to values collected in fall. Treatment regimens did not show any influence on salivary flow either, since aOR of having a pathological salivary flow was 1.23 CI 95% , 0.71 CI 95% and 0.83 CI 95% , in spring, summer and winter, respectively, in comparison to values collected in fall .

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Instruments For Measuring Fatigue In Pss

The Profile of Fatigue and Discomfort-Sicca Symptoms Inventory , whose fatigue component measures the somatic and mental fatigue, and the EULAR Sjögrens Syndrome Patients Reported Index , which uses 0-10 numerical scales for the assessment of dryness, fatigue, and musculoskeletal pain domain, are two SS-specific instruments for measuring fatigue. Future studies may prefer to use one of these two instruments or both. The development of objective measures of fatigue depends on the elucidation of the pathophysiological mechanism of fatigue in pSS, which is still unclear.

The 10-cm fatigue visual analogue scale provides a global fatigue score where a higher score represents greater severity or intensity of fatigue. VAS is often used in pSS research, probably due to its simplicity. However, a multidimensional assessment may provide a more complete picture, improving understanding of the clinical associations of fatigue and potential treatment. Studies on pSS have also used many non-disease specific multi-item questionnaires which would be most recommended when one of the study objectives is to compare fatigue across diseases. Commonly used instruments are summarized in Table 1.

Table 1 Current fatigue measures used for Sjögrens syndrome.

More Sjogrens Syndrome Symptoms

The disease can affect parts of the body other than the eyes and mouth. You may experience dryness in your nose or throat or on your skin. Sjögrens syndrome can also affect the joints, lungs, kidneys, blood vessels, digestive organs and nerves, causing symptoms such as:

• Swollen glands, specifically behind the jaw and in front of the ears
• Joint pain, swelling or stiffness
• Prolonged dry skin
• Chronic dry cough
• Vaginal dryness
• Problems urinating, including pain, urinating more than usual, getting up at night often to urinate and needing to urinate suddenly
• Numbness or tingling in your fingers and toes
• Prolonged fatigue and/or a feeling of tiredness that keeps you from daily activities

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