Sjögren’s Syndrome (SS) was named after Henrik Sjögren, a Swedish ophthalmologist who firstly identified a group of female patients and correlated the triad of keratoconjunctivitis sicca, xerostomia and polyarthritis. It is an autoimmune disease, which means that the patient's immune system attacks his or her own cells.
Under normal circumstances, the immune system protects us from external harmful organisms such as viruses and bacteria. When diagnosed with SS, the immune cells inside the body of patients transform from friend to foe and attack many of the body's own organs, especially the glands producing tears and saliva. The disease can appear at any age, but predominantly affects women older than 40.
· Symptoms of SS
When it comes to SS, many people will think that dryness is its main clinical manifestation, and even think that dryness is the only symptom. In fact, because of the complicated clinical manifestations many patients lack a systematic and comprehensive scientific understanding of SS, which may lead to delay of the diagnosis and treatment.
The main lesion site of SS is exocrine glands, and besides lacrimal gland and salivary gland, it also involves sweat gland, sebaceous gland, gastric gland and intestinal gland. For example, SS can also cause arthralgia, gastritis, kidney disease, and even recurrent fever and malaise.
In addition, as a systemic, chronic, autoimmune inflammatory disease, SS causes patients to not only suffer from long-term pain, but also face the side effects of medication, limited work ability, less social activities, lower quality of life, and many other factors, resulting in mental stress and causing emotional anxiety and depression.
· Clinical Treatments of SS
In daily life, quitting smoking and drinking plays an important role in treatment. Besides, dietary intake of sugary foods should be reduced (sugar tends to adhere to the teeth and increases the risk of bacterial proliferation and caries), beverages that tend to cause tooth decay and enamel erosion (such as soda, fruit juices, coffee and any acidic beverages) should be avoided, as well as constant drinking of water (drinking water washes away saliva and weakens its protective effect). In addition, oral hygiene is also necessary.
For topical treatment, pilocarpine and cevimeline have the function of stimulating saliva and lacrimal glands and can be used to treat symptoms of dryness in SS.
If systemic treatment is involved, those with systemic damage should be treated according to the damaged organ and its severity. Patients are often treated with glucocorticoids, and immunosuppressants are often used in combination for those with rapidly progressive disease.
· Latest Research on SS Diagnosis and Treatment
For diagnosis, the addition of data on novel autoantibodies related to Sjogren’s syndrome (SS) may improve screening dry eye patients for SS, according to research presented at the recently held annual meeting of the Association for Research in Vision and Ophthalmology. One of recent studies concluded that antibodies to salivary protein, parotid secretory protein, and carbonic anhydrase isoenzyme VI (CA-6) may be novel markers for SS. In mouse studies these novel antibodies were detected earlier in the disease process.
“Natural autoantibodies may be used as early biomarkers for Sjögren's Syndrome detection and prevention,” said a scientist from Creative Biolabs, “many natural autoantibody targets have been proved to have this potential, including anti-Ro antibodies, anti-La antibodies, and anti-centromere antibodies.”
For treatment, recent research published on July 20, 2021, titled A Study of Nipocalimab in Adults With Primary Sjogren's Syndrome (pSS), proved that Nipocalimab, a fully human aglycosylated immunoglobulin (Ig)G1 monoclonal antibody, can block the binding site for IgG on FcRn, lead directly to increased IgG catabolism and a decrease in circulating IgG antibody concentration, and directly inhibit inflammatory cellular responses to these pathogenic IgG. Therefore, Nipocalimab has the potential to treat pSS and improve disease manifestations.
The great progress made in the knowledge on the pathologic aspects and biological mechanisms of the disease will further open up new horizons in SS treatment.