Motivation: Every time someone comes with painful feet, I ask "Do you have dry mouth or dry eyes?" Patients usually look at me suspiciously. What does dry eyes have to do with painful feet? Sjogren's syndrome, of course - an elusive syndrome of dry eyes, dry mouth, and autoimmune destruction of exocrine glands often with associated peripheral neuropathy. To avoid those suspicious glances, I wonder what are the characteristics of neuropathy from Sjogren's syndrome.
Paper: Berkowitz, AL and Samuels MA. "The neurology of Sjogren's syndrome and the rheumatology of peripheral neuropathy and myelitis." Pract Neurol (2013); 0: 1-9.
Methods: Review of peripheral nervous system presentations of Sjogren's syndrome and characteristics of serologic testing. This is part of a broader paper reviewing Sjogren's associated myelitis as well.
Results:
Prevalence: Neuropathy accompanies Sjogren's syndrome in approximately 5-15% of cases. Neuropathy preceded other symptoms in 37%, occurred concurrently in 16%,and occurred after other symptoms in 37%.
Types of Neuropathy: The most common forms of neuropathy involve the dorsal root ganglia (hence pure sensory loss) in 39% and small unmyelinated fibers (hence painful) in 20%. Other presentations included trigeminal neuropathy in 16%, multiple mononeuropathies in 12%, multiple cranial neuropathies in 5%, and polyradiculoneuropathies in 4%.
Testing: The classical serum auto-antibodies anti-Ro (SSA) and/or anti-La (SSB) occur in 10-55% of patients with Sjogren's neuropathy. For dorsal root involvement, the sensitivities of SSA and SSB are 53% and 11%. For painful small fiber neuropathy, the sensitivities of SSA and SSB are 39% and 17%. Anti-nuclear antibody (ANA) is positive in 20-67%. Schirmer's test evaluating tear production (degree of moistening of filter paper in lower eyelid after 5 minutes) is positive in 56-89%. Lip salivary gland showing lymphocytic infiltration is diagnostic in 37-75% of patients.
Discussion:
The first depressing conclusion of this paper is that the manifestations of Sjogren's syndrome are protean without good diagnostic tests. Nonetheless, Sjogren's associated neuropathy is most often sensory in nature (dorsal root gagnlia or just painful neuropathy) without significant motor involvement. The second point is that serologic testing may be negative in about 50% or even more number of patients. Similarly, classical symptoms of dry eyes or dry mouth may follow neuropathy and should not be used to exclude Sjogren's syndrome. In the office, stocking filter paper and learning to perform the Schirmer's test may be more helpful than sending for serologic testing.
Paper: Berkowitz, AL and Samuels MA. "The neurology of Sjogren's syndrome and the rheumatology of peripheral neuropathy and myelitis." Pract Neurol (2013); 0: 1-9.
Methods: Review of peripheral nervous system presentations of Sjogren's syndrome and characteristics of serologic testing. This is part of a broader paper reviewing Sjogren's associated myelitis as well.
Results:
Prevalence: Neuropathy accompanies Sjogren's syndrome in approximately 5-15% of cases. Neuropathy preceded other symptoms in 37%, occurred concurrently in 16%,and occurred after other symptoms in 37%.
Types of Neuropathy: The most common forms of neuropathy involve the dorsal root ganglia (hence pure sensory loss) in 39% and small unmyelinated fibers (hence painful) in 20%. Other presentations included trigeminal neuropathy in 16%, multiple mononeuropathies in 12%, multiple cranial neuropathies in 5%, and polyradiculoneuropathies in 4%.
Testing: The classical serum auto-antibodies anti-Ro (SSA) and/or anti-La (SSB) occur in 10-55% of patients with Sjogren's neuropathy. For dorsal root involvement, the sensitivities of SSA and SSB are 53% and 11%. For painful small fiber neuropathy, the sensitivities of SSA and SSB are 39% and 17%. Anti-nuclear antibody (ANA) is positive in 20-67%. Schirmer's test evaluating tear production (degree of moistening of filter paper in lower eyelid after 5 minutes) is positive in 56-89%. Lip salivary gland showing lymphocytic infiltration is diagnostic in 37-75% of patients.
Discussion:
The first depressing conclusion of this paper is that the manifestations of Sjogren's syndrome are protean without good diagnostic tests. Nonetheless, Sjogren's associated neuropathy is most often sensory in nature (dorsal root gagnlia or just painful neuropathy) without significant motor involvement. The second point is that serologic testing may be negative in about 50% or even more number of patients. Similarly, classical symptoms of dry eyes or dry mouth may follow neuropathy and should not be used to exclude Sjogren's syndrome. In the office, stocking filter paper and learning to perform the Schirmer's test may be more helpful than sending for serologic testing.
Thank you for your article. I thought it was very informative.
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Unfortunately, as with many autoimmune diseases, there is no known medical treatment and medication for this condition; Sjogren's Syndrome Natural Treatment can only lessen the severity of the symptoms and support the body’s general health. Now, let’s take a look at some of these alternative treatments for Sjogren’s Syndrome.
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