Practical Approach to Treatment of Sjögren's Syndrome – Dry Mouth and Gynecologic Complaints

Sjogren’s syndrome (SS) is characterized by dry eyes and dry mouth, but there is a wide spectrum of additional symptoms due to dryness. The treatment of dry mouth remains largely unsatisfactory and the correlation of dry mouth symptoms with either minor salivary biopsies or salivary gland flow rates remains low. These currently used methods of diagnosis (and therapeutic outcome) measure predominantly the transport of water and the transporters (acini and ducts) of water, electrolytes and selective associated proteins. Proteomics of saliva in SS patients have demonstrated the altered content of salivary proteins and their post-translational processing in comparison to age matched individuals. Also, the microfloral colonization of the mouth and the content of the “biofilm” differ in SS patients. However, it is likely that the major factor that remains unknown in the SS patient’s symptoms of dryness reflect the poorly understood role of oral mucins that play a key role in the viscosity of movement of the tongue and oral membranes. Saliva is a water/mucin mixture that contributes to the comfort of the oral mucosa during chewing, talking and swallowing. Also of great importance, the symptoms of “burning mouth” are frequently exacerbated by low-grade oral erythematous yeast infection, especially as a complication of dentures that are frequent in this population of patients. Another important factor is local neuropathy of the oral surfaces or the “burning mouth syndrome”. All of these “dry mouth” symptoms are exacerbated by “chronic central sensitization,” the current term for fibromyalgia, where afferent pain stimuli are amplified at the level of dorsal column or centrally in the brain. These latter symptoms are exacerbated by stress and sleep disturbances that reflect the complex immuneneuro-endocrine-exocrine axes. Also, a wide variety of medications used for neuropathy or fibromyalgia, as well as other medical problems in these patients, may exacerbate the oral dryness symptoms. Similar considerations apply to