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Sjogren's Syndrome



Sjogren’s Syndrome

Sjogren's syndrome is an autoimmune condition in which the immune system destroys moisture-producing glands, such as tear glands and salivary glands. When Sjogren's syndrome occurs by itself, it is called primary Sjogren’s syndrome. When it occurs in the context of other autoimmune conditions, such as rheumatoid arthritis or systemic lupus erythematosus (lupus) , it is called secondary Sjogren’s syndrome.
Sjogren’s is most common in women aged 40 to 60. Symptoms include dry eyes (sicca), dry mouth (xerostomia), difficulty swallowing, loss of taste and smell, swollen salivary glands, severe dental cavities caused by dry mouth, oral yeast infections (thrush), and vaginal dryness. Fatigue and joint pain may occur as well, ranging in intensity from mild to disabling. Sjogren's can also affect the kidneys, digestive tract, lungs, liver, pancreas, or other internal organs.
As with other autoimmune diseases, symptoms of Sjogren’s tend to wax and wane. The disease is diagnosed by blood tests as well as examination of the eyes and mouth. Treatment primarily involves use of artificial tears, artificial saliva, and vaginal lubricants to relieve dryness. In some cases, anti-inflammatory or immune suppressant drugs may be used.

Principal Proposed Natural Treatments

N-acetyl Cysteine

N-acetyl cysteine (NAC) is a specially modified form of the dietary amino acid cysteine. When taken orally, NAC helps the body make the important antioxidant enzyme glutathione. It is also thought to help loosen secretions, and for this reason it has been tried as a treatment for Sjogren’s syndrome.
In a double-blind, placebo-controlled crossover trial of 26 people with Sjogren’s syndrome, use of NAC at a dose of 200 mg 3 times per day improved eye-related symptoms. 1 The supplement also showed some promise for mouth-related symptoms, but the effects were less clear-cut. While these are promising results, a much larger trial would be necessary to fully document the potential benefits of this treatment approach.
For more information, see the full NAC article.

Herb-Vitamin-Mineral Combination

A product containing vitamins and minerals as well as the herbs paprika, rosemary, peppermint , milfoil, hawthorn , and pumpkin seed has been used in Scandinavia for many years as a treatment for various mouth-related conditions. A double-blind, placebo-controlled study of 44 people found that 4 months’ treatment with this combination improved some signs and symptoms of Sjogren’s syndrome, including rate of salivary flow. 4 A larger study is needed to fully explore the potential benefits of this treatment.

Other Proposed Natural Treatments

Colostrum is the fluid that a woman's breasts produce during the first day or two after she has given birth. Very preliminary evidence suggests that oral hygiene products containing bovine colostrum (colostrum from cows) may provide beneficial effects for the mouth symptoms of Sjogren’s syndrome. 2
One small study found preliminary evidence that toothpaste containing betaine may be helpful for dry mouth symptoms of Sjogren's syndrome. 5
Gamma-linolenic acid (GLA), an essential fatty acid in the omega-6 family , has been tried as a treatment for the fatigue often associated with Sjogren’s. 3 However, in a 6-month, double-blind, placebo-controlled trial of 90 people, use of GLA failed to prove more effective than placebo. 3 One small double-blind study, however, found that a combination of GLA and the omega-6 fatty acid linoleic acid (found in many vegetable oils) may improve dry eye symptoms in Sjogren's. 8Flax oil , a source of omega-3 fatty acids, has also shown some promise for this latter purpose. 10
A 12-month, double-blind, placebo-controlled study failed to find benefit with the hormone DHEA , taken at a dose of 200 mg daily. 9 The researchers noted that the belief by participants that they were being given DHEA instead of placebo “was a stronger predictor for improvement of fatigue and well-being than the actual use of DHEA.” A previous double-blind, placebo-controlled study also failed to find benefit. 6
Numerous other natural products are widely recommended for Sjogren’s syndrome, but they lack supporting scientific evidence. These include Aloe vera , citrus bioflavonoids , dandelion , echinacea , fish oil , garlic , inositol , magnesium , methionine , olive leaf extract , red clover , vitamin A , vitamin C , vitamin E , and zinc .

Herbs and Supplements to Use Only With Caution

One case report weakly hints that the herb echinacea might potentially trigger dangerous symptoms (specifically, critical hypokalemic renal tubular acidosis) in people with Sjogren's. 7
Numerous herbs and supplements may interact adversely with drugs used to treat Sjogren’s syndrome. For more information, see the individual drug articles in the Drug Interactions section of this database.

References

1 Walters MT, Rubin CE, Keightley SJ, et al. A double-blind, cross-over, study of oral N-acetylcysteine in Sjogren's syndrome. Scand J Rheumatol Suppl. 1986;61:253-258.

2 Pedersen AM, Andersen TL, Reibel J, et al. Oral findings in patients with primary Sjogren's syndrome and oral lichen planus—a preliminary study on the effects of bovine colostrum-containing oral hygiene products. Clin Oral Investig. 2002;6:11-20.

3 Theander E, Horrobin DF, Jacobsson LT, et al. Gammalinolenic acid treatment of fatigue associated with primary Sjogren's syndrome. Scand J Rheumatol. 2002;31:72-79.

4 Pedersen A, Gerner N, Palmvang I, et al. LongoVital in the treatment of Sjogren's syndrome. Clin Exp Rheumatol . 1999;17:533-538.

5 Rantanen I, Tenovuo J, Pienihakkinen K, Soderling E. Effects of a betaine-containing toothpaste on subjective symptoms of dry mouth: a randomized clinical trial. J Contemp Dent Pract . 2003;4:11-23.

6 Pillemer SR, Brennan MT, Sankar V, et al. Pilot clinical trial of dehydroepiandrosterone (DHEA) versus placebo for Sjogren's syndrome. Arthritis Rheum . 2004;51:601-604.

7 Logan JL, Ahmed J. Critical hypokalemic renal tubular acidosis due to Sjögren's syndrome: association with the purported immune stimulant echinacea. Clin Rheumatol . 2003;22:158-159.

8 Aragona P, Bucolo C, Spinella R, et al. Systemic Omega-6 Essential Fatty Acid Treatment and PGE1 Tear Content in Sjogren's Syndrome Patients. Invest Ophthalmol Vis Sci. 2005;46:4474-4479.

9 Hartkamp A, Geenen R, Godaert GL, et al. Effect of dehydroepiandrosterone administration on fatigue, well-being, and functioning in women with primary Sjogren's Syndrome. A randomized controlled trial. Ann Rheum Dis. 2007 June 1. [Epub ahead of print]

10 Pinheiro MN Jr, dos Santos PM, dos Santos RC, et al. Oral flaxseed oil ( Linum usitatissimum ) in the treatment for dry-eye Sjogren's syndrome patients. Arq Bras Oftalmol. 2007;70:649-655.

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