AboutDr. Timothy K. Durnin Expertise I can answer, diagnosis and professionally advise people suffering from any type of arthritis. I have been treating and diagnosing arthropathies for over 18 years.
Experience I am clinic and medical director of over 24 out patient facilities in the Chicago land area. I am on staff at Olympia Fields Osteopathic Hospital (St. James) and in active private practice. My emphasis is on arthritis and disc herniations but can answer any internal medicine questions. Past Chicago Bulls team physician.
Presently running RCT (random clinical trials on cold laser applications for pain, PVD, smoking cessation and weight loss) for Thor laser Corporation/Life Extension Laser Corporation
Organizations AASP (American Association of Spinal Physicians) ACA (American Chiropractic Association), ICS (Illinois Chiropractic Society)
Presidential Cabinet Member and guest lecturer at National University of Health Sciences, Many other related health organizations.
Publications JMPT (Journal of Manipulation and Physiological Therapeutics), Several News paper columns on neuromusculoskeletal pathology in Chicago news papers.
Education/Credentials B.S./D.C.(Human Biology and Doctor of Chiropractic)
Board Certified AMA impairment ratings.
Awards and Honors Phi Theta Kappa, Who's Who in America, Past physician of the year award, NHS (Nation Honors Society)
Past/Present Clients Several professional Athletes, currently seeing over 150 patient visits/week
Question I had a positive ANA 1:320 speckled so I went to the rheumatologist and I asked to see my blood test results and it said sjogren's 350 High. No one is telling me anything. He said he will explain in 4 weeks when he sees me. He prescribed me Plaquenil well the generic. What does all of this mean?
Answer Ayanna. It means you ptobably will need steroid therapy if it turns out that way.
What is Sjogren's syndrome?
Sjogren's syndrome is an autoimmune disease. Autoimmune diseases are characterized by the abnormal production of extra antibodies in the blood that are directed against various tissues of the body. This particular autoimmune illness features inflammation in certain glands of the body. Inflammation of the glands that produce tears (lacrimal glands) leads to decreased water production for tears and eye dryness. Inflammation of the glands that produce the saliva in the mouth (salivary glands, including the parotid glands) leads to mouth dryness.
Sjogren's syndrome with gland inflammation (resulting dry eyes and mouth, etc.) that is not associated with another connective tissue disease is referred to as primary Sjogren's syndrome. Sjogren's syndrome that is also associated with a connective tissue disease, such as rheumatoid arthritis, systemic lupus erythematosus, or scleroderma, is referred to as secondary Sjogren's syndrome.
What causes Sjogren's syndrome?
While the exact cause of Sjogren's syndrome is not known, there is growing scientific support for genetic (inherited) factors. The illness is sometimes found in other family members. It is also found more commonly in families that have members with other autoimmune illnesses, such as systemic lupus erythematosus, autoimmune thyroid disease, juvenile diabetes, etc. 90% of patients with Sjogren's syndrome are female.
What are symptoms of Sjogren's syndrome?
Symptoms of Sjogren's syndrome can involve the glands, as above, but there are also possible affects of the illness involving other organs of the body (extraglandular manifestations).
When the tear gland (lacrimal gland) is inflamed from Sjogren's, the resulting eye dryness can progressively lead to eye irritation, decreased tear production, "gritty" sensation, infection, and serious abrasion of the dome of the eye (cornea).
Inflammation of the salivary glands can lead to mouth dryness, swallowing difficulties, dental decay, gum disease, mouth sores and swelling, stones and/or infection of parotid gland inside of the cheeks.
Other glands that can become inflamed, though less commonly, in Sjogren's syndrome include those of the lining of the breathing passages (leading to lung infections) and vagina (sometimes noted as pain during intercourse recurrent vaginal infections).
Extraglandular (outside of the glands) problems in Sjogren's syndrome include joint pain or inflammation (arthritis), Raynaud's phenomenon, lung inflammation, lymph node enlargement, kidney, nerve, and muscle disease. A rare serious complication of Sjogren's syndrome is inflammation of the blood vessels (vasculitis), which can damage the tissues of the body that are supplied by these vessels.
A common disease that is occasionally associated with Sjogren's syndrome is autoimmune thyroiditis (Hashimoto's thyroiditis), which can lead to abnormal thyroid hormone levels detected by thyroid blood tests. Heartburn and difficulty swallowing can result from gastroesophageal reflux disease (GERD), another common condition associated with Sjogren's syndrome. A rare disease that is uncommonly associated with Sjogren's syndrome is primary biliary cirrhosis, an immune disease of the liver that leads to scarring of the liver tissue. A small percentage of patients with Sjogren's syndrome develop cancer of the lymph glands (lymphoma). This usually develops only after many years with the illness. Unusual gland swelling should be reported to the physician.
Sjogren's Syndrome (cont.)
In This ArticleWhat is Sjogren's syndrome?
What causes Sjogren's syndrome?
What are symptoms of Sjogren's syndrome?
How is Sjogren's syndrome diagnosed? How is Sjogren's syndrome treated? Conclusion
Sjogren's Syndrome At A Glance
Sjogren's Syndrome GlossarySjogren's Syndrome Index
How is Sjogren's syndrome diagnosed?
The diagnosis of Sjogren's syndrome involves detecting the features of dryness of the eyes and mouth. The dryness of the eyes can be determined in the doctor's office by testing the eye's ability to wet a small testing paper strip placed under the eyelid (Schirmer's test). More sophisticated eye testing can be done by an eye specialist (ophthalmologist). Salivary glands can become larger and harden or become tender. Salivary gland inflammation can be detected by radiologic nuclear medicine salivary scans. Also, the diminished ability of the salivary glands to produce saliva can be measured with salivary flow testing. The diagnosis is strongly supported by the abnormal findings of a biopsy of salivary gland tissue.
The glands of the lower lip are often used to obtain a biopsy sample the salivary gland tissue in the diagnosis of Sjogren's syndrome. The lower lip salivary gland biopsy procedure is easily performed under local anesthesia with the surgeon making a tiny incision on the inner part of the lower lip to expose and remove a sample of the tiny salivary glands within.
Patients with Sjogren's syndrome typically produce a myriad of extra antibodies against a variety of body tissues (autoantibodies). These can be detected through blood testing and include antinuclear antibodies (ANAs), which are present in nearly all patients. Typical antibodies that are found in most, but not all patients, are SS-A and SS-B antibodies, rheumatoid factor, thyroid antibodies, and others. Low red blood count (anemia) and abnormal blood testing for inflammation (sedimentation rate) are seen.
How is Sjogren's syndrome treated?
The treatment of patients with Sjogren's syndrome is directed toward the particular areas of the body that are involved and complications, such as infection. There is no cure for Sjogren's syndrome.
Dryness of the eyes can be helped by artificial tears, eye lubricant ointments at night, and minimizing the use of hair dryers. When dryness becomes more significant, the ophthalmologist can plug the tear duct closed so that tears cover the eye longer. Cyclosporine eyedrops (Restasis) are recently approved medicated drops that can reduce the inflammation of the tear glands improving their function. Signs of eye infection (conjunctivitis), such as pus or excessive redness or pain, should be evaluated by the doctor.
The dry mouth can be helped by drinking plenty of fluids, humidifying air, and good dental care to avoid dental decay. The glands can be stimulated to produce saliva by sucking on sugarless lemon drops or glycerin swabs. Additional treatment for the symptom of dry mouth are prescription medications that are saliva stimulants, such as pilocarpine (Salagen) and cevimeline (Evoxac). These medications should be avoided by persons with certain heart diseases, asthma or glaucoma. Artificial saliva preparations can ease many of the problems associated with dry mouth. Many of these types of agents are available as over-the-counter products including toothpaste, gum, and mouthwash (Biotene). Vitamin E oil has been used with some success. Infections of the mouth and teeth should be addressed as early as possible in order to avoid more severe complications. Diligent dental care is very important.
Salt water (saline) nasal sprays can help dryness in the passages of the nose. Vaginal lubricant should be considered for sexual intercourse.
Hydroxychloroquine (Plaquenil) has been helpful for some manifestations of Sjogren's syndrome. Serious complications, such as vasculitis, can require immune suppression medications, including cortisone (prednisone and others) and/or azathioprine (Imuran) or cyclophosphamide (Cytoxan).
Infections, which can complicate Sjogren's syndrome, are addressed with appropriate antibiotics. A rare complication of Sjogren's syndrome, cancer of the lymph glands (lymphoma) is treated independently.
Conclusion
Sjogren's syndrome is an area of active immunology research. Many new treatments will be available in the near future.
Sjogren's syndrome is named after a Swedish ophthalmologist, Henrik Sjogren. In the early 1900s, Sjogren called the syndrome "keratoconjunctivitis sicca." The name sicca syndrome is technically now used only to describe the combination of dryness of the mouth and eyes, regardless of cause. The term "sicca" refers to the dryness of the eyes (and mouth).
Sjogren's Syndrome At A Glance
Sjogren's syndrome is an autoimmune disease.
Sjogren's syndrome involves inflammation of glands and other tissues of the body.
90% of Sjogren's syndrome patients are female.
Sjogren's syndrome can be complicated by infections of the eyes, breathing passages, and mouth.
Sjogren's syndrome is typically associated with antibodies against a variety of body tissues (auto-antibodies).
Diagnosis of Sjogren's syndrome can be aided by a saliva gland biopsy.
Treatment of patients with Sjogren's syndrome is directed toward the particular areas of the body that are involved and complications, such as infection.
