Symptoms of Sjogren's syndrome

[Edit this paragraph] The clinical manifestations of Sjogren's syndrome in ten parts of human body. The clinical manifestations are slow onset, fatigue and even fever.

First, dry mouth wants to drink, and it is difficult to eat dry food in severe cases. Because there is less saliva, the washing effect is reduced, and dental caries are prone to occur. 63% patients with primary barnyard grass ss have dental caries. 40% of eloquence salivary glands are swollen and symmetrical, and the surface is smooth and not hard. Gland swelling can persist or recur, and secondary infection is rare. If the glands are hard and nodular, be alert to malignant transformation.

Second, dry eye has a foreign body rubbing feeling or no tears, and the lacrimal gland is generally not swollen or slightly swollen.

Third, the skin mucous membrane skin is dry and itchy. The common rashes are purpura and urticaria, which are polymorphic and erythema nodosum. There are chapped lips, oral ulcers, nasal dryness and vaginal mucosa.

Four, 70% ~ 80% of joints and muscles have joint pain, even arthritis, but necrotizing arthritis is rare. Muscle weakness may occur, and myositis may occur in 5%.

Five, nearly half of the kidneys are complicated with renal damage, and the common involved part is the distal renal tubule. The clinical manifestation is symptomatic or subclinical renal tubular acidosis. The former is characterized by low blood pHH and inability to acidify urine (pH > 6). Amine chloride load test can detect subclinical type. The complications of renal tubular acidosis are: ① periodic hypokalemic paralysis; ② Osteochondrosis of kidney; (3) Renal diabetes insipidus, accompanied by amino acid urine, phosphorus urine, glycosuria and β2 microsphere proteinuria on the surface of proximal renal tubule. Glomerular involvement is rare, but the prognosis is poor.

6. 17% lung patients have dry cough, but there is no recurrent lung infection. There are too many inflammatory cells in bronchoalveolar lavage fluid in 50% patients, which indicates alveolar inflammation, and only a few patients have diffuse pulmonary interstitial fibrosis. Pulmonary function tests often show decreased function, but most of them have no clinical symptoms.

Seven, digestive system ① atrophic inflammation, low acid secretion function, lack of acid; ② Small intestinal malabsorption; ③ Low exocrine function of pancreas; ④ Hepatomegaly, elevated serum transaminase, liver biopsy in patients with jaundice often showed changes of chronic active hepatitis, and such patients responded well to adrenocortical hormone.

8. Due to vasculitis in different parts, the central nervous system is damaged to varying degrees. Symptoms include epilepsy, hemiplegia, hemianopia, myelitis, cranial neuritis and peripheral neuritis. The latter mainly involves sensory fibers.

9. The hemogram of 1/4 ~ 1/5 showed leukopenia and thrombocytopenia, with a few bleeding.

X 5% ~ 10% of patients with lymphoid hyperplasia have lymphadenopathy. At least 50% patients have a large number of lymphocytes infiltration in internal organs during the course of the disease. More importantly, the incidence of lymphoma in patients with this disease is 44 times higher than that in normal people. During the follow-up of 50 SS cases in China/KLOC-0, 2 cases were lymphoma. SS before lymphoma may have macroglobulinemia or monoglobulinemia. After the occurrence of lymphoma, the blood immunoglobulin level can be reduced and the autoantibodies disappear.

Sjogren's syndrome-auxiliary examination

Moderate thrombocytopenia can also be accompanied by severe normal cell anemia (25%), leukopenia (6% ~ 33%) and eosinophilia (5% ~ 25%). The erythrocyte sedimentation rate increased rapidly (80% ~ 94%). About half of the cases have decreased albumin and increased globulin peak, mainly γ globulin, but also α and β globulin. Immunoglobulin is mainly IgG and IgM increased, and about 3/4 patients are positive for rheumatoid factor, often IgM type; Anti-nuclear antibody is positive (17% ~ 68%), anti-dsDNA antibody is rare, macroglobulin and cryoglobulin can be positive, and there is high viscosity syndrome; Anti-thyroglobulin and anti-gastric parietal cell antibody were positive (30% each), and anti-human globulin test and anti-mitochondrial antibody were positive (10% each). The positive rates of anti-SS-A antibody and anti-SS-B antibody in primary SS were 70% ~ 75% and 48% ~ 60%, respectively, while SS with rheumatoid arthritis was 9% and 3%, respectively. The positive rate of anti-salivary duct epithelial cell antibody (ASDA) in primary SS was 25%, while that in SS with rheumatoid arthritis was 70% ~ 80%, and β in serum and saliva. The content of IgG in saliva increased, and the levels of IgA and IgMRF were higher. DIF showed that IgG was deposited in and near the basal layer of epidermis. Peripheral blood T lymphocytes decreased, especially Ts and Ia positive T lymphocytes increased, and lymphocyte transformation test and active petal formation test were low. Increased circulating immune complex; CH50 and C3 are elevated or normal, and can be decreased when vasculitis occurs. About 2/3 patients have Fc receptor dysfunction in reticuloendothelial system. When SS benign lymphocyte hyperplasia turns into malignant lymphoma, hypergammaglobulinemia can turn into gammaglobulinemia, and the titer of autoantibodies decreases or turns negative.

(1) The function of lacrimal gland was detected by Schirmer test (the tear flow was measured by filter paper, and the filter paper of ×35mm was bent at 5mm and placed in the lower conjunctival sac. After 5', the length of the filter paper wetted by tears was observed, and < < 10mm was lower than the normal value); Tear film rupture time (but < 10 "is abnormal), cornea was stained with 2% fluorescein or 1% Congo red or 1% Bengal rose red (staining spots < 10 are normal). The above two modern positive results are consistent with keratoconjunctivitis sicca.

(2) salivary gland detection has the measurement of salivary secretion (sugar measurement is to press sucrose into tablets, each tablet is 800mg, and put it in the center of the back of the tongue, and record the time required for complete dissolution, and < 30' is normal; Saliva velocity measurement: a small suction cup connected with a hollow catheter was adsorbed at the opening of a unilateral parotid duct, and the amount of saliva secretion was collected under negative pressure (normal > 0.5 ml/min). Parotid radiography: use 40% lipiodol radiography to observe the gland morphology, whether there is damage or atrophy, the retention time of the contrast agent in the parotid gland, whether the parotid duct is narrow or dilated, scan the parotid isotope 13 1 iodine or 99m technetium to observe the radioactive distribution, whether its excretion and concentration are delayed or decreased, and understand the secretion function. Pathological changes of glands were observed by lip, palate or nasal mucosa biopsy, and the above two positive results were consistent with Sjogren's syndrome.

(3) Histopathology The lacrimal gland, parotid gland and submandibular gland showed a large number of lymphocyte infiltration, mainly β cells. In severe cases, β -cell infiltration can be like lymph node germinal center, gland atrophy, epithelial cell proliferation of glandular duct to form epithelial-myoepithelial cells, glandular duct stenosis or expansion, and then replaced by connective tissue. Lymphatic infiltration outside glands can involve lung, kidney or skeletal muscle and cause its dysfunction.

Diet of Sjogren's syndrome

Spicy and hot drinks and food should be avoided to prevent dryness from damaging body fluids and aggravating the condition. Do not eat spicy, fragrant, dry and warm products, such as wine, tea, coffee, all kinds of fried foods, mutton, dog meat, venison, ginger, onion, garlic, pepper, pepper, fennel, etc., and do not smoke.

Although it should be taboo to treat diet correctly, we should not be too strict. If the diet is too strict, it will affect the nutrient absorption for many years, which is not good for the condition. In short, the food should be fresh, mixed with meat and vegetables, eat less and eat more meals, and the diet should be suitable for the taste to ensure adequate nutrition.

Sjogren's syndrome is a common autoimmune disease, which mainly affects exocrine glands, including lacrimal glands and salivary glands, and causes dryness of eyes and mouth. The basic dietary principle of Sjogren's syndrome patients is to eat foods that nourish yin, promote fluid production and moisten dryness, light and juicy fresh fruits and vegetables with multiple vitamins, and sweet and sour foods.

Specifically, special attention should be paid to the diet of patients with Sjogren's syndrome.

1, suitable for eating: frog meat, clam meat, oyster meat, sage, squid fish, eel, donkey-hide gelatin, honey, royal jelly, herring, mullet, crucian carp, egg, red bean soup, mung bean soup, bean curd, lily, lotus seed, radish, carrot, green vegetables, soybean sprouts, etc.

2, not suitable for eating: It is worth noting that: dog meat, fried peanuts, fried rice, ginger, pepper, cinnamon, ginseng, fried broad beans, fried soybeans, peppers, pepper, fennel, sparrow meat, longan, litchi, kumquat, betel nut, Cordyceps sinensis, Astragalus, Atractylodes macrocephala and other foods are not suitable for Sjogren's syndrome patients.

Gastrointestinal manifestations of Sjogren's syndrome

Primary Sjogren's syndrome invading gastrointestinal tract is common, but not all patients have obvious gastrointestinal symptoms. In addition to dysphagia caused by dry mouth and dryness of pharynx and esophagus, atrophic gastritis is as high as 70.5% (the result of fiberoptic gastroscopy, while the total result of routine gastroscopy in gastrointestinal department is only 7.6%). The patients with low gastric acid and no gastric acid secretion were 36.4% and 13.6% respectively. 35% patients were positive for anti-parietal cell antibody. Jejunal mucosa biopsy showed that villi in some cases were swollen and shortened under scanning electron microscope, although only bilateral villi atrophy was shown under different microscopes. 20.5% patients have low intestinal absorption function. 15% has abnormal pancreatic exocrine function. Although acute pancreatitis is rare, it seems that subclinical pancreatic involvement is not uncommon due to the increase of blood amylase in 1/4 patients. Due to the above intestinal and pancreatic reasons, malabsorption syndrome (fatty diarrhea, pseudointestinal paralysis, cachexia) appears in a few cases and leads to death.