Sjogren’s syndrome

News Article
Sjogren’s syndrome - Seizing Life
Thursday, 06 l 05 l 2010 ; Source: Mind Your Body, The Straits Times
By Geraldine Ling
Sheralyn Tay (right) suffers from a rare autoimmune disease which destroyed her kidney. GERALDINE LING reports With her bubbly personality and animated expressions, Ms Sheralyn Tay is a picture of youth and vitality. It is hard to imagine that the 29-year-old has an unusual condition, Sjogren's syndrome, an autoimmune disorder, and that she needed a kidney transplant. This was because the freelance writer and editor developed kidney failure, a severe but uncommon complication of the syndrome. Sufferers of this condition often have dry eyes and a dry mouth because the immune system attacks the glands that produce tears and saliva – resulting in their decreased production. It may also lead to the dysfunction of other organs like the kidneys and lungs. Ms Tay’s symptoms first appeared when she was a 13-year-old Secondary 1 student but her condition was not diagnosed until she was 19. It began with a dry mouth, tongue and throat and she chugged copious amounts of water each day to soothe them. She would also wake up in the middle of the night with a dry tongue, which she said often felt like a wooden board. Her dry mouth also led to dental cavities. All her molars, or back teeth, required dental fillings. But the fillings kept falling out, again due to her dry mouth, and she would have to re-do them yearly. “The dentist said I had powdery teeth – they would disintegrate easily,” she said. She also had to forgo contact lenses because of her dry eyes. Then, when she was a mass communication student at a local polytechnic, she felt intense pain in her knee joints and developed thrush in her mouth. Oral thrush is a condition where creamy white lesions usually appear on the tongue or inner cheeks. It is likely to occur in people with a weakened immune system. Ms Tay’s mother, who has lupus, another autoimmune disorder, took Ms Tay – then aged 19 – to an endocrinologist. She was found to have Sjogren’s syndrome and a kidney biopsy also showed that she had early-stage renal failure. However, the doctor did not put her on dialysis due to her young age. Her condition was managed through drugs and diet modification. However, it remained stable and she was able to go to Australia for two years to study for a journalism degree. Shortly after her return in March 2005, her condition took a turn for the worse. Symptoms of renal failure made her lethargic, she vomited frequently and she had uric crystals (uric acid deposits which appear as lumps) on her skin. Doctors recommended a kidney transplant and her younger brother, Alphonsus, then 21, was found to be a suitable donor. However, the transplant had to be delayed as the 1.8m tall student was told to lose 10kg before the procedure. At 100kg, he was considered overweight for the surgery. He took three months to lose the excess weight and the transplant took place that November. Initially, Ms Tay had to fight fever and urinary tract infections as her body struggled to accept its new organ. Her condition has stabilised but she has to be on medication for life. Today, she takes about 20 pills a day, including immunosuppressants to help prevent her immune system from attacking the new kidney. She also has to make a conscious effort to avoid people who are sick for fear of being infected, due to her weakened immune system. She still struggles with joint pain, dry eyes and mouth, but she is grateful for the second chance at life. “My brother sacrificed a part of himself for me. I want to live in such a way that will not put this gift to waste,” she said.

Genes may trigger Sjogren’s syndrome Sjogren’s (pronounced show-grens) syndrome is a disorder of the immune system that curtails the flow of two body fluids we take for granted, tears and saliva. Hence, dry eyes and a dry mouth are obvious signs. It can become more serious when vital organs like the kidneys and lungs begin to malfunction. However, such severe symptoms are uncommon. While the exact cause is unknown, genes may play a role in triggering it. Dr Bernard Thong, the head & senior consultant of Rheumatology, Allergy and Immunology in Tan Tock Seng Hospital, said there is no one specific treatment for Sjogren’s syndrome. Treatment depends on the symptom. For example, lubricant eye drops are used to treat dry eyes. The lack of saliva makes the oral cavity more acidic. The array of protective anti-bacterial enzymes, normally found in saliva, is also reduced. All this makes tooth decay more likely, said Dr Lynette Ng, the dental director of The Dental Studio. If internal organs are affected, oral corticosteroids or immunosuppressants may be needed. When kidneys are affected, their tubules may be inflamed, leading to low blood potassium levels, said Dr Thong. But it rarely results in kidney failure which would require dialysis or a transplant, he added. Kidney tubules filter blood, reabsorbing what is needed and excreting the rest as urine. No local statistics are available but about 1 to 1.5 per cent of people in the developed world are said to suffer from the condition. It is more common among women, said Dr Leong Keng Hong, a consultant rheumatologist at Gleneagles Medical Centre. The syndrome can occur alone or with other autoimmune diseases, like rheumatoid arthritis or lupus. About 20 per cent of those with any autoimmune disease may have Sjogren’s syndrome too,” said Dr Leong. Sjogren’s syndrome club, a support group for people who suffer from the condition, was launched on April 24. E-mail sjogrenclubsg@hotmail.com for more information.