Guest
Chen Weiwei, Tang Huayan and Xia Jia
Interview Background
Sjogren’s syndrome is a chronic autoimmune disease characterized by lymphocyte infiltration and inflammation of the lacrimal and salivary glands, which causes dryness symptoms such as dry mouth and dry eyes. The disease has an insidious onset and diverse clinical manifestations, which can easily cause dysfunction of multiple organs in the body and even endangers patients’ lives in severe cases. Let’s listen to the authoritative science popularization from the doctors of the Department of Rheumatology of Shanghai Municipal Hospital of Traditional Chinese Medicine.
Xia Jia:
Hello, everyone! I’m your host today, Xia Jia, an Associate Senior Physician at the Department of Rheumatology of Shanghai Municipal Hospital of Traditional Chinese Medicine. Today We are honored to invite two guests to the interview, Senior Physician Chen Weiwei and Associate Senior Physician Tang Huayan from the Department of Rheumatology of Shanghai Municipal Hospital of Traditional Chinese Medicine. Welcome!
Xia Jia:
Let’s talk about Sjogren’s syndrome today. Sjogren’s syndrome is a chronic autoimmune disease characterized by lymphocyte infiltration and inflammation of the lacrimal and salivary glands, which causes dryness symptoms such as dry mouth and dry eyes. The disease has an insidious onset and diverse clinical manifestations, which can easily cause dysfunction of multiple organs in the body and even endangers patients’ lives in severe cases. First of all, what is an autoimmune disease?
Chen Weiwei:
Immunity is the human body’s defense system, which can help the human body resist the invasion of external bacteria, viruses, and other pathogens under normal conditions. If the immune system is too sthenic, the body attacks and destroys its own tissues, which can lead to a variety of autoimmune diseases. Autoimmune diseases include systemic lupus erythematosus, rheumatoid arthritis, Sjogren’s syndrome, and Hashimoto’s thyroiditis.
Xia Jia:
What is Sjogren’s syndrome?
Tang Huayan:
Sjogren’s syndrome is a chronic systemic autoimmune disease that mainly attacks the salivary and lacrimal glands, with dry mouth and dry eyes as common symptoms, and also causes dysfunction of other systems and organs, such as the liver, lungs, kidneys, thyroid gland, hematological system, and nervous system, thus causing problems such as interstitial lung fibrosis, renal tubular acidosis, and arthritis. Besides, patients may also develop symptoms such as fatigue, fever, tooth decay, and gingival atrophy. The incidence of Sjogren’s syndrome in China is 3%-4%, and the age of onset is 40-60 years old. The disease can also be seen in children and the elderly, and the incidence rate of males and females is 1: (9-20). It is neither an infectious nor a genetic disease; however, it has a certain risk of genetic susceptibility.
Chen Weiwei:
Sjogren’s syndrome is divided into primary and secondary. Primary Sjogren’s syndrome occurs in the absence of other connective tissue diseases; Secondary Sjogren’s syndrome is associated with (and may be secondary to or earlier than) the presence of other diagnosed connective tissue diseases, such as systemic lupus erythematosus and rheumatoid arthritis.
Xia Jia:
What triggers Sjogren’s syndrome?
Chen Weiwei:
It’s still unclear about the etiology of Sjogren’s syndrome, but the following factors are mostly considered: infectious factors: the immune system may be activated after infection; genetic factors: the disease has genetic susceptibility and is related to some alleles and regulatory genes; estrogen: the disease tends to occur in women, which is presumed to be related to estrogen.
Xia Jia:
How to distinguish Sjogren’s syndrome from autumn dryness?
Tang Huayan:
Both Sjogren’s syndrome and autumn dryness have symptoms such as dry mouth, dry eyes, dry skin, and constipation, but the nature of the two is completely different. Autumn dryness results from the weather and is a seasonal ailment; while the onset of Sjogren’s syndrome is not related to the season. In addition, Sjogren’s syndrome not only leads to dryness in the mouth and eyes but also damages other systems and organs in severe cases. Therefore, it needs to be diagnosed by examination of relevant antibodies and labial gland mucosal biopsy.
Xia Jia:
What tests are required for Sjogren’s syndrome?
Tang Huayan:
Dental examination: including parotid angiography, labial gland biopsy, and saliva flow measurement. Blood test: patients may have multiple positive antibodies in their blood, such as antinuclear antibodies, anti-SSA antibodies, anti-SSB antibodies, etc. Besides, most patients have decreased platelets and white blood cells. Ophthalmic examination: corneal staining, tear break-up time, Schirmer (filter paper), etc.
Xia Jia:
What is a labial gland biopsy?
Chen Weiwei:
A labial gland biopsy, as its name implies, is a biopsy of the labial gland. The surgeon typically makes a shallow incision of about 0.5 cm wide on the patient’s lower inner lip after numbing the area with a local anesthetic, and some labial gland tissue is removed for pathological examination. Traditional labial gland biopsy is characterized by a big incision, deep laceration, and suture, which is generally performed in the Department of Stomatology, and most patients show psychological resistance to it. A modified labial gland biopsy only needs a small laceration without any sutures, and it can also be performed in the Department of Rheumatology. Labial gland biopsy is the gold standard for the diagnosis of Sjogren’s syndrome. If a patient develops symptoms such as dry mouth and eyes, but shows negative or weakly positive results of anti-SSA and SSB antibodies tests, a labial gland biopsy will be recommended.
Xia Jia:
How is Sjogren’s syndrome treated?
Tang Huayan:
Symptomatic treatment can be performed for mild cases, while glucocorticoids and/or immunosuppression can be used to treat severe cases. Besides, corresponding treatment should be given according to the condition of the affected organs. Patients with different degrees of severity differ in sensitivity to drugs, so accurate individualized treatment will be carried out clinically.
Xia Jia:
How do patients with Sjogren’s syndrome spend dry autumn?
Chen Weiwei:
It is advisable for patients to eat more vegetables and fruits that can regenerate body fluid and nourish yin, such as pears, pomelos, and water chestnut; herbal meals or tea drinks can also be made for recuperation, such as pear porridge, tremella soup, Ophiopogon japonicus lotus nut tea, chrysanthemum babury wolfberry tea, and bamboo leaf tea; regularly rest their eyes, and have an eye massage or use eyedrops; pay attention to oral hygiene, brush teeth or gargle in time after eating to avoid tooth decay; have daily use of moisturizing cream to avoid dry skin; keep warm to avoid lung infection, have regular work and rest, and do not stay up late.
Xia Jia:
How to understand Sjogren’s syndrome in Traditional Chinese Medicine (TCM)?
Chen Weiwei:
Sjogren syndrome belongs to the category of “dryness disorder” in TCM. There are two causes of the disease: the external one refers to dryness pathogen, and the internal one refers to yin deficiency and depletion of fluid. There is a saying of “five viscera transform into five fluids” in TCM. Perspiration, snivel, tears, thin saliva, and saliva are called five fluids, which are transformed respectively by the five viscera, the heart, lungs, liver, spleen, and kidney. Therefore, a deficiency of kidney yin will lead to a dry mouth, a deficiency of liver yin and liver blood will lead to dry eyes, a deficiency of lung yin will lead to a dry nose, and at the same time, because the lung dominates skin and hair, dry skin will also appear. The treatment is mainly based on tonifying the liver and kidney, nourishing yin and moistening the lung, and promoting blood circulation and regenerating fluid. Some patients may develop the symptom of “dryness and diarrhea”, which is manifested as dry mouth and eyes but a loose stool. It is may be related to the uneven transportation and transformation of water and dampness in the body. Such patients also need to be treated by invigorating the spleen and removing dampness.
Xia Jia:
Can patients with Sjogren’s syndrome eat medicinal gel (Gaofang)?
Tang Huayan:
Patients with Sjogren’s syndrome have a sthenic immune system, so they should not take health supplements such as ginseng, astragalus, or lingzhi to improve immunity. Such products are easy to activate autoantibodies in the body and aggravate the disease, so patients with Sjogren’s syndrome should take “mild reinforcing” medicinal gel. We always select drugs in accordance with the patient’s constitution and condition to form the medicinal gel that can help patients improve their symptoms.
Chen Weiwei:
Patients with Sjogren’s syndrome need to take medicines for a long time, but most TCMs have a bitter taste, so it’s difficult for patients to stick to taking them. Compared with ordinary TCMs, the medicinal gel tastes better and is easier to take.
Xia Jia:
Thank you. That’s all for today’s interview. See you soon!