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Sjogren's Syndrome: Dry Mouth and Eyes

Sjogren's syndrome means that a person develops dry eyes and mouth and often has joint pains and blood tests that show that a person's immune cells are trying to kill a germ, but doctors can't find a specific germ that causes the symptoms. When doctors cannot find a cause for a disease, they often call it autoimmune which means that they don't have the foggiest idea of the cause. Just because doctors cannot culture a germ from a disease does not mean that the disease is not infectious. New bacteria are discovered every day and doctors do not have available dependable tests for chlamydia, mycoplasma and ureaplasma, common causes of dry eyes, mouth or vagina.

A report from Israel showed that antibiotics may control Sjogren's syndrome (1). Some cases of Sjogren's disease are associated with helicobacter inflection in the stomach causing belching and burning in the stomach (2). Hepatitis C is associated with Sjogren's syndrome (3). There's another reason for people with Sjogren's syndrome to take antibiotics. Saliva continually washes bacteria from the mouth into the stomach where they are killed by stomach acids. Lack of saliva allows bacteria to accumulate and cause gum and tooth disease (4).

For DRY EYES: I recommend a bacterial culture of the eye and Neosporin ointment twice a day in each eye for a week and Neosporin ointment in each nostril at bedtime for a few weeks.  If that does not help, your doctor may want to try Zithromax 250 mg once a day for 9 days.

For DRY MOUTH: Lack of saliva can cause severe mouth and neck pain, frequent mouth infections, difficulty talking and sleeping, dental cavities, and difficulty swallowing because saliva lubricates the food and allows it to pass down your throat. Dry mouth can be caused by 1) infection that may be cured with antibiotics, 2) nerve damage, or 3) drugs such as blood pressure medications, clonidine, Prilosec or other ulcer medications, antihistamines, stimulants such as amphetamines, or intestinal medications such as atropine. Sjogren's syndrome can be associated with arthritis (4a). Since the mouth is normally full of germs that belong there, it is very difficult to culture a bacteria that causes dry mouth, but some people are cured by taking the antibiotics metronidazole and clarithromycin for a week. If that doesn't cure you, you may try a 5 mg pilocarpine pill four times a day, but this can cause sweating, nausea, running nose, chills, dizziness and frequent urination (5,6,7,8). A device that uses an electrical probe in the mouth to stimulate the salivary glands to produce saliva may help. Originally marketed as Salitron by Biosonics, I have not been able to locate a current source for these machines (9).

1) M Stein, G Miller, L Green. Prophylactic antibiotics in recurrent parotitis in a patient with Sjogren's syndrome. Clinical Rheumatology, 1999, Vol 18, Iss 2, pp 163-164.

2) P Aragona, G Magazzu, G Macchia, S Bartolone, G DiPasquale, C Vitali, G Ferreri.Presence of antibodies against Helicobacter pylori and its heat-shock protein 60 in the serum of patients with Sjogren's syndrome.Journal of Rheumatology, 1999, Vol 26, Iss 6, pp1306-1311.

3) M RamosCasals, M GarciaCarrasco, R Cervera, J Font. Sjogren's syndrome and hepatitis C virus. Clinical Rheumatology, 1999, Vol 18, Iss 2, pp 93-100.

4) A Almstahl, U Kroneld, A Tarkowski, M Wikstrom. Oral microbial flora in Sjogren's syndrome. Journal of Rheumatology 26: 1 (JAN 1999):110-114.

4a)Interferon treats Sjogren's syndrome. British Med Journal Jan, 1993

5) Archives of Internal Medicine 1999(January);159:174-181.

6) NEJM, 1993;329:390.

7) The Medical Letter August 19, 1994.

7a) FB Vivino, I Alhashimi, Z Khan, FG Leveque, PL Salisbury, TK Tranjohnson, CC Muscoplat, M Trivedi, B Goldlust, SC Gallagher. Pilocarpine tablets for the treatment of dry mouth and dry eye symptoms in patients with Sjogren syndrome - A randomized, placebo-controlled, fixed-dose, multicenter trial. Archives of Internal Medicine 159: 2 (JAN 25 1999):174-181.

8) S Nusair, A Rubinow.The use of oral pilocarpine in xerostomia and Sjogren's syndrome.Seminars in Arthritis and Rheumatism, 1999, Vol 28, Iss 6, pp 360-367.

9) Strietzel FP, Martín-Granizo R, Fedele S, et al. Electrostimulating device in the management of xerostomia. Oral Dis. 2007;13(2):206-213.

Checked 5/4/16

May 30th, 2013
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About the Author: Gabe Mirkin, MD

Sports medicine doctor, fitness guru and long-time radio host Gabe Mirkin, M.D., brings you news and tips for your healthful lifestyle. A practicing physician for more than 50 years and a radio talk show host for 25 years, Dr. Mirkin is a graduate of Harvard University and Baylor University College of Medicine. He is board-certified in four specialties: Sports Medicine, Allergy and Immunology, Pediatrics and Pediatric Immunology. The Dr. Mirkin Show, his call-in show on fitness and health, was syndicated in more than 120 cities. Read More
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