{"id":19324,"date":"2019-01-23T15:47:55","date_gmt":"2019-01-23T20:47:55","guid":{"rendered":"https:\/\/www.med.unc.edu\/medicine\/?post_type=podcast&#038;p=19324"},"modified":"2023-06-06T13:56:34","modified_gmt":"2023-06-06T17:56:34","slug":"sjogrens-syndrome","status":"publish","type":"episode","link":"https:\/\/www.med.unc.edu\/medicine\/news\/chairs-corner\/podcast\/sjogrens-syndrome\/","title":{"rendered":"Sjogren&#8217;s Syndrome &#8211; with Beth Jonas, MD"},"content":{"rendered":"<figure id=\"attachment_4787\" class=\"thumbnail wp-caption alignright\" style=\"width: 250px\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-4787\" src=\"https:\/\/www.med.unc.edu\/medicine\/wp-content\/uploads\/sites\/945\/2018\/12\/rheumatologist-beth-l-jonas-m-d-receives-reeves-foundation-distinguished-professorship-image2-240x300.jpeg\" alt=\"Dr. Beth Jonas\" width=\"240\" height=\"300\" srcset=\"https:\/\/www.med.unc.edu\/medicine\/wp-content\/uploads\/sites\/945\/2018\/12\/rheumatologist-beth-l-jonas-m-d-receives-reeves-foundation-distinguished-professorship-image2-240x300.jpeg 240w, https:\/\/www.med.unc.edu\/medicine\/wp-content\/uploads\/sites\/945\/2018\/12\/rheumatologist-beth-l-jonas-m-d-receives-reeves-foundation-distinguished-professorship-image2-819x1024.jpeg 819w, https:\/\/www.med.unc.edu\/medicine\/wp-content\/uploads\/sites\/945\/2018\/12\/rheumatologist-beth-l-jonas-m-d-receives-reeves-foundation-distinguished-professorship-image2-768x960.jpeg 768w, https:\/\/www.med.unc.edu\/medicine\/wp-content\/uploads\/sites\/945\/2018\/12\/rheumatologist-beth-l-jonas-m-d-receives-reeves-foundation-distinguished-professorship-image2-1228x1536.jpeg 1228w, https:\/\/www.med.unc.edu\/medicine\/wp-content\/uploads\/sites\/945\/2018\/12\/rheumatologist-beth-l-jonas-m-d-receives-reeves-foundation-distinguished-professorship-image2-600x750.jpeg 600w, https:\/\/www.med.unc.edu\/medicine\/wp-content\/uploads\/sites\/945\/2018\/12\/rheumatologist-beth-l-jonas-m-d-receives-reeves-foundation-distinguished-professorship-image2-301x376.jpeg 301w, https:\/\/www.med.unc.edu\/medicine\/wp-content\/uploads\/sites\/945\/2018\/12\/rheumatologist-beth-l-jonas-m-d-receives-reeves-foundation-distinguished-professorship-image2.jpeg 1594w\" sizes=\"auto, (max-width: 240px) 100vw, 240px\" \/><figcaption class=\"caption wp-caption-text\">Beth Jonas, MD<\/figcaption><\/figure>\nThis is Episode Eight of &#8220;Autoimmune Disease: Pieces of the Picture.&#8221; Dr. Beth Jonas tells listeners about Sjogren&#8217;s syndrome and how patients can manage the condition. Dr. Jonas is an Associate Professor of Medicine in the Division of Rheumatology, Allergy, and Immunology, and directs the UNC Rheumatology Fellowship Training Program. She is a rheumatologist with the UNC Thurston Arthritis Research Center.<\/p>\n<div class=\"alert alert-grey\">\n\u201cOne of the things that we know is our saliva is full of immunoglobulin that really helps maintain healthy teeth, and when you lose that saliva, you\u2019re at risk for dental decay. So keeping your teeth as clean as possible and visiting the dentist four times a year is very important for patients with Sjogren\u2019s syndrome.\u201d<br \/>\n&#8211; Beth Jonas, MD\n<\/div>\n<!--[if lt IE 9]><script>document.createElement('audio');<\/script><![endif]-->\n\t<div class=\"wp-playlist wp-audio-playlist wp-playlist-light\">\n\t\t\t<div class=\"wp-playlist-current-item\"><\/div>\n\t\t<audio controls=\"controls\" preload=\"none\" width=\"1118\"\n\t\t\t><\/audio>\n\t<div class=\"wp-playlist-next\"><\/div>\n\t<div class=\"wp-playlist-prev\"><\/div>\n\t<noscript>\n\t<ol>\n\t\t<li><a class=\"thumbnail img-thumbnail\" href='https:\/\/www.med.unc.edu\/medicine\/wp-content\/uploads\/sites\/945\/2019\/03\/sjogrens-syndrome.mp3'>Sjogren's Syndrome - with Dr. Beth Jonas<\/a><\/li><li><a class=\"thumbnail img-thumbnail\" href='https:\/\/www.med.unc.edu\/medicine\/wp-content\/uploads\/sites\/945\/2019\/01\/sjogrens-what-is-it.mp3'>Sjogren\u2019s & how it is diagnosed<\/a><\/li><li><a class=\"thumbnail img-thumbnail\" href='https:\/\/www.med.unc.edu\/medicine\/wp-content\/uploads\/sites\/945\/2019\/01\/sjogrens-treatment.mp3'>Treatment for Sjogren\u2019s<\/a><\/li><li><a class=\"thumbnail img-thumbnail\" href='https:\/\/www.med.unc.edu\/medicine\/wp-content\/uploads\/sites\/945\/2019\/01\/sjogrens-managing.mp3'>Managing this condition<\/a><\/li><li><a class=\"thumbnail img-thumbnail\" href='https:\/\/www.med.unc.edu\/medicine\/wp-content\/uploads\/sites\/945\/2019\/01\/sjogrens-lymphoma.mp3'>Risk for lymphoma<\/a><\/li>\t<\/ol>\n\t<\/noscript>\n\t<script type=\"application\/json\" class=\"wp-playlist-script\">{\"type\":\"audio\",\"tracklist\":true,\"tracknumbers\":true,\"images\":true,\"artists\":true,\"tracks\":[{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/uploads\\\/sites\\\/945\\\/2019\\\/03\\\/sjogrens-syndrome.mp3\",\"type\":\"audio\\\/mpeg\",\"title\":\"Sjogren's Syndrome - with Dr. Beth Jonas\",\"caption\":\"\",\"description\":\"\\\"Sjogren's Syndrome - with Dr. Beth Jonas\\\" from Autoimmune Disease: Pieces of the Picture by UNC Department of Medicine: Dr. Ron Falk. Released: 2017.\",\"meta\":{\"artist\":\"UNC Department of Medicine: Dr. Ron Falk\",\"album\":\"Autoimmune Disease: Pieces of the Picture\",\"year\":\"2017\",\"length_formatted\":\"9:35\"},\"image\":{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/plugins\\\/media-library-assistant\\\/images\\\/crystal\\\/audio.png\",\"width\":48,\"height\":64},\"thumb\":{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/plugins\\\/media-library-assistant\\\/images\\\/crystal\\\/audio.png\",\"width\":48,\"height\":64}},{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/uploads\\\/sites\\\/945\\\/2019\\\/01\\\/sjogrens-what-is-it.mp3\",\"type\":\"audio\\\/mpeg\",\"title\":\"Sjogren\\u2019s & how it is diagnosed\",\"caption\":\"\",\"description\":\"\\\"sjogrens-what-is-it\\\". Released: 2019.\",\"meta\":{\"year\":\"2019\",\"length_formatted\":\"2:57\"},\"image\":{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/plugins\\\/media-library-assistant\\\/images\\\/crystal\\\/audio.png\",\"width\":48,\"height\":64},\"thumb\":{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/plugins\\\/media-library-assistant\\\/images\\\/crystal\\\/audio.png\",\"width\":48,\"height\":64}},{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/uploads\\\/sites\\\/945\\\/2019\\\/01\\\/sjogrens-treatment.mp3\",\"type\":\"audio\\\/mpeg\",\"title\":\"Treatment for Sjogren\\u2019s\",\"caption\":\"\",\"description\":\"\\\"sjogrens-treatment\\\". Released: 2019.\",\"meta\":{\"year\":\"2019\",\"length_formatted\":\"1:22\"},\"image\":{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/plugins\\\/media-library-assistant\\\/images\\\/crystal\\\/audio.png\",\"width\":48,\"height\":64},\"thumb\":{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/plugins\\\/media-library-assistant\\\/images\\\/crystal\\\/audio.png\",\"width\":48,\"height\":64}},{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/uploads\\\/sites\\\/945\\\/2019\\\/01\\\/sjogrens-managing.mp3\",\"type\":\"audio\\\/mpeg\",\"title\":\"Managing this condition\",\"caption\":\"\",\"description\":\"\\\"sjogrens-managing\\\". Released: 2019.\",\"meta\":{\"year\":\"2019\",\"length_formatted\":\"1:47\"},\"image\":{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/plugins\\\/media-library-assistant\\\/images\\\/crystal\\\/audio.png\",\"width\":48,\"height\":64},\"thumb\":{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/plugins\\\/media-library-assistant\\\/images\\\/crystal\\\/audio.png\",\"width\":48,\"height\":64}},{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/uploads\\\/sites\\\/945\\\/2019\\\/01\\\/sjogrens-lymphoma.mp3\",\"type\":\"audio\\\/mpeg\",\"title\":\"Risk for lymphoma\",\"caption\":\"\",\"description\":\"\\\"sjogrens-lymphoma\\\". Released: 2019.\",\"meta\":{\"year\":\"2019\",\"length_formatted\":\"2:33\"},\"image\":{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/plugins\\\/media-library-assistant\\\/images\\\/crystal\\\/audio.png\",\"width\":48,\"height\":64},\"thumb\":{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/plugins\\\/media-library-assistant\\\/images\\\/crystal\\\/audio.png\",\"width\":48,\"height\":64}}]}<\/script>\n<\/div>\n\t\n<p><strong>Ron Falk, MD:<\/strong> Hello, and welcome to the Chair\u2019s Corner from the Department of Medicine at the University of North Carolina.<\/p>\n<p>This is our series where we explore topics related to autoimmune disease, to help patients and their loved ones understand and manage their condition. Today we will talk about Sjogren\u2019s syndrome.<\/p>\n<p>We welcome Dr. Beth Jonas, who is an Associate Professor of Medicine in our Division of Rheumatology, Allergy, and Immunology. Last week Dr. Jonas joined us for a discussion on rheumatoid arthritis. Welcome back.<\/p>\n<p><strong>Beth Jonas, MD:<\/strong> Thank you.<\/p>\n<h3>Sjogren\u2019s &amp; how it is diagnosed<\/h3>\n<p><strong>Falk:<\/strong> I can barely say the word Sjogren\u2019s. What does Sjogren\u2019s syndrome mean? What is it?<\/p>\n<p><strong>Jonas:<\/strong> Sjogren\u2019s syndrome is an autoimmune disorder that causes dryness of the eyes, dryness of the mouth, and sometimes enlargement of the parotid gland. Occasionally patients will have internal organ involvement where the disease involves the lungs or the kidneys but by far, most patients have what we call the <em>sicca syndrome<\/em>, which is dryness of the eyes and the mouth.<\/p>\n<p><strong>Falk:<\/strong> What separates patients who have dry eyes only from patients who have Sjogren\u2019s? Some of them could have Sjogren\u2019s, some of them probably don\u2019t. How does one tell?<\/p>\n<p><strong>Jonas:<\/strong> That can be difficult sometimes. We see a lot of patients in our clinic who have dry eyes or dry mouth, or both. One of the things that can help us is certain antibodies that may be present in the blood, \u201c<em>Ro\u201d<\/em> and \u201c<em>La\u201d<\/em> antibodies. Most patients with Sjogren\u2019s will have these antibodies in their blood, and sometimes we need to biopsy one of the salivary glands to make a definitive diagnosis if we\u2019re not sure.<\/p>\n<p><strong>Falk:<\/strong> So if you took 100 patients who have dry eyes for example, how many of them will have Sjogren\u2019s?<\/p>\n<p><strong>Jonas:<\/strong> I think it\u2019s probably a pretty small number. I think it\u2019s a minority of patients with dry eyes \u2013 there are so many things that can make your eyes dry. Medications can do it, aging can do it\u2014many people will have dry eyes, but a very small percentage of them will actually have true Sjogren\u2019s syndrome.<\/p>\n<p><strong>Falk:<\/strong> The same is probably true for dry mouth\u2014lots of reasons to have a dry mouth. The combination of dry eyes and dry mouth\u2014not being able to form spit, not being able to form tears, that combination, that at least should raise the possibility that this is Sjogren\u2019s.<\/p>\n<p><strong>Jonas:<\/strong> That\u2019s how patients come to us. When they have both of them, then it does raise your level of suspicion for Sjogren\u2019s syndrome.<\/p>\n<p><strong>Falk:<\/strong> What helps in your diagnosis are blood tests, these autoantibodies that you just described. When do you do biopsies?<\/p>\n<p><strong>Jonas:<\/strong> I don\u2019t biopsy most of the patients with Sjogren\u2019s syndrome. If I have a high index of suspicion for Sjogren\u2019s syndrome\u2014someone has had profoundly dry eyes, profoundly dry mouth, they may have enlargement of the parotid glands or other lymphadenopathy, and if their antibodies are negative\u2014which can happen\u2014in those cases I might recommend a biopsy.<\/p>\n<p><strong>Falk:<\/strong> So you wouldn\u2019t do a biopsy on everybody, right?<\/p>\n<p><strong>Jonas:<\/strong> No, most patients do not get a biopsy.<\/p>\n<h3>Treatment for Sjogren\u2019s<\/h3>\n<p><strong>Falk:<\/strong> What do you tell patients about treatment? Are there treatments for Sjogren\u2019s?<\/p>\n<p><strong>Jonas:<\/strong> This can be very difficult. The treatment is really very symptomatic. If your eyes are dry, we often recommend certain kinds of wetting agents\u2014artificial tears and other kinds of tear substitutes which can be used. The ophthalmologist may close off some of the tear ducts, to prevent the tears from moving out of the eye. There are other medications that have been approved for this, such as topical cyclosporine for the eyes, but the treatment is really symptom-oriented, and for the mouth also, using wetting agents&#8211;there are certain toothpastes, mouth washes, that can improve the moisture in the mouth.<\/p>\n<p><strong>Falk:<\/strong> So it\u2019s really symptomatic treatment\u2014you wouldn\u2019t use immunosuppressive therapy unless the disease was in some other organ.<\/p>\n<p><strong>Jonas:<\/strong> Many patients with Sjogren\u2019s syndrome will have either joint pain\u2014arthralgia, or skin rashes, and under those circumstances we might use a medication called hydroxychloroquine which can be very helpful for those manifestations. Hydroxychloroquine really does not help the dryness at all, so if those other things are absent we generally do not use any systemic therapy.<\/p>\n<h3>Managing this condition<\/h3>\n<p><strong>Falk:<\/strong> What kinds of factors can make Sjogren\u2019s worse? What is the effect, for example, of stress?<\/p>\n<p><strong>Jonas:<\/strong> Well, like all autoimmune diseases, patients who feel stressed or are under unusual stress will often have exacerbation of their symptoms. Learning to manage that stress in your life is very important.<\/p>\n<p><strong>Falk:<\/strong> And exercise is fine?<\/p>\n<p><strong>Jonas:<\/strong> Exercise is great.<\/p>\n<p><strong>Falk:<\/strong> Really it\u2019s just trying to make the best of a difficult situation, especially if you have very dry eyes and a very dry mouth.<\/p>\n<p><strong>Jonas:<\/strong> Right, and I tell my patients it\u2019s very important to have an ophthalmologist that they work closely with, one they see regularly and can help them with that, and also to visit their dentist, usually four times a year for a good cleaning. One of the things that we know is our saliva is full of immunoglobulin that really helps maintain healthy teeth, and when you&#8217;ve lost that saliva, you\u2019re at risk for dental decay. So keeping your teeth as clean as possible and visiting the dentist four times a year, is very important for patients with Sjogren\u2019s syndrome.<\/p>\n<p><strong>Falk:<\/strong> Generally patients can learn for themselves how best to use these wetting agents, how best to figure out ways to make sure there\u2019s enough moisture in the mouth. If they can manage that, their long-term outlook is pretty good.<\/p>\n<p><strong>Jonas:<\/strong> That\u2019s true, and that learning curve is really important for patients to learn how to manage their symptoms with the agents that we have, but the prognosis and the outlook for the future for most patients with Sjogren\u2019s syndrome is actually quite good.<\/p>\n<h3>Risk for lymphoma<\/h3>\n<p><strong>Falk:<\/strong> One of the more worrisome, albeit uncommon concerns for patients with Sjogren\u2019s syndrome is that they can have a form of a cancer that affects the lymphoid tissue, and that\u2019s called a lymphoma. Lymphomas can occur in patients with Sjogren\u2019s. How do you screen for lymphomas and what do you tell patients? When they come to see you, when do you start worrying about whether a lymphoma is present, and the next steps?<\/p>\n<p><strong>Jonas:<\/strong> First, I want to say that the incidence of lymphoma in patients with Sjogren\u2019s syndrome is actually pretty low. Probably 5% of patients or less with Sjogren\u2019s syndrome will ever develop a lymphoma. So the vast majority of patients will never have to worry about this.<\/p>\n<p>If you\u2019re going to get a lymphoma, it usually occurs more than 6, 7, or 8 years after the diagnosis, so it\u2019s a late finding. When I evaluate patients I\u2019m looking for swollen lymph glands, new fevers or other clues that might tell us that lymphoma may be occurring. We know that patients who have persistent enlargement of the parotid glands are at particular risk, so we look for that all the time and we risk-stratify our patients. There are some blood tests that might help us to predict which patients are at higher risk, but as I mentioned, the risk is actually pretty low.<\/p>\n<p><strong>Falk:<\/strong> Dr. Jonas, where are the parotid glands? Could you describe it for patients, where they should be feeling?<\/p>\n<p><strong>Jonas:<\/strong> A parotid gland is right in front of the ear, sort of on the jaw line. You may know the parotid glands from when you had the mumps as a kid, so-called chipmunk cheeks. They\u2019re right in front of the ear and just on the jaw line.<\/p>\n<p><strong>Falk:<\/strong> That\u2019s the gland that is involved in Sjogren\u2019s syndrome. If a patient\u2019s looking for more information or trying to research Sjogren\u2019s syndrome, where should they look?<\/p>\n<p><strong>Jonas:<\/strong> There are a couple of places to look. The American College of Rheumatology, <a href=\"http:\/\/www.rheumatology.org\">www.rheumatology.org<\/a>, the Arthritis Foundation, <a href=\"http:\/\/www.arthritis.org\">www.arthritis.org<\/a>, and there\u2019s also a Sjogren\u2019s Syndrome Foundation which has excellent information on the web, <a href=\"http:\/\/www.sjogrens.org\">www.sjogrens.org<\/a>.<\/p>\n<p><strong>Falk:<\/strong> Thank you, Dr. Jonas. And thanks to our listeners for tuning in. If you enjoy this series, you can <a href=\"https:\/\/itunes.apple.com\/us\/podcast\/unc-department-of-medicine-chairs-corner\/id1076686662?mt=2\">subscribe to the Chair\u2019s Corner on iTunes<\/a> or <a href=\"https:\/\/www.facebook.com\/UNCDeptMedicine\">like the UNC Department of Medicine on FaceBook<\/a>. Stay tuned for our next episode.<\/p>\n<p>*<\/p>\n<p><strong>Visit these sites for information referenced in the podcast conversation.<\/strong><\/p>\n<ul>\n<li><a href=\"http:\/\/www.rheumatology.org\">American College of Rheumatology<\/a><\/li>\n<li><a href=\"http:\/\/www.arthritis.org\">Arthritis Foundation<\/a><\/li>\n<li><a href=\"\/tarc\/people\/beth-l-jonas-md\">Dr. Beth Jonas&#8217;s UNC School of Medicine profile<\/a><\/li>\n<li><a href=\"http:\/\/www.sjogrens.org\">Sjogren&#8217;s Syndrome Foundation<\/a><\/li>\n<li><a href=\"\/tarc\">UNC Thurston Arthritis Research Center (TARC)<\/a><\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>This is Episode Eight of &#8220;Autoimmune Disease: Pieces of the Picture.&#8221; Dr. Beth Jonas tells listeners about Sjogren&#8217;s syndrome and how patients can manage the condition. Dr. Jonas is an Associate Professor of Medicine in the Division of Rheumatology, Allergy, and Immunology, and directs the UNC Rheumatology Fellowship Training Program. She is a rheumatologist with the UNC Thurston Arthritis Research Center.<\/p>\n","protected":false},"featured_media":4231,"menu_order":0,"template":"","meta":{"_acf_changed":false,"layout":"","cellInformation":"","apiCallInformation":"","_links_to":"","_links_to_target":""},"podcast-category":[634,639],"class_list":["post-19324","episode","type-episode","status-publish","has-post-thumbnail","hentry","podcast-category-podcast-autoimmune-disease-series","podcast-category-podcast","odd"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Sjogren&#039;s Syndrome - with Beth Jonas, MD | Department of Medicine<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.med.unc.edu\/medicine\/news\/\/news\/chairs-corner\/podcast\/sjogrens-syndrome\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Sjogren&#039;s Syndrome - with Beth Jonas, MD | Department of Medicine\" \/>\n<meta property=\"og:description\" content=\"This is Episode Eight of &quot;Autoimmune Disease: Pieces of the Picture.&quot; Dr. Beth Jonas tells listeners about Sjogren&#039;s syndrome and how patients can manage the condition. 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