Dry Syndrome and Joint Cartilage Issues: A Guide to Immune Disorders

Sjögren's syndrome, articular cartilage

Hello, Director Gao! I have several symptoms and I'm unsure if they are related to an autoimmune disease.

1.
My dentist informed me that my mouth is very dry.
This condition has persisted for at least three years, especially during sleep when it is particularly dry (I cannot drink water or stimulate saliva production at all times).
Sometimes, I feel like my tongue is sticking to the roof of my mouth, and my lips are also dry.

2.
The dryness in my eyes began even earlier, at least five years ago, and it has been getting progressively worse, sometimes causing a stinging sensation.
I consulted an ophthalmologist, who advised me to continue using artificial tears daily and a 0.1% ophthalmic suspension.
3.
About seven years ago, I was incidentally found to have scoliosis during a chest X-ray.
The doctor noted that my lungs were clear but insisted I see an orthopedic specialist.
The orthopedic doctor pointed out that my cartilage was the issue, stating, "You have almost no cartilage!" and this was true for every joint.
He remarked, "That must hurt! I will prescribe anti-inflammatory pain medication for you." However, I did not feel any pain at that time, so I declined the medication, fearing it might cause stomach pain.
In the last three to four years, I have started to frequently experience joint pain, especially while sleeping or sitting for long periods.
4.
About three years ago, I began to notice that the joints in my fingers and toes feel stiff and "sticky," particularly from the time I wake up until I get out of bed.
I have to continuously stretch and move them to find relief.
5.
I experience a vague squeezing pain (dull pain?) in the abdominal area between my navel and right hip, and I also have pain in my right lower back.
I have been taking thyroid supplements for seven and a half years (the doctor said it was subacute thyroiditis leading to hypothyroidism), and my kidney and liver functions are regularly checked and are normal.
I am unsure of the cause of this pain.
6.
About six years ago, I noticed that my body temperature is higher than before, usually between 37.2-37.8°C, most commonly around 37.4-37.6°C.
My thyroid doctor suggested I see an infectious disease specialist, but no issues were found.
Instead, the day after returning home, I experienced asthma for the first time in my life! I then started coughing and had to return for another consultation.
I would like to ask you, Director Gao, if I should see a specialist in immunology or another department.
Thank you!

Dr. Hsieh, 50~59 year old female. Ask Date: 2018/09/06

Dr. Gao Jiankai reply Internal Medicine

Hello, I apologize for the late response.
I believe your symptoms are indeed related to Sjögren's syndrome, including dry eyes, dry mouth, thyroid dysfunction, cough, and generalized body aches, even lower back pain, which may all be associated with Sjögren's syndrome.
I recommend that you visit a rheumatology and immunology specialist for further evaluation.
Changhua Hospital, Ministry of Health and Welfare, cares about you.

Reply Date: 2018/09/06

More Info

Hello! Thank you for reaching out with your concerns regarding your symptoms, which may be related to immune disorders. Based on the information you've provided, it seems that you are experiencing a combination of symptoms that could be indicative of an autoimmune condition, particularly Sjögren's syndrome, which is characterized by dry mouth and dry eyes, along with potential joint issues.

1. Dry Mouth and Dry Eyes: The persistent dryness in your mouth and eyes is a significant symptom. Sjögren's syndrome is an autoimmune disorder that primarily affects the glands that produce moisture, leading to dry mouth (xerostomia) and dry eyes (xerophthalmia). The fact that you've been experiencing these symptoms for several years, along with the need for artificial tears and other treatments, suggests that this could be a possibility. It's essential to have these symptoms evaluated by a rheumatologist, who can perform specific tests, such as checking for autoantibodies (like SSA/Ro and SSB/La) that are often present in Sjögren's syndrome.

2. Joint Pain and Cartilage Issues: The joint pain you are experiencing, particularly in the fingers and toes, along with the history of cartilage issues noted by your orthopedic doctor, raises further concern for an autoimmune process. Conditions like rheumatoid arthritis (RA) or other inflammatory arthritides can lead to joint pain and stiffness, especially in the morning or after periods of inactivity. The stiffness you describe, particularly in the morning, is characteristic of inflammatory arthritis.
3. Abdominal Pain: The discomfort you feel in the abdominal area could be related to several factors, including referred pain from joint issues or even gastrointestinal involvement, which can occur in some autoimmune diseases. It is essential to discuss this symptom with your healthcare provider to rule out any underlying conditions.

4. Elevated Body Temperature: The slightly elevated body temperature you mentioned (37.2-37.8°C) could indicate an underlying inflammatory process. Chronic low-grade fever is often seen in autoimmune diseases and can be a sign of active disease.
5. Asthma Symptoms: The onset of asthma-like symptoms and coughing could also be related to an autoimmune condition, as some patients with autoimmune diseases can develop respiratory issues. It is crucial to have these symptoms evaluated, especially since they are new to you.

Given the complexity of your symptoms, it would be advisable to consult with a rheumatologist. They can perform a comprehensive evaluation, including blood tests for autoimmune markers, imaging studies for joint assessment, and possibly a biopsy of the salivary glands if Sjögren's syndrome is suspected.
In terms of treatment, if an autoimmune condition is diagnosed, management typically involves immunosuppressive medications to reduce inflammation and manage symptoms. Early intervention can lead to better outcomes and potentially reduce the need for long-term medication.
In summary, your symptoms warrant further investigation by a specialist in immunology or rheumatology. They can help clarify the diagnosis and develop a tailored treatment plan to address your specific needs. Please don't hesitate to seek medical attention, as early diagnosis and treatment can significantly improve your quality of life. Thank you for sharing your concerns, and I wish you the best in your journey toward better health!

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