Sjögren's Syndrome and the Role of Mycophenolate

Sjögren's syndrome and myositis?

Dear Doctor,
I am 51 years old and was diagnosed with Sjögren's syndrome in 2015.
My main symptoms include dry eyes, mild vasculitis in the lower extremities, weight loss, and a white blood cell count of approximately 2800 to 3500.
So far, I have been taking one tablet of Plaquenil daily.
Earlier this year, I developed a submandibular gland cyst, and for the first time, my serum tests showed the presence of antinuclear antibodies (1:80).
Prior to this, all related antibodies were negative.

Do these changes indicate that my condition is worsening? If my financial situation allows, would starting self-funded treatment with rituximab help prevent further deterioration of my condition? Additionally, can autoimmune patients take probiotics long-term?
Thank you for your response.

SUNNY, 50~59 year old female. Ask Date: 2019/02/26

Dr. Gao Jiankai reply Internal Medicine

Hello SUNNY, thank you for your message.
The disease activity of Sjögren's syndrome is related to clinical symptoms (such as gland swelling and new vasculitis lesions) and laboratory results; however, changes in antinuclear antibody levels do not necessarily indicate disease worsening.
I recommend discussing this further with your attending physician.
Additionally, it seems that your dosage of Plaquenil is on the lower side, and there appears to be room for adjustment in your oral medication.
It is advisable to start with adjustments to the oral medication first.
The use of corticosteroids can be considered later if the response to oral medications remains inadequate.
Lastly, you may consider using probiotics.
The Allergy, Immunology, and Rheumatology Department of Changhua Hospital, Ministry of Health and Welfare, is concerned about your well-being.

Reply Date: 2019/02/26

More Info

Sjögren's Syndrome is a chronic autoimmune disorder characterized primarily by dry eyes and dry mouth due to the destruction of the exocrine glands, particularly the salivary and lacrimal glands. This condition can also lead to systemic complications, including joint pain, fatigue, and in some cases, vasculitis, as you have experienced. The presence of anti-nuclear antibodies (ANA) can indicate an autoimmune process, and the emergence of these antibodies in your case may suggest a shift in your disease activity or progression.

Regarding your specific concerns, the symptoms you are experiencing, such as dry eyes, mild vasculitis, and weight loss, could indicate that your Sjögren's Syndrome is becoming more active or complicated. The presence of a submandibular gland cyst and the new detection of ANA are important factors to consider in your ongoing management. It is crucial to have regular follow-ups with your rheumatologist or healthcare provider to monitor these changes closely.

As for the use of mycophenolate mofetil (MMF), this medication is an immunosuppressant that can be beneficial for patients with autoimmune diseases, particularly those with more severe manifestations. It is often used in cases of Sjögren's Syndrome that involve significant systemic symptoms or complications, such as vasculitis or interstitial lung disease. If your healthcare provider recommends starting MMF, it may help in managing your symptoms and potentially preventing further disease progression. However, the decision to initiate this treatment should be made collaboratively with your healthcare team, considering your overall health, disease severity, and personal preferences.

Regarding the long-term use of probiotics, there is generally no contraindication for autoimmune patients to take probiotics. In fact, some studies suggest that probiotics may help support gut health and modulate the immune system, which can be beneficial for individuals with autoimmune conditions. However, it is essential to choose high-quality probiotics and consult with your healthcare provider before starting any new supplement regimen, especially since autoimmune patients can have unique responses to various treatments.

In summary, your current symptoms and laboratory findings warrant careful monitoring and possibly a reassessment of your treatment plan. Starting mycophenolate could be a viable option to manage your condition more effectively, but this should be discussed in detail with your healthcare provider. Additionally, incorporating probiotics into your diet may be beneficial, but professional guidance is recommended to ensure safety and efficacy. Regular follow-ups and open communication with your healthcare team will be crucial in managing your Sjögren's Syndrome effectively.

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