Lymphadenopathy and Sjögren's Syndrome: Symptoms and Concerns

Unilateral lymphadenopathy, Sjögren's syndrome?

I apologize for the inconvenience, but I would like to ask the doctor about some symptoms I experienced as a child.
I discovered a lump under my right armpit and underwent a breast ultrasound, where the doctor diagnosed it as a cyst.
However, it was considered normal, and it did not change in size as I grew older.
Later, I frequently felt a pressure sensation on the right side of my neck, and I experienced difficulty breathing and swallowing.
I noticed several enlarged lymph nodes on the same side of my neck, with the largest measuring 1.4 cm.
I underwent a biopsy and ultrasound, both of which did not reveal any concerning findings.
Some lymph nodes decreased slightly in size, but others increased, and I have been returning for follow-ups every six months, with the largest node remaining under 1.4 cm.
Other nodes have also been biopsied, and the reports were normal, but the entire cluster of nodes has not resolved.
I also had a nasal endoscopy (normal), sinus X-ray (normal), and gastroscopy (mild gastroesophageal reflux).
Recently, I have been experiencing joint pain, fatigue, and recurrent hives.
Blood tests showed elevated AN1280 and ECP levels at 26.8, while the results for lupus and rheumatoid factors were normal.
However, I tested positive for SSA at 319 and RNP at 425.
The doctor suspects Sjögren's syndrome and advised me not to worry too much and to observe the situation.
I would like to know if the symptoms and lymph node issues are related to Sjögren's syndrome.
Should I pursue further examinations regarding the lymph nodes? Is my Sjögren's syndrome considered severe? Thank you.

Dou Dou, 30~39 year old female. Ask Date: 2022/06/24

Dr. Chen Sirong reply Oncology

Doudou / 32 years old / Female
1.
I apologize! I am an oncology specialist.
Based on your condition, after evaluation by the physician, there is a suspicion of Sjögren's syndrome, which is an autoimmune disease that commonly occurs in individuals aged 40 to 60, predominantly in females, with a female-to-male ratio of approximately 10:1.
It affects about 0.5% of the total population and can be classified as primary or secondary, depending on whether there are other associated autoimmune diseases.
The most common conditions associated with secondary Sjögren's syndrome include rheumatoid arthritis, systemic lupus erythematosus, and scleroderma.
Sjögren's syndrome is the second most common autoimmune disease after rheumatoid arthritis.
2.
You can search for relevant information online.
3.
If diagnosed, you may apply for a major illness card.
4.
I apologize! I am an oncology specialist; you may want to consult a rheumatologist for further evaluation.
Wishing you peace and health.
Taoyuan Hospital
Chen Si-Rong

Reply Date: 2022/06/24

More Info

Sjögren's syndrome is an autoimmune disorder characterized primarily by dry eyes and dry mouth due to the immune system attacking the glands that produce these fluids. It can also affect other parts of the body, leading to a variety of symptoms, including joint pain, fatigue, and potentially lymphadenopathy, which is the enlargement of lymph nodes.

In your case, the history of lymphadenopathy, particularly on the right side of your neck, along with the presence of a cyst in your axilla (armpit area) that has remained stable over time, is noteworthy. The lymph nodes can become enlarged for various reasons, including infections, autoimmune diseases, and malignancies. However, since your ultrasound and biopsy results have not indicated any malignancy, and given that your lymphadenopathy has not significantly changed, it is likely benign.

Your symptoms of pressure in the neck, difficulty swallowing, and recurrent joint pain, combined with the positive results for SSA and RNP antibodies, suggest a possible connection to Sjögren's syndrome. The presence of these autoantibodies is often associated with autoimmune conditions, including Sjögren's syndrome and other connective tissue diseases like systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). The fact that your doctor has suggested Sjögren's syndrome as a possibility indicates that they are considering the broader context of your symptoms and lab results.

Regarding the severity of your Sjögren's syndrome, it can vary widely among individuals. Some may experience mild symptoms that are manageable, while others may have more severe manifestations affecting multiple organ systems. The presence of joint pain and recurrent urticaria (hives) could indicate that your immune system is quite active, which may warrant closer monitoring and possibly more aggressive treatment.

As for your concerns about lymphadenopathy and whether further examination is necessary, it is essential to maintain regular follow-ups with your healthcare provider. If your lymph nodes continue to enlarge or if you develop new symptoms, further investigations may be warranted. This could include imaging studies or even a referral to a specialist in rheumatology or hematology, depending on the clinical judgment of your primary care physician.

In summary, while your symptoms and lab results suggest a potential link to Sjögren's syndrome, the benign nature of your lymphadenopathy, as indicated by previous tests, is reassuring. It is crucial to continue monitoring your symptoms and maintain open communication with your healthcare provider about any changes you experience. They can help guide you on the appropriate next steps, including potential treatments for Sjögren's syndrome and any necessary evaluations for your lymphadenopathy. Remember that managing an autoimmune condition often requires a multidisciplinary approach, including lifestyle modifications, medication management, and regular check-ups to monitor your health status.

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