Sjögren's Syndrome: Symptoms, Medication Concerns, and Risks

Q: Sjögren's Syndrome: Symptoms, Medication Concerns, and Risks

Hello, thank you for your inquiry. <br>Here are my responses：<br>1. <br>Based on the blood test report and the current symptom of dry mouth, do I need to take quinine? If I do not take it, what potential complications might arise in the future? (I have been hesitant to take medic

Symptoms of Sjögren's syndrome and medication issues?

Hello Doctor, I was diagnosed with Sjögren's syndrome two years ago, initially experiencing only dry mouth.
By June, I developed stiffness in my finger joints (sometimes only in the morning, sometimes lasting half a day, but it rarely persists for a full day).
However, after November, I no longer experienced stiffness in my finger joints.
In November, my blood test results showed abnormalities: C4 (complement component 4) at 10.4, IgG (immunoglobulin G) at 1950, RF (rheumatoid factor) at 28, and LEU (white blood cells) at 25, while other values were normal.
In June of this year, my doctor suggested taking quinine, but I have not taken any medication since my diagnosis two years ago.
I am concerned about potential future complications and would like to ask Dr.
Gao the following questions:
1.
Based on my blood test results and the current symptom of dry mouth, do I need to take quinine? If I choose not to take it, what potential complications might arise in the future? (I am hesitant to take medication because quinine requires long-term use.) If I do take quinine, is it possible to stop taking it in the future? Would the timing for discontinuation be when blood tests return to normal and I no longer have dry mouth symptoms?
2.
In your responses to other articles, you mentioned that Sjögren's syndrome can cause skin petechiae.
Could you please explain what petechiae are? I have a few red spots (each about 0.1 cm) scattered across both of my arms, and I am unsure if this is related.
(However, I had a similar condition many years ago and am uncertain if the red spots have changed locations.)
3.
My blood test showed the presence of rheumatoid factor, and I previously experienced stiffness and occasional pain in my finger joints.
Is this related to rheumatoid arthritis?
A friend recommended Dr.
Gao for being very professional and patient.
Thank you very much for your detailed response, Dr.
Gao.

Miss Qian, 40~49 year old female. Ask Date: 2023/12/02

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your inquiry.
Here are my responses:
1.
Based on the blood test report and the current symptom of dry mouth, do I need to take quinine? If I do not take it, what potential complications might arise in the future? (I have been hesitant to take medication since quinine needs to be taken long-term.) If I take quinine, is it possible to stop the medication in the future? Would the timing for stopping be when blood tests are normal and there are no symptoms of dry mouth? --> Our decision to prescribe medication will be based on a comprehensive assessment, not just a single symptom like dry mouth.
If Sjögren's syndrome is left untreated, the risk of developing lymphoma increases, especially in patients with abnormal blood test results.
Whether to discontinue quinine will depend on the physician's experience, as practices may vary among different doctors.
If symptoms improve with treatment and blood test results are normal or stable (quinine typically stabilizes the condition but does not normalize blood test results), we may gradually reduce the dosage.
After reaching a certain dose, if symptoms and blood test results remain stable, I would consider stopping the medication, with regular follow-up appointments for monitoring.
2.
The physician mentioned in other articles that Sjögren's syndrome can cause petechiae.
What is the condition of petechiae? I have a few red spots (each about 0.1 cm) scattered on both arms, and I am unsure if this is related.
(However, I have had a similar condition many years ago and am uncertain if the red spots have changed location.) --> Petechiae are a manifestation of small blood vessel inflammation, and a proper assessment requires visual examination of the skin.
Some small red spots may be cherry angiomas and not necessarily petechiae, so it is important to return to the clinic for the physician to see and palpate them for a more accurate diagnosis.
3.
The blood test showed rheumatoid factors, and I have previously experienced stiffness and occasional pain in my finger joints.
Is this related to rheumatoid arthritis? --> Patients with Sjögren's syndrome often have elevated rheumatoid factor levels, but this does not necessarily indicate rheumatoid arthritis.
However, early rheumatoid arthritis can present with symptoms similar to Sjögren's syndrome, so it is important to continue monitoring joint pain symptoms.
If joint pain becomes difficult to control, further discussion with the physician is needed to evaluate whether the initial diagnosis of Sjögren's syndrome may be evolving into rheumatoid arthritis.
Sincerely, the Allergy, Immunology, and Rheumatology Department of Changhua Hospital, Ministry of Health and Welfare.

Reply Date: 2023/12/02

More Info

Sjögren's Syndrome is a chronic autoimmune disorder characterized primarily by dry eyes and dry mouth due to the destruction of the glands that produce tears and saliva. It can also affect other parts of the body, leading to a variety of symptoms and complications. Your concerns regarding the management of this condition, especially in relation to your recent lab results and symptoms, are quite valid and deserve a thorough discussion.

1. Medication Concerns: Regarding the use of quinine, it's important to clarify that quinine is not typically a first-line treatment for Sjögren's Syndrome. Instead, medications such as pilocarpine or cevimeline are often prescribed to stimulate saliva and tear production. Your lab results indicate elevated levels of IgG and rheumatoid factor (RF), which may suggest an autoimmune process, but the decision to start any medication should be based on a comprehensive evaluation by your healthcare provider. If you are currently experiencing only mild symptoms, such as dry mouth, and no significant joint pain or swelling, it may be reasonable to monitor your condition without immediate medication. However, if symptoms worsen or new symptoms arise, treatment may become necessary.

If you choose not to take medication, there is a risk of developing complications associated with Sjögren's Syndrome, such as increased risk of dental caries due to dry mouth, potential for oral infections, and possibly systemic complications affecting other organs. Regular follow-ups and monitoring of your symptoms and lab results are crucial. If you do start medication, the possibility of discontinuing it would depend on your clinical status and lab results indicating stable disease without significant symptoms.

2. Skin Manifestations: The red spots you mentioned on your arms could be petechiae, which are small red or purple spots caused by bleeding under the skin. While Sjögren's Syndrome can lead to various skin manifestations, including rashes, the presence of petechiae may suggest a different underlying issue, such as a platelet disorder or vasculitis. It is essential to have these spots evaluated by a healthcare professional to determine their cause, especially since you have a history of similar spots. If they have changed in appearance or distribution, it warrants further investigation.

3. Joint Symptoms and Rheumatoid Factor: The joint stiffness and pain you experienced could indeed be related to Sjögren's Syndrome, as it can overlap with other autoimmune conditions, including rheumatoid arthritis (RA). The presence of rheumatoid factor in your blood can indicate an increased risk for developing RA, but not everyone with a positive RF will develop the disease. It is crucial to monitor your symptoms and communicate any changes to your healthcare provider, as they may recommend further evaluation or treatment if you develop more significant joint issues.

In summary, managing Sjögren's Syndrome involves a careful balance of monitoring symptoms, understanding potential complications, and making informed decisions about medication. Regular consultations with your healthcare provider will help tailor a management plan that suits your individual needs and addresses your concerns. It's also beneficial to maintain a healthy lifestyle, stay hydrated, and avoid irritants that may exacerbate your symptoms. If you have any further questions or concerns, don't hesitate to reach out to your healthcare team for personalized advice.

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