Secondary Sjögren's Syndrome and Major Illness Claims

Q: Secondary Sjögren's Syndrome and Major Illness Claims

Hello, netizen： According to regulations, only those with secondary Sjögren's syndrome related to autoimmune diseases can apply for major illness benefits. <br>Please refer to the information (autoimmune-related dry syndrome is referred to as Sjögren's syndrome). <br>Thank you fo

Application for Major Illness due to Sjögren's Syndrome

Hello Doctor: I went to National Taiwan University for an examination, and the doctor said I have secondary Sjögren's syndrome caused by a virus.
He mentioned that this condition cannot be applied for major illness benefits.
I would like to ask if there is indeed such a regulation.
Thank you.

Max, 40~49 year old female. Ask Date: 2010/04/30

Dr. Zeng Guosen reply Internal Medicine

Hello, netizen: According to regulations, only those with secondary Sjögren's syndrome related to autoimmune diseases can apply for major illness benefits.
Please refer to the information (autoimmune-related dry syndrome is referred to as Sjögren's syndrome).
Thank you for your question.
The diagnostic criteria for Sjögren's syndrome are as follows:
Diagnostic Criteria for Sjögren's Syndrome (based on the European classification criteria established in 2002)
1.
Subjective ocular symptoms: At least one of the following must be met:
(1) Are there daily, persistent, bothersome dry eye symptoms lasting more than three months?
(2) Is there a recurrent sensation of foreign body in the eyes?
(3) Do you use artificial tears more than three times a day?
2.
Subjective oral symptoms: At least one of the following must be met:
(1) Do you feel dry mouth symptoms daily lasting more than three months?
(2) Have you experienced recurrent or persistent swelling of the salivary glands after adulthood?
(3) Do you often use liquids to help swallow drier foods?
3.
Objective ocular findings: At least one of the following tests must be positive:
(1) Schirmer's test: Less than or equal to 5 mm after 5 minutes without anesthesia.
(2) Rose Bengal score or other ocular staining score of greater than or equal to 4 (according to van Bijsterveld's scoring system).
4.
Histopathology: In a 4 mm² salivary gland tissue biopsy, there is evidence of glandular inflammation with ≥1 focus of lymphocytic infiltration (1 focus: ≥50 lymphocytes aggregated).
5.
Salivary gland involvement: At least one of the following tests must be positive:
(1) Reduced total salivary secretion without stimulation (less than 1.5 c.c.
in 15 minutes).
(2) Sialography shows diffuse enlargement of the salivary ducts (appearing as spotty, cystic, or irregular) without duct obstruction.
(3) Salivary gland scintigraphy shows delayed uptake of radioactive isotopes, low concentration, and/or delayed excretion.
6.
Autoimmune antibodies: Presence of the following autoantibodies:
(1) SSA or SSB or both, consistent with the diagnostic criteria for Sjögren's syndrome.
Classification:
1.
Primary Sjögren's syndrome: No associated diseases and must meet either of the following conditions:
(1) Four of the six criteria are met, including either the fourth (histopathology) or sixth (serological examination) criteria.
(2) Three of the four objective criteria (i.e., criteria 3, 4, 5, and 6) are met.
2.
Secondary Sjögren's syndrome: The patient has an underlying associated disease (e.g., any defined connective tissue disease) and meets either the first or second criteria, plus any two of the third, fourth, or fifth criteria, indicating consideration for secondary Sjögren's syndrome.

Reply Date: 2010/04/30

More Info

Secondary Sjögren's Syndrome (SSS) is a complex autoimmune disorder that often arises as a complication of other underlying diseases, such as rheumatoid arthritis, systemic lupus erythematosus (SLE), or other connective tissue diseases. Unlike primary Sjögren's syndrome, which occurs independently, secondary Sjögren's syndrome is associated with these pre-existing conditions. The hallmark symptoms of Sjögren's syndrome include dry mouth (xerostomia) and dry eyes (keratoconjunctivitis sicca), which result from the immune-mediated destruction of exocrine glands, particularly the salivary and lacrimal glands.

The assertion that secondary Sjögren's syndrome can be caused by a viral infection is somewhat misleading. While certain viral infections, such as Epstein-Barr virus (EBV) or cytomegalovirus (CMV), have been implicated in triggering autoimmune responses, the primary cause of secondary Sjögren's syndrome is typically linked to the underlying autoimmune disease rather than a direct viral infection. Therefore, it is crucial to understand the context in which your doctor made this statement. If your doctor indicated that your condition is secondary to a viral infection, it may be worth discussing further to clarify the relationship between the viral infection and your autoimmune symptoms.

Regarding the claim for major illness benefits, the regulations surrounding such claims can vary significantly by country and even by specific healthcare systems or insurance policies. In many cases, major illness claims are reserved for conditions that are deemed severe enough to warrant significant medical intervention or long-term care. While secondary Sjögren's syndrome can lead to serious complications, including an increased risk of lymphoma and other systemic issues, it may not always meet the criteria for major illness claims, especially if the symptoms are manageable and do not severely impact daily functioning.

To address your specific question about whether there is a regulation that prevents you from applying for major illness claims due to secondary Sjögren's syndrome, it would be best to consult directly with your healthcare provider or a representative from your insurance company. They can provide detailed information about the specific criteria that must be met for a claim to be approved. Additionally, it may be beneficial to gather comprehensive documentation of your diagnosis, treatment history, and any complications you may be experiencing, as this information can support your case for a claim.

In summary, while secondary Sjögren's syndrome can be a serious condition, its classification as a major illness for claims purposes depends on various factors, including the severity of symptoms, the presence of complications, and the specific regulations of your healthcare system. It is essential to have open communication with your healthcare provider and insurance representatives to navigate this process effectively.

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