Progress in Sjögren's syndrome: profitable despite the "rheumatism" of salivary and tear glands

Sjögren's syndrome is an inflammatory rheumatic autoimmune disease: the body's own defense attacks the exocrine glands and causes inflammatory processes. Sufferers suffer first and foremost from dry and dull eyes and dry mouth. Cervical, laryngeal and vaginal mucosa are rarely affected, and sometimes dry skin may be found. At least 0.2 percent of adults suffer from Sjögren's syndrome. Unfortunately, we do not know exactly how many people are in Germany, we assume a lot more, "explains Professor DGRh. honey. Hendrik Schulze-Koops from Munich. More than 90 percent of women are affected, most of whom are ill in their mid-forties and suffer from consequences throughout their lives. "Of course, not all of the symptoms of dry mouth – the consequence of Sjögren syndrome. The Sjögren syndrome is an inflammation of the salivary gland.

Like other inflammatory rheumatic diseases, Sjögren's syndrome affects the entire body. "Above all, the joints and nerves, as well as the lungs and the kidneys, can be affected. The development of malignant lymphoma, that is, of the lymphatic system, is also associated with Sjögren's syndrome," explains Professor Schulze-Koops: "Additionally, the disease puts pressure on the psyche Many patients suffer from fatigue from depression.
"We've seen in the past that patients were often on sick or totally out of work," Dr. weapons. Doctor. Johanna Callhoff of the German Rheumatism Research Center (DRFZ) in Berlin. There has been some reversal here in the last two decades, as the epidemiologist has shown in the recent assessment of the documentation of "Basic Documentation for Adult" DRFZ. This project involves rheumatic centers from all over Germany with the aim of describing and analyzing medical care for rheumatic patients. This can determine the time development of care and its correlation with the patient's health condition.

According to the data from the Adult Documentation, which is currently published in "Clinical and Experimental Rheumatology", in the year 2016, a total of 64 percent of patients were involved, of whom under 87 were 87 percent. "In 1996 there were only 43 and 44 percent," says Dr. Med. Callhoff. "The proportion of early retired patients dropped from 22 to 10 percent." Instead of 39 percent in 1996, only 27 percent of the patients were on sick leave at least once a year. Only 7 percent of the patients had to be treated in the hospital instead of 13 percent of the patients.

The employment rate also increased in other rheumatic diseases: "This is attributed to other rheumatic diseases of early treatment, especially the use of antibodies and other biological agents that stop progressive wound healing," explains Professor Schulze-Koops, Head of the Department of Rheumatism at Ludwig-Maximilians University in Munich . However, biologically they are rarely used in Sjögren's syndrome. According to the basic documentation, it is only 4.3 percent. By contrast, the regulation of hydroxychloroquine (HCQ) increased. "The drug was originally used for the prevention and treatment of malaria," explains Professor Schulze-Koops. It was later discovered that it also works with rheumatic diseases. Sjögren's syndrome often improves the lethality that many patients suffer. The share of Sjogren's patients treated with antimalarial drugs has risen from 31 to 50 percent.

Today, 93 percent of the disease is milder, compared with 62 percent two decades ago. "The perception of the disease has changed so today Sjögren syndrome has been discovered earlier." Then we try to treat immunosuppressive drugs early, with drugs such as hydroxychloroquine (HCQ). Combination with other basic therapies, such as leflunomide or cyclosporin, is currently being tested in the assays. "In treating, patients also learn how to relieve permanent symptoms with eye drops and saliva substitutions.

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J. Callhoff, K. Thiele, T. Dörner, A. Zink, J.G. Richter, J. Henes, K. Albrecht, Trends in Employment and Hospitalization of Sickness Syndromes 1996-2016: Results from the German National Database, Clin Exp Rheumatol 2019; 37 (Appendix 118): S00-S00.

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With more than 1,400 members, DGRh is the largest medical science company in Germany in the field of rheumatology. For 90 years it has been the rheumatological science and research and its development. As a non-profit organization, DGRh operates independently and without realizing economic goals for the benefit of the general public.

German Society of Rheumatology e. V.
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idw 2019/07