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Sjögren’s Syndrome in the Elderly

  • Raymond L. YungEmail author
  • Sheeja Francis
Chapter

Abstract

Sjögren’s syndrome is an important disease for the geriatric population in part because it often affects the elderly. In addition, it is a major women’s health issue that is often overlooked and neglected. It is important to distinguish the condition from age-related exocrine gland pathology and drug-induced ocular and oral dryness. Age-related physiological and pathological changes may exacerbate the patient’s symptoms. Understanding the pathogenesis of this disease may also provide important clues of the relationship among aging, autoimmunity, and cancer. This chapter focuses the discussion on the effect of aging on the clinical manifestation and treatment consideration in the geriatrics population.

Keywords

Sjögren’s syndrome Aging Autoimmunity Cancer 

References

  1. 1.
    Whaley K, Williamson J, Wilson T, McGavin DD, Hughes GR, Hughes H, et al. Sjogren’s syndrome and autoimmunity in a geriatric population. Age Ageing. 1972;1:197–206.PubMedCrossRefGoogle Scholar
  2. 2.
    Drosis AA, Andonopoulos AP, Costopoulos JS, Papadimitrio CS, Moutsopoulos HM. Prevalence of primary Sjogren’s syndrome in an elderly population. Br J Rheumatol. 1988;27:123–7.CrossRefGoogle Scholar
  3. 3.
    Schein OD, Hochberg MC, Munoz B, Tielsch JM, Bandeen-Roche K, Provost T, et al. Dry eye and dry mouth in the elderly: a population-based assessment. Arch Intern Med. 1999;159:1359–63.PubMedCrossRefGoogle Scholar
  4. 4.
    Hochberg MC, Tielsch J, Munoz B, Bandeen-Roche K, West SK, Schein OD. Prevalence of symptoms of dry mouth and their relationship to saliva production in community dwelling elderly: the SEE project. Salisbury Eye Evaluation. J Rheumatol. 1998;25:486–91.PubMedGoogle Scholar
  5. 5.
    Takada K, Suzuki K, Okada M, Nakashima M, Ohsuzu F. Salivary production rates fall with age in subjects having anti-centromere, anti-Ro, and/or anti-La antibodies. Scand J Rheumatol. 2006;35:23–8.PubMedCrossRefGoogle Scholar
  6. 6.
    García-Carrasco M, Cervera R, Rosas J, Ramos-Casals M, Morlá RM, Sisó A, et al. Primary Sjögren’s syndrome in the elderly: clinical and immunological characteristics. Lupus. 1999;8:20–3.PubMedCrossRefGoogle Scholar
  7. 7.
    Ng KP, Isenberg DA. Sjögren’s syndrome: diagnosis and therapeutic challenges in the elderly. Drugs Aging. 2008;25:19–33.PubMedCrossRefGoogle Scholar
  8. 8.
    Marsh P, Pflugfelder SC. Topical nonpreserved methylprednisolone therapy for keratoconjunctivitis sicca in Sjögren’s syndrome. Ophthalmology. 1999;106:811–6.PubMedCrossRefGoogle Scholar
  9. 9.
    Hong S, Kim T, Chung S, Kim EK, Seo KY. Recurrence after topical nonpreserved methylprednisolone therapy for keratoconjunctivitis sicca in Sjögren’s syndrome. J Ocul Pharmacol Ther. 2007;23:78–82.PubMedCrossRefGoogle Scholar
  10. 10.
    Stevenson D, Tauber J, Reis BL. Efficacy and safety of cyclosporin A ophthalmic emulsion in the treatment of moderate-to-severe dry eye disease: a dose ranging, randomized trial. Ophthalmology. 2000;107:967–74.PubMedCrossRefGoogle Scholar
  11. 11.
    Foulks GN. Pharmacological management of dry eye in the elderly patient. Drugs Aging. 2008;25:105–18.PubMedCrossRefGoogle Scholar
  12. 12.
    Tsifetaki N, Kitsos G, Paschides CA, Alamanos Y, Eftaxias V, Voulgari PV, et al. Oral pilocarpine of the treatment of ocular symptoms in patients with Sjögren’s syndrome: a randomized 12 week controlled study. Ann Rheum Dis. 2003;62:1204–7.PubMedCrossRefGoogle Scholar
  13. 13.
    Al-Hashimi I. Xerostomia secondary to Sjögren’s syndrome in the elderly: recognition and management. Drugs Aging. 2005;22:887–99.PubMedCrossRefGoogle Scholar
  14. 14.
    van der Reijden WA, van der Kwaak H, Vissink A, Veerman ECI, Nieuw Amerongen AV. Treatment of xerostomia with polymer-based saliva substitutes in patients with Sjögren’s syndrome. Arthritis Rheum. 1996;39:57–63.PubMedCrossRefGoogle Scholar
  15. 15.
    Vivino FB, Al-Hashimi I, Khan Z, LeVeque FG, Salisbury PL, Tran-Johnson TK, et al. Pilocarpine tablets for the treatment of dry mouth and dry eye symptoms in patients with Sjögren’s syndrome. Arch Intern Med. 1999;159:174–81.PubMedCrossRefGoogle Scholar
  16. 16.
    Petrone D, Condemi JJ, Fife R, Gluck O, Cohen S, Dalgin P. A double-blind placebo-controlled randomized study of cevimeline in Sjögren’s syndrome patients with xerostomia and keratoconjunctivitis sicca. Arthritis Rheum. 2002;46:748–54.PubMedCrossRefGoogle Scholar
  17. 17.
    Miyawaki S, Nishiyama S, Matoba K. Efficacy of low-dose prednisolone maintenance for saliva production and serological abnormalities in patients with primary Sjögren’s syndrome. Intern Med. 1999;38:938–43.PubMedCrossRefGoogle Scholar
  18. 18.
    Fox RI, Dixon R, Guarrasi V, Krubel S. Treatment of primary Sjögren’s syndrome with hydroxychloroquine: a retrospective, open-label study. Lupus. 1996;5(1):S31–6.PubMedCrossRefGoogle Scholar
  19. 19.
    Delalande S, de Seze J, Fauchais AL, Hachulla E, Stojkovic T, Ferriby D, et al. Neurologic manifestations in primary Sjögren’s syndrome: a study of 82 patients. Medicine. 2004;83:280–91.PubMedCrossRefGoogle Scholar
  20. 20.
    Sankar V, Brennen MT, Kok MR, Leakan RA, Smith JA, Manny J, et al. Etanercept in Sjögren’s syndrome: a twelve-week randomized, double-blind, placebo-controlled pilot clinical trial. Arthritis Rheum. 2004;50:2240–5.PubMedCrossRefGoogle Scholar
  21. 21.
    Mariette X, Ravaud P, Steinfeld S, Baron G, Goetz J, Hachulla E, et al. Inefficacy of infliximab in primary Sjögren’s syndrome: results of the randomized, controlled trial of Remicade in ­primary Sjögren’s syndrome (TRIPSS). Arthritis Rheum. 2004;50:1270–6.PubMedCrossRefGoogle Scholar
  22. 22.
    Pijpe J, van Imhoff GW, Spijkervet FKL, Roodenberg JLN, Wolbink GJ, Mansour K, et al. Rituximab treatment in patients with primary Sjögren’s syndrome: an open-label phase II study. Arthritis Rheum. 2005;52:2740–50.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Department of Internal MedicineUniversity of MichiganAnn ArborUSA

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