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sjogren’s syndrome

Diseases and Conditions Tips and Tricks

How to Care for Your Oral Health with Sjogren’s Syndrome

February 6, 2024

Today we’re going to learn about Sjogren’s syndrome oral health and steps you can take to protect your teeth and gums. But before we delve into the matter, let’s talk about Sjogren’s Syndrome.

Introduction to Sjögren’s Syndrome

Sjögren’s syndrome is an autoimmune disorder that affects the body’s moisture-producing glands like the salivary and tear glands. This causes symptoms of dry eyes and dry mouth and can negatively affect your oral health. Sjögren’s syndrome mostly affects middle-aged women, with 9 out of 10 Sjögren’s patients being female. The condition can occur at any age though, including childhood.

Sjögren’s syndrome is considered a systemic disease because it can affect organs and body systems beyond the eyes and mouth. However, the hallmark symptoms remain dry eyes and dry mouth due to impaired gland function. According to a 2014 study, the prevalence of primary Sjögren’s syndrome ranges from 0.01 to 0.72% of the population).

How Sjögren’s Syndrome Affects Saliva Production

Sjögren’s syndrome is an autoimmune disease that attacks the body’s exocrine glands, including the salivary glands. This leads to significant reductions in saliva and tear production. The hallmark symptom of Sjögren’s is dry mouth, also known as xerostomia. With Sjögren’s, the salivary glands become inflamed and damaged, impairing their ability to produce saliva. This results in chronic feelings of dry mouth.

Saliva plays a critical protective role in oral health. Having minimal saliva in the mouth due to Sjögren’s syndrome can allow bacteria to grow, leading to increased risk of tooth decay and fungal infections. Lack of saliva also makes chewing and swallowing food more difficult. According to the National Institutes of Health, nearly all patients with primary Sjögren’s syndrome report symptoms of dry mouth.

Without adequate saliva to lubricate and rinse the teeth and gums, Sjögren’s patients face heightened risk of cavities, gum disease, mouth sores, and other dental problems. Ensuring proper oral hygiene is especially important for Sjögren’s patients due to reduced saliva production.

Dry Mouth and Sjogren’s Syndrome Oral Health Complications

Sjögren’s syndrome dramatically reduces saliva production, resulting in a chronic dry mouth condition known as xerostomia. Saliva is critical for oral health, and without adequate saliva flow, Sjögren’s patients experience uncomfortable dry mouth symptoms and an increased risk of dental problems.

Common dry mouth symptoms caused by Sjögren’s syndrome include:

  • Chapped or cracked lips
  • Burning or tingling sensation in the mouth
  • Difficulty chewing, speaking, and swallowing
  • Dry, sticky, or burning tongue
  • Mouth sores or infections
  • Bad breath

With decreased saliva production, Sjögren’s patients are also at higher risk for complications like gum disease, tooth decay, and oral fungal infections. Dry mouth creates an environment favorable to bacteria growth, acid damage, and irritation.

Specifically, Sjögren’s patients may experience:

  • Increased dental cavities due to lack of saliva’s buffering capacity and remineralization properties
  • Gingivitis and periodontitis as saliva is not present to wash away plaque and acids
  • Oral thrush or candidiasis fungal infections in the mouth

Left untreated, dry mouth can seriously impact oral health over time. That’s why managing symptoms and dental care are so important for Sjögren’s patients.

Other Sjogren’s Syndrome Oral Health Problems

In addition to dry mouth, Sjögren’s syndrome can lead to several other oral health issues including:

Tooth decay – With less saliva to wash away food and neutralize acids, cavities can develop more frequently (https://pearlypros.com/category/cosmetic-dentistry/oral-health-tips/).

Gum disease/infections – Dry mouth allows bacteria to grow, increasing risk of gingivitis, periodontitis and other infections (https://m.facebook.com/kabanidental/posts/4169354456419345/).

Fungal infections – Candida fungus thrives in the dry mouth environment.

Mouth sores – Lack of protective saliva causes sensitive tissue in mouth to crack and ulcerate.

Loss of taste – Saliva helps stimulate taste buds. Reduced saliva flow can diminish the sense of taste.

Importance of Saliva for Oral Health

Saliva is critical for maintaining good oral health. It serves several key functions:

Lubricates and Protects Tissues – Saliva acts as a lubricant for the mucous membranes in the mouth and throat. This helps protect against friction that can cause irritation or damage. The lubricating properties of saliva also keep the mouth comfortable and aid in functions like talking and swallowing.

Neutralizes Acids – Saliva contains minerals like calcium and phosphate that help neutralize acids in the mouth. Acids are produced when plaque bacteria metabolize sugars and attack tooth enamel. Saliva helps restore a neutral pH balance to prevent acid erosion of enamel.

Contains Minerals That Strengthen Enamel – Saliva provides a constant source of calcium, phosphate, and fluoride ions that are essential for re-mineralizing and strengthening tooth enamel. Minerals in saliva help protect teeth from bacterial acids and also aid in repairing early tooth decay.

With reduced saliva production, these protective factors are diminished. This puts Sjögren’s patients at a much higher risk of gum disease, tooth decay, and other problems.

Managing Dry Mouth

There are several methods Sjögren’s syndrome patients can use to help manage dry mouth symptoms and increase comfort:

  • Sipping cool water – Keeping hydrated by frequently sipping cool water can help provide relief and moisture.
  • Saliva substitutes – Artificial saliva sprays or gels can serve as saliva substitutes to coat and lubricate the mouth. Some examples are Biotene, Oasis, and Xerolube.
  • Alcohol-free mouth rinses – Swishing with alcohol-free oral rinses without irritating ingredients can help moisten the mouth. Some options are Biotene, ACT Total Care, and Crest Pro-Health rinses.
  • Chewing gum – Chewing sugar-free gum stimulates saliva production and can help keep the mouth moist. Look for brands containing xylitol.
  • Moisturizing sprays and gels – Moisturizing oral sprays and gels provide quick, temporary relief. Products like Mouth Kote and Oasis moisturizing gels can coat and hydrate the mouth.

Patients should work with their dentist to determine the best dry mouth remedies based on their symptoms. Using a combination of methods throughout the day provides the most effective relief.

Source: https://sjogrens.org/sites/default/files/inline-files/Sjogrens-DryMouth.pdf

Daily Sjogren’s Syndrome Oral Health Recommendations

Maintaining good oral hygiene is essential for Sjögren’s patients to prevent cavities, gum disease, and other dental problems. Here are some tips for keeping your mouth healthy on a daily basis:

Brush gently with a soft-bristled toothbrush. Use gentle, circular motions when brushing and avoid scrubbing aggressively on your teeth and gums. This helps prevent abrasions or irritation of the soft tissues.

Use a fluoride toothpaste. Fluoride helps strengthen enamel and prevent cavities, which is very important for those with dry mouth. If your mouth is very dry, look for toothpastes specially formulated for dry mouth.

Floss once daily. Flossing removes plaque and food particles between teeth that brushing misses. Be very gentle when flossing if you have inflamed gums.

Ask your dentist about fluoride treatments. In-office fluoride treatments or prescription high-concentration fluoride gels can help protect your teeth by strengthening weakened enamel.

Don’t forget to brush your tongue to help freshen breath. End each day with a thorough brushing and flossing to keep your mouth clean while sleeping.

Seeing the Dentist Regularly

It is critical for Sjögren’s patients to see their dentist regularly, every 6 months, so they can monitor symptoms and get preventive treatments.

During dental checkups, patients should discuss any dry mouth symptoms, cavities, tooth sensitivity, gum recession, and other issues with their dentist. Getting exams twice a year allows dentists to track changes in oral health over time.

The dentist may recommend more frequent cleanings or fluoride treatments to help prevent cavities in Sjögren’s patients. They can also advise patients on proper brushing techniques for sensitive teeth and receding gums.

Other preventive dental treatments that may help Sjögren’s patients include dental sealants to protect teeth from decay and prescription strength fluoride toothpaste or varnish.

Finding a dentist experienced in treating Sjögren’s patients can provide specialized care and advice. Research local dentists to find one familiar with dry mouth management and preventive dental care.

With routine exams and treatments, Sjögren’s patients can minimize oral health issues despite reduced saliva. Seeing the dentist regularly is key to maintaining dental health.

Sjogrens Syndrome Oral Health Considerations

There are some special dental considerations for Sjögren’s syndrome patients to be aware of.

Toothpaste for Dry Mouth

Using a toothpaste made specifically for dry mouth can help Sjögren’s patients protect their teeth. These toothpastes are formulated to be extra gentle and to help stimulate saliva production. They also contain ingredients like xylitol and calcium to help strengthen tooth enamel and neutralize mouth acids.

Finding Support for Oral Health

Living with Sjögren’s syndrome and dealing with the oral health complications can feel overwhelming at times. However, there are excellent resources and support systems available to help you manage your oral health:

  • Connect with national and local patient foundations like the Sjögren’s Syndrome Foundation (SSF). The SSF provides education, awareness, and support programs to empower patients. Joining local support groups can also help you connect with other patients facing similar challenges.
  • Build a collaborative relationship with your dentist so you can work as a team to protect your oral health. Make sure to discuss all your symptoms openly and get specialized guidance for your unique needs.
  • Ask your dentist to coordinate with your rheumatologist for a more integrated treatment approach.
  • Consider getting a second opinion if you feel your oral health needs are not being adequately addressed.
  • Stay on top of regular dental visits and cleanings every 6 months.

You don’t have to manage Sjögren’s oral health complications alone. By utilizing available resources and being your own advocate, you can maintain better dental and gum health.

Medical Disclaimer

The information in this video is not intended nor implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images, and information, contained in this article is for general information purposes only and does not replace a consultation with your own doctor/health professional

Journal Club

Sjögren’s Relief in Sight? Exciting Trial Results for Ianalumab

January 2, 2024

Ianalumab a new medication currently in trials may finally bring some relief to people living with Sjogren’s syndrome. Sjögren’s syndrome is an autoimmune disease that affects the body’s moisture-producing glands, causing symptoms like dry eyes, dry mouth, fatigue, and joint pain. It can occur by itself as primary Sjögren’s syndrome, or alongside other autoimmune diseases like rheumatoid arthritis as secondary Sjögren’s.

While there are treatments to help manage symptoms, there are currently no approved therapies that target the underlying autoimmune disease process in Sjögren’s syndrome. This represents a major unmet need, as the chronic inflammation caused by Sjögren’s can lead to other serious complications over time if left unchecked. Patients are eager for new treatment options that could offer better disease control.

About the Study

This randomized, double-blind, placebo-controlled phase 2b study aimed to evaluate the efficacy and safety of the monoclonal antibody ianalumab in patients with primary Sjögren’s syndrome.

This trial enrolled patients from different continents and had 3 groups: different amounts of ianalumab compared to a fake treatment. The goal was to find the best dose of ianalumab for treatment and to see how well it worked and how safe it was compared to the fake treatment.

As a phase 2b study, this trial represents an intermediate stage of clinical research. Phase 2 studies gather preliminary data on effectiveness and look at common short-term side effects. If results are favorable, the treatment proceeds to larger and longer phase 3 trials which focus more on safety, efficacy, and optimal dosage.

Study Objective

The main goal of this study was to check if ianalumab, a type of medication, is safe and effective for people with Sjögren’s syndrome. This syndrome is an autoimmune illness that affects the salivary and lacrimal glands, causing dry mouth and dry eyes. Ianalumab targets B-cell activating factor (BAFF), a substance that affects the survival and development of B cells. By targeting BAFF, ianalumab aims to reduce the hyperactivity of B cells, which is linked to Sjögren’s syndrome. Essentially, ianalumab works by breaking B cells and blocking BAFF to stop the development of B cells. This study aimed to find out if treatment with ianalumab could safely improve symptoms and reduce disease activity in Sjögren’s patients compared to a placebo.

Study Participants

The research looked at adults with primary Sjögren’s syndrome, an autoimmune disease that causes long-term inflammation and harm to the glands that produce moisture, such as the salivary and tear glands.

Participants were required to meet the 2016 ACR-EULAR classification criteria for primary Sjögren’s syndrome. They also had to have an ESSDAI (EULAR Sjögren’s Syndrome Disease Activity Index) score of ≥6, indicating active disease.

Key eligibility criteria included:

  • Adults aged 18-75 years old
  • Confirmed diagnosis of primary Sjögren’s syndrome
  • Active disease with ESSDAI score ≥6
  • Presence of at least one domain with an ESSDAI score ≥3
  • Eligible participants were not allowed corticosteroids exceeding 10mg/day prednisone equivalent.

The study aimed to enroll patients representing the full spectrum of primary Sjögren’s syndrome. Overall, it included adults with active and untreated disease across multiple centers internationally.

Ianalumab Treatment Arms

The study compared 5 treatment arms:

  • Placebo – Patients received a placebo injection every 4 weeks
  • Ianalumab 5 mg – Patients received 5 mg of ianalumab subcutaneously every 4 weeks
  • Ianalumab 50mg – Patients received 50 mg of ianalumab subcutaneously every 4 weeks
  • Ianalumab 300 mg – Patients received 300 mg of ianalumab subcutaneously every 4 weeks

Outcome Measures

The main outcome measures for assessing efficacy were the EULAR Sjögren’s Syndrome Disease Activity Index (ESSDAI) at week 24, and patient-reported outcomes using EULAR Sjögren’s Syndrome Patient Reported Index (ESSPRI) and Short Form 36 Health Survey (SF-36) scores at weeks 4 and 24.

The ESSDAI measures disease activity across 12 organ-specific domains including salivary gland, articular, cutaneous, peripheral nervous system, etc. Typically a high ESSDAI is anything above 13, medium is between 5 and 13, and low is less than 5.

ESSPRI is used to measure patient-reported symptoms of dryness, fatigue, and pain. The SF-36 assesses quality of life across 8 domains – physical functioning, bodily pain, vitality, social functioning, emotional role functioning, mental health, general health perceptions, and physical role functioning.

By evaluating a combination of physician-assessed and patient-reported outcomes, the study aimed to provide a comprehensive view of ianalumab’s efficacy in treating both the clinical and symptomatic manifestations of primary Sjögren’s syndrome. The results across these measures would determine whether ianalumab could significantly improve disease activity, symptoms, and quality of life compared to placebo.

Ianalumab Key Results

The key results of the study showed that treatment with ianalumab improved ESSDAI and ESSPRI compared to placebo.

  • Patients treated with ianalumab 300mg had statistically significant improvements in ESSDAI scores compared to placebo at week 24.
  • Stimulated salivary flow increased with time and was most beneficial with people receiving the 300 mg dose.
  • Unfortunately, tear flow did not improve.

So in summary, treatment with ianalumab showed promising efficacy in improving patient-reported symptoms and disease activity in primary Sjögren’s syndrome compared to placebo in this phase 2b study.

Safety

Ianalumab demonstrated a safety profile comparable to placebo in this Phase 2b study. The rates of adverse events were similar between the ianalumab and placebo groups. The majority of adverse events were mild or moderate in severity.

The most common adverse events reported in the ianalumab groups were upper respiratory infections and sinus infections as well as headache, and urinary tract infection. These events occurred at similar frequencies in the placebo group as well.

There wasn’t a clear link between the dose given and the negative effects after using ianalumab. It’s important to note that the serious negative effects and infections were similar in both the ianalumab and placebo groups.

No deaths occurred during this study. Overall, subcutaneous dosing of ianalumab showed no significant safety signals in patients with primary Sjögren’s syndrome.

Next Steps

The results from this study indicate that ianalumab treatment shows promising efficacy in patients with primary Sjögren’s syndrome. Specifically, the 300 mg ianalumab dose significantly reduced ESSDAI scores compared to placebo after 24 weeks of treatment. The ESSDAI is a key outcome measure to assess efficacy of treatments for Sjögren’s syndrome.

Overall, ianalumab demonstrated an acceptable safety profile. While infusion reactions occurred more frequently with ianalumab compared to placebo, they were mostly mild to moderate in severity.

In summary, this phase 2b study provides evidence that targeting the BAFF cytokine with ianalumab could be an effective approach for treating Sjögren’s syndrome. The verdict is still out regarding the effect on fatigue but these results represent an encouraging development for patients with Sjogren’s syndrome.

References

Bowman SJ, Fox R, Dörner T, Mariette X, Papas A, Grader-Beck T, Fisher BA, Barcelos F, De Vita S, Schulze-Koops H, Moots RJ, Junge G, Woznicki JN, Sopala MA, Luo WL, Hueber W. Safety and efficacy of subcutaneous ianalumab (VAY736) in patients with primary Sjögren’s syndrome: a randomised, double-blind, placebo-controlled, phase 2b dose-finding trial. Lancet. 2022 Jan 8;399(10320):161-171. doi: 10.1016/S0140-6736(21)02251-0. Epub 2021 Nov 30. PMID: 34861168.

Medical Disclaimer

This information is offered to educate the general public. The information posted on this website does not replace professional medical advice, but for general information purposes only. There is no Doctor – Patient relationship established. We strongly advised you to speak with your medical professional if you have questions concerning your symptoms, diagnosis and treatment.

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Diseases and Conditions When to see a rheumatologist

10 Warning signs you could have Sjögren’s syndrome

March 1, 2017
Sjögren's syndrome can cause dry eyes and dry mouth as well as many other symptoms. Read on to learn more!

Today is a most bizarre weather-related day.  It’s warm, like you don’t need a coat warm, and there’s a raging thunderstorm.  Did I mention it’s February in upstate New York?  In honor of this most bizarre day, I’d thought I’d write a few words on a somewhat bizarre and illusive autoimmune disease called Sjögren’s syndrome.

Henrich Sjögren gave Sjögren’s syndrome its name.  He was a Swedish physician who first described the disease in 1933.  Sjögren’s syndrome is a common autoimmune disease that primarily causes dryness.  But it’s a lot more complicated than that because Sjögren’s syndrome can involve almost any organ so can present with a myriad of symptoms.  The symptoms arise from infiltration of lymphocytes into glands and affected organs.  Simply put, Sjögren’s syndrome is on the differential diagnosis in any person who has a positive ANA presenting with unexplained symptoms.

10 Warning signs you may be suffering from Sjögren’s syndrome

The following are some of the common manifestations of Sjögren’s syndrome.  Believe me, there are A LOT more but these are some of the common ones.

  1. Dry eyes
  2. Dry mouth
  3. Swollen cheek(s) i.e., parotid gland enlargement
  4. Profound tiredness
  5. Joint pain, sometimes with swelling
  6. Swollen glands
  7. Numbness, tingling, burning of the skin
  8. Raynaud’s
  9. Shortness of breath with minimal work
  10. Having a child that suffered from congenital heartblock

Dry mouth symptoms

The following are some common symptoms of dry mouth.

  1. Difficulty swallowing dry foods
  2. Inability to talk continuously
  3. Change in taste
  4. Burning sensation
  5. Large dentist bill! – Cavities, cracked teeth, loose fillings
  6. Problems with your dentures
  7. Worsening heartburn
  8. Thrush

As you can see the symptoms are a little all over the place and quite frankly are kind of vague.  Furthermore, many different conditions can mimic some of these symptoms: dehydration, depression, various medications, uncontrolled diabetes, multiple sclerosis, hepatitis C, sarcoidosis, etc etc.  Literally.

Classification criteria

Now it’s important to note that the following classification criteria are used for research purposes, and not necessarily for the day-to-day clinic.  Although they are important, there is such a thing called the art of medicine.

As we all know, not everyone fits into a neat little box.

Recently the American College of Rheumatology and the European League Against Rheumatism came up with a new system to classify Sjögren’s.  Basically, a group of hot-shot Sjögren’s specialists got together, looked at the literature, probably had more than one heated discussion, and came up with the following.

To test positive you need to have a score ≥4.  There are five items but they are weighted differently.

  • 3 Points – Anti-SSA/Ro antibody positivity
  • 3 Points – Focal lymphocytic sialadenitis with a focus score of ≥1 foci/4 mm2
  • 1 Point – Abnormal Ocular Staining Score of ≥5 (or van Bijsterveld score of ≥4)
  • 1 Point – Schirmer’s test result of ≤5 mm/5 mi
  • 1 Point – Unstimulated salivary flow rate of ≤0.1 mL/min, each scoring = 1

The sensitivity of this score is 96% and the specificity is 95%.  The sensitivity tells you how likely you are to detect all cases of Sjögren’s syndrome and the specificity tells you how accurate you are with the diagnosis using these set of diagnostic criteria.  These are pretty good figures.

What does this mean?

As you can see, the diagnosis favors objective findings, NOT symptoms.  This is a huge change from the previous set of diagnostic criteria.  You’ll also note that positive ANA, rheumatoid factor, and positive anti-SSB/La antibody positivity are not included in the new classification criteria.

Now I don’t want people thinking that I think symptoms are unimportant.  They are VERY important.  It’s just that symptoms should prompt a workup looking for objective features of the disease.

Now, try to remember the 10 warning signs.  If you find yourself checking a few of these items, check-in to your local rheumatologist.

References

Rheumatology Secrets 3rd edition

Shiboski CH, et al. 2016 American College of Rheumatology/European League Against Rheumatism classification criteria for primary Sjögren’s syndrome: A consensus and data-driven methodology involving three international patient cohorts.Ann Rheum Dis. 2017 Jan;76(1):9-16.

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Diseases and Conditions

What is Raynaud’s Phenomenon?

February 1, 2017
Raynaud's phenomenon: Classic white discoloration of the pinky

What is Raynaud’s?  They do say that a picture is worth a thousand words.

In a previous article about scleroderma, I alluded to something called Raynaud’s phenomenon.  Tis the season of the Raynaud flare, so I thought this post would be especially relevant.

This phenomenon is super common.  Some studies estimate that it occurs in 3 to 4% of the population but it’s probably a lot more than that.  In colder climates its is present in up to 30% of the population.  It’s more common in women, in younger people, and it tends to run in families.

Raynaud’s is a vasospastic disorder.  Basically the blood vessels clamp up when exposed to the cold, when there is a sudden change in temperature, or sometimes when you are extremely stressed out.  No joke!  Cigarette smoking is also a known cause.  Typically, the finger goes white, then dusky, and when the blood comes back, bright red.  If the change in color involves the palm, this is not Raynaud’s.

Raynaud’s can be associated with many conditions.  And they’re not all autoimmune.

  • Autoimmune – scleroderma, lupus, rheumatoid arthritis, Sjogren’s syndrome, myositis
  • Vibration injury – riveters, rock drillers, etc.
  • Frost bite
  • Medications and chemicals – beta blockers, cocaine, chemo
  • Arterial diseases – carpal tunnel, clots, pressure from a crutch
  • Hormonal diseases – low thyroid, pheochromocytoma
  • Hyperviscosity syndromes – paraproteinemia, polycythemia, cryoglobulinemia
  • Infections – Lyme, hepatitis, endocarditis
  • Cancers – ovarian cancer, lymphoma, leukemia

And then there’s the most common cause… just cause.  Idiopathic primary Raynaud’s.  Typically, this occurs in women during their teens or 20’s.  There are a lot more causes but these are some of the common and… not so common ones.

Primary Raynaud’s vs. Secondary Raynaud’s

When Raynaud’s is idiopathic, this means that it is NOT caused my any underlying condition.  This is primary Raynaud’s.  When there IS an underlying condition, we are dealing with secondary Raynaud’s.

In primary Raynaud’s, the blood vessels are structurally normal.  In secondary Raynaud’s, the structure of the blood vessels can deform because of the underlying cause.

Secondary Raynaud’s can cause finger ulcers, pitting, fissuring, and gangrene.  People tend to have an ANA and or antibodies.  In addition sometimes the doctor can actually see that the blood vessels above your nails look distorted using a pocket microscope.    While, you don’t see any of these things with primary Raynaud’s.

Can people with primary Raynaud’s develop secondary Raynaud’s

The simple answer is YES.  About 1% of patients with primary Raynaud’s develop some form of autoimmune disease yearly.  There are a few risk factors that increase that risk.

  • Having any specific antibody like anticentromere antibodies
  • Abnormal blood vessels above your nails
  • Having a ANA with a nucleolar pattern
  • First flare after the age of 40 years
  • Male gender
  • Finger ulcers, pits, gangrene

If you have any or a few of these, it’s important to see a rheumatologist periodically to make sure that you aren’t developing an autoimmune disease.  Early diagnosis is key.

How do you treat Raynaud’s?

Keep your hands and feet warm and, keep your core temperature warm.  Easier said than done.  I know, I grew up in Canada!  The trick is layering, mittens, scarves, and warm socks. Need to remove your gloves to answer your phone?  Don’t.  Either wear touchscreen friendly gloves or convert them.  I recently discovered nanotips.  It does the job.  Note, this is NOT an affiliate marketing link.  Basically, try to avoid triggers like the cold, stress, or any chemicals that could cause it in the first place.  Known chemicals include cigarettes, decongestants, diet pills… stimulant drugs.  Some heart medications may also worsen Raynaud’s.  Before making any changes, talk to your doctor.

Fish oil to treat Raynaud’s

When it comes to conventional medications, you do have a few options.  Provided you are not allergic to fish, omega-3 fatty acid supplementation could be beneficial.  One of my teachers/colleagues, conducted a double-blind, controlled, prospective study looking at fish oil supplementation in patients with both primary and secondary Raynaud’s phenomenon back in the 80’s.  Basically, 3 grams of fish oil daily improves tolerance to cold exposure and delays the onset of vasospasm in patients with primary Raynaud’s.  This effect was not seen in people with secondary Raynaud’s.

Medications for Raynaud’s

Finally, doctors sometimes prescribe medications like calcium channel blockers: amlodipine and nifedipine.  These are generally considered first-line and help about 35% of people.  Calcium channel blockers like verapamil and nicardipine are essentially useless.  Other medications include prazosin, sildenafil, and talalafil.  All of these can decrease your blood pressure.  For those with normal or low blood pressure, fluoxetine is a possibility.  Although this is an anti-depressent, it’s thought that the increase in serotonin dilates the blood vessels thereby alleviating Raynaud’s.  Sometimes topicals are effective: nifedpine and nitroglycerine.  But again, sometimes they can cause a drop in blood pressure.   Again, this does not constitute medical advice.  Please talk to your doctor before making any change.

What about finger or toe threatening situations

Sometimes Raynaud’s is particularly severe and refractory to medications.  This tends to happen with people suffering from scleroderma.  Sometimes, you can see gangrene because the decrease in blood flow is so severe.  Obviously, you don’t want it to get to that point.  In these situations, hospitalization often times is necessary.  Consequently doctors use medications like epoprostenol or iloprost to aggressively open up those blood vessels.  Surgical intervention may also be necessary: sympathectomy.  It can be performed at the cervical, lumbar, wrist, or digital (finger) levels.  These interventions are reserved for very severe cases.

What’s the prognosis

For primary Raynaud’s prognosis is excellent.  Simply a nuisance for the most part.  However, in high risk people, it’s important to see a rheumatologist on an annual basis to see if anything changes.  Thankfully, in about 10% of people the attacks disappear completely with time.

In contrast, things are little more complicated with secondary Raynaud’s.  It really depends on the underlying problem.  Remember this is treatable.  Not curable, but treatable.

I hope this has been informative and enlightening.  Remember, bundle up and stay warm this winter!

References

Rheumatology Secrets, 3rd Edition

DiGiacomb RA, Kremer JM, Shah DM. Fish-oil dietary supplementation in patients with Raynaud’s phenomenon: a double-blind, controlled, prospective study. Am J Med. 1989 Feb;86(2):158-64.

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