OpenHealth Q&A

When Should I Seek Help for Possible Sjogren's Syndrome?

I am a 47-year-old female with a medical background that includes gastroesophageal reflux disease (GERD), asthma, ADHD, depression, and osteoarthritis affecting my hip and lower back. Over the years, I've undergone multiple surgeries on my left hip due to slipped capital femoral epiphysis (SCFE), and I have a scheduled hip replacement in about six weeks. My medication regimen includes Nexium, Symbicort, Singulair, Zyrtec, and a daily dose of Concerta at 36 mg. Occasionally, I manage to remember to take a multivitamin along with calcium and vitamin D supplements, and I also include omega-3 fatty acids in my intake. Recently, I added tramadol at a dosage of 50 mg, which I take a couple of times daily to help with hip discomfort. Additionally, I am on hormone replacement therapy with Lyllana (0.05 mg biweekly) and nightly progesterone (100 mg) to alleviate symptoms related to perimenopause. My concern, which is outlined in the title, stems from experiencing persistent dryness in my mouth for several years, despite maintaining adequate hydration. A year ago, my dentist showed concern regarding this issue and suggested I try Biotene products; however, both the mouthwash and spray haven't provided notable relief. A few years prior, I had been diagnosed with dry eye condition after treatment for a corneal cyst. Lately, I've also been facing episodes of intense itchiness on my hands and feet, which are accompanied by reddish circular marks on the palms and wrists. These spots appear situated beneath the skin's surface and are not raised, resembling neither rashes nor hives. The itchiness arises sporadically, with no identifiable triggers, and at times is severe enough that I've scratched my feet during the night, leading to cuts. While recovering from my hip surgery over the last month, I've occasionally felt sharp pains in my salivary glands while I swallow. I wouldn't classify it as swallowing difficulties, but there's a persistent irritation in my throat, making it feel raw, similar to the sensation when I have a cold, and I find myself losing my voice more often. Increased fatigue has become a challenge to the extent that standing in the shower can be a struggle, alongside worsening joint pain, which I have attributed to hormonal changes. I had blood tests during a physical exam last year, the results of which appeared normal, although I noted my glomerular filtration rate (GFR) was at 58; I was also regularly taking Aleve for my hip discomfort. I recognize that diagnosing Sjogren's syndrome can be quite complex, and I seem to have many disparate symptoms. The combination of itchiness, dry eye, dry mouth, and hoarseness is becoming increasingly bothersome. However, I feel somewhat embarrassed about discussing these issues with my primary care physician, and I also worry about falling prey to confirmation bias.

Answers (1)

6/28/2025, 10:40:41 PM

OpenHealth AI

It’s understandable to feel concerned about the persistent symptoms you’re experiencing, especially with your complex medical history. Sjogren's syndrome often presents with dryness in the mouth and eyes, among other symptoms, and it’s important to address these concerns with your healthcare provider to get the right evaluation and support.

Explanation

Sjogren's syndrome is an autoimmune condition that can lead to dryness in various parts of the body, primarily the mouth (xerostomia) and eyes (keratoconjunctivitis sicca). Other symptoms can include joint pain, fatigue, and sometimes rashes or itchiness. Given your history of dryness in your mouth and eyes, combined with other symptoms like hoarseness, fatigue, and joint pain, it’s reasonable to consider the possibility of Sjogren's syndrome.

Next Steps

1. Document Your Symptoms: Keep a symptom diary to track your dryness, itchiness, fatigue, and any changes or patterns. Note when symptoms worsen, their frequency, and duration. This will help articulate your concerns clearly.

2. Evaluate Pain in Salivary Glands: The sharp pains in your salivary glands and the feeling of a raw throat should be addressed. These could indicate issues that need attention, such as inflammation or blockage.

3. Consult with Your Primary Care Provider: It’s crucial to have an open conversation with your doctor about your symptoms, despite any hesitations you might feel. Remember, physicians are there to help and addressing your concerns is essential for your health. They may suggest specific tests like blood work to check for autoantibodies associated with Sjogren's syndrome (e.g., anti-Ro/La antibodies).

4. Ask About Referrals: If your primary care doctor feels it’s appropriate, consider asking for a referral to a rheumatologist, who specializes in autoimmune conditions and can provide a more thorough evaluation.

5. Consider an Eye and Mouth Care Routine: While you're experiencing these symptoms, continue using moisturizing products like artificial tears for your eyes and saliva substitutes for your mouth. Explore other oral moisture products if Biotene isn’t helping.

6. Monitor Fatigue Levels: Track your fatigue, especially post-surgery; it’s important to differentiate whether this is due to recovery from your hip surgery or a chronic condition.

7. Be Honest About All Symptoms: Don’t hesitate to mention any discomfort or new symptoms, such as the reddish marks and the severe itchiness, as these can provide vital clues to your doctor.

It's perfectly acceptable to bring up these concerns, and being proactive in sharing what you’re experiencing is the first step towards finding relief and getting the appropriate care. You deserve to feel better and have your symptoms addressed.