Sjogren’s Syndrome is one of the most common diseases in my practice, Rheumatologist Oncall. In this video, I will discuss the most common 10 manifestations of Sjogren’s Syndrome from dry eyes and mouth, arthritis, joint pain, to lung disease, heart disease, neurological manifestations to, fatigue, depression, fibromyalgia and many more.
EULAR, the European Alliance of Associations for Rheumatology, has developed new recommendations for CVR management in people with gout, vasculitis, systemic sclerosis (SSc), myositis, mixed connective tissue disease (MCTD), Sjögren’s syndrome (SS), systemic lupus erythematosus (SLE), and antiphospholipid syndrome (APS). People with inflammatory RMDs have an increased risk of developing and dying from CVD compared to people in the general population. Furthermore, people with these conditions are often exposed to immunomodulators and steroid medications. Although controlling inflammation may reduce CVR, cardiovascular side effects might outweigh any anti-inflammatory benefit.
A EULAR taskforce was set up to develop recommendations in this important area. The taskforce included methodologists, clinical experts, healthcare professionals and patient representatives. They looked at the published evidence around cardiovascular risk factors and interventions.
The group developed four overarching principles to emphasise the need for regular screening and management of modifiable risk factors, and endorse patient education. These are supported by 19 individual recommendations covering three central topics: CVR prediction tools, interventions on traditional CVR factors, and interventions on disease-related CVR factors. Since the advice varies depending on the underlying RMD, the recommendations are split into two groups. The first set of recommendations is intended to support CVR management in people with gout, vasculitis, systemic sclerosis, myositis, mixed connective tissue disease, or Sjögren’s syndrome. The second set focuses on people with systemic lupus erythematosus or antiphospholipid syndrome. Some traditional CVR management practices can be followed in people with this subset of RMDs as for the general population including for example, the guidelines for lipid management in people with gout, vasculitis, SSc, MCTD, SS, SLE, or APS. However, there are tailored recommendations about blood pressure management and the use of platelet inhibitors such as aspirin. Among interventions related to disease-specific risk factors, adequate control of disease activity and restriction of the use of glucocorticoids are also recommended. Specific recommendations also highlight the need to modify some standard CVR assessment tools to take into account certain factors for people with some of these RMDs.
Overall, these new recommendations provide guidance for rheumatologists, health professionals, and people with RMDs. It is hoped they will support clinical practice and future research for improving CVR management in people with RMDs.
New therapies for autoimmune rheumatic diseases (AIRDs) that are designed to better regulate lipid (fat) metabolism, could significantly reduce the harmful side-effects caused by conventional treatments, finds a new large-scale review led by UCL researchers.
AIRDs affect millions globally and include rheumatoid arthritis, lupus and Sjögren’s syndrome – all with high rates of morbidity. They occur when the immune system mistakenly attacks and damages its own tissues, though the pathogenesis (the mechanism which triggers this) is still ill-defined and delivering targeted therapeutic strategies is challenging.
As a result, current treatments for AIRDs are primarily designed to supress the symptoms (inflammation), but are ‘low target’ meaning the drugs may also have unintended side-effects. In this regard, AIRDs drugs often cause changes to cell metabolism (such as lipid metabolism) and function, putting patients at greater risk of co-morbidities such as cardiovascular disease (CVD).
Lead author Dr George Robinson (Centre for Rheumatology Research, UCL Division of Medicine) said: “While the mechanisms that cause rheumatic diseases are ill-defined, some recent research indicates cell metabolism may play an important role in triggering or worsening their onset or affect.
“In this review we therefore sought to understand the effect of both conventional and emerging therapies on lipid metabolism in patients with AIRDs.”
For the study, published in the Journal of Clinical Investigation, researchers carried out a literature review of more than 200 studies, to assess and interpret what is known regarding the on-target/off-target (adverse) effects and mechanisms of action of current AIRD therapies on lipid metabolism, immune cell function and CVD risk.
Explaining the findings, Dr Robinson said: “Our review found that current AIRD therapies can both improve or worsen lipid metabolism, and either of these changes could cause inflammation and increased CVD risk.
“Many conventional drugs also require cell metabolism for their conversion into therapeutically beneficial products; however drug metabolism often involves the additional formation of toxic by-products, and rates of drug metabolism can be different between patients.”
The review noted that better control of inflammation using optimal combinations of immunosuppressive treatments, could lead to an improved metabolic/lipid profile in AIRDs.
However, it also revealed many studies have shown that lipid lowering drugs (such as statins) are not sufficient to reduce CVD risk in some AIRDs, potentially because they cannot completely restore the anti-inflammatory properties
Dr Robinson added: “The unfavourable off-target adverse effects of current therapies used to treat AIRDs provides an opportunity for optimal combination co-therapies targeting lipid metabolism that could reduce immune complications and potential increased CVD risk in patients.
“New therapeutic technologies and research have also highlighted alternative metabolic pathways that can be more specifically targeted to reduce inflammation but also to prevent undesirable off-target metabolic consequences of conventional anti-inflammatory therapies.”
Sjogren’s Syndrome
Donne Spencer has produced this brilliant Sjogren’s Syndrome Awareness Butterfly. Please like and share to help us raise awareness of Sjogren’s Syndrome. To find out more about Sjogren’s Syndrome and the early signs and symptoms of Sjogren’s Syndrome please go our previous blog post on the subject here.
There you can read the stories of people who have been diagnosed with Sjogren’s Syndrome.
This month is Sjögren’s Syndrome Awareness Month.
Sjögren’s Syndrome is an autoimmune condition which affects around 1% of the population. You can find out more about it’s signs and symptoms at our previous post – https://patienttalk.org/tag/symptoms-of-sjogrens-syndrome/.
Indeed many people have only heard of it because Venus Williams suffers from Sjögren’s Syndrome.
To show our support for Sjögren’s Syndrome Awareness Month and to help raise awareness for the month we have produce the picture below. It would be great if you could like and share it to help us promote Sjögren’s Syndrome Awareness Month.
Sjögren’s Syndrome Awareness Month