Why Is Sjogren’s Syndrome So Often Misdiagnosed?
Sjogren’s syndrome, an autoimmune disorder, is usually misdiagnosed numerous times before the correct diagnosis is made.
You may have Sjogren’s syndrome and not even know this, despite visiting one doctor after another and after another to find out what’s gone wrong with your body.
Sjogren’s (show-grens) syndrome is an autoimmune disease that may affect many of the body’s different systems, various organs and cause an assortment of symptoms, and these range from annoying to moderate, to significant to life-threatening (though the latter outcome is rare).
Though Sjogren’s syndrome affects two to four million people here in the U.S., it is actually one of the most misdiagnosed diseases, even though there are several tests that can confirm it.
Because Sjogren’s syndrome causes joint pain in 80 percent of its patients, doctors who specialize in this condition are usually rheumatologists.
“Sjogren’s syndrome can be associated with a variety of autoimmune diseases including thyroiditis, rheumatoid, lupus, celiac sprue, scleroderma, and even with non-rheumatic autoimmune diseases like hepatitis-C, autoimmune hepatitis, HIV,” explains Ali D. Askari, MD, Professor of Medicine, Case Western Reserve University; Chief, Division of Rheumatology, University Hospitals Case Medical Center.
“Primary Sjogren’s syndrome (as opposed to secondary SS), though, is not associated with any of these conditions and there are differential points in each case.
“As opposed to rheumatoid arthritis, the joint involvement is not symmetrical, and nodules are formed less commonly, and destructive changes of the bones are seen less likely.”
Nine out of 10 people with SS are women, for reasons that are not known. The condition can affect any age, but it’s rare in those under 20. The mean age of onset is early to mid-40s.
“The specific radiologic changes and presence of subacute cutaneous nodules are more associated with rheumatoid arthritis,” says Dr. Askari.
“In lupus there is more involvement of the kidneys, the central nervous symptom (as opposed to peripheral nerves), and although the ANA is positive in both, anti-DNA is more positive in lupus than it is in Sjogren’s syndrome.
“Although photosensitivity can occur in both conditions, the very typical butterfly or malar rash (on the patient’s face) is more suggestive of systemic lupus.”
Celiac disease usually causes skin rashes, but the blood test for celiac disease will not show Sjogren’s syndrome antibodies. Furthermore, in celiac disease, diarrhea is far more common.
If you don’t get tested for celiac disease, yet you have this, and you go gluten-free (completely!) for 30 days, there should be remarkable improvement in your condition.
Dr. Askari continues, “Thyroid disease could be associated with Sjogren’s syndrome.
“Conversely, primary Sjogren’s syndrome is associated with more frequent occurrence of thyroid inflammation, the so-called Hashimoto’s thyroiditis.
“Neurological conditions such as MS can be mistaken for Sjogren’s syndrome. More so, primary MS is getting diagnosed in those with Sjogren’s.
“The differential can be achieved by the more frequent presence of specific antibodies in the blood in Sjogren’s syndrome and positive lip biopsy, but lesions on the MRI of the brain are similar to identical in both cases.”
The lip biopsy would confirm a decreased production of the salivary glands (the lips contain salivary glands), and this is a hallmark feature of Sjogren’s syndrome.
Dr. Askari explains, “Finally, in some cases of primary Sjogren’s syndrome, the dry eyes and mouth are later manifestations, and some unusual neurological manifestations, liver or cardiac disease may be one of the first findings.
“Additionally, the findings of dryness are not spontaneously expressed by the patient and are mainly attributed to the age, use of drugs, etc., and they should be solicited.”
Update: As of April 2024, Sjogren’s syndrome is now known as Sjogren’s disease.
Dr. Askari’s special interests include diseases of the muscles, fibromyalgia, general rheumatology, lupus and Sjögren’s syndrome.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
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Can Sjogren’s Syndrome Cause ONLY a Cotton Dry Mouth?
If you’ve been suffering from a cotton dry mouth, could this possibly be Sjogren’s syndrome, even as your only symptom?
One of the hallmark symptoms of Sjogren’s syndrome is the very dry mouth.
This situation can have a number of causes, and one of the most notable, if not the absolute most notable, is that of the side effects of medications.
Hundreds of prescription drugs can cause the dry mouth. But what if you haven’t been on any medication?
What if you don’t have diabetes, which is another cause? AIDS and also Parkinson’s disease can be culprits.
But you’re healthy, right? So is it possible to have Sjogren’s syndrome with only that one symptom of dry mouth?
For this article I interviewed Ali D. Askari, MD, Professor of Medicine – Case Western Reserve University; Chief, Division of Rheumatology – University Hospitals Case Medical Center; Director, Rheumatology – University Hospitals Case Medical Center. Sjogren’s syndrome causes joint pain in many patients.
“Dry mouth and dry eyes are important components of Sjögren’s syndrome,” begins Dr. Askari, “and indicate the presence of inflammation in the salivary glands, and in a whole variety of other exocrine glands (these glands are the ones putting the secretions out into the body and not into the circulation).”
It’s possible for a cottony dry mouth to be the first sign of Sjogren’s syndrome, and the only symptom actually for many years before other symptoms (such as dry eyes, joint pain, a burning throat) begin to show.
But usually, the Sjogren’s dry mouth is also accompanied with eyes that are dry (which may include itchiness, burning or a gritty feeling). In 80 percent of patients, joint aches or pain present themselves.
Antibodies associated with Sjogren’s syndrome are present in 60-70 percent of the patients.
“In the absence of clinical manifestations and the absence of antibodies, one can proceed with doing a lip biopsy,” says Dr. Askari, “which is a small incision biopsy of the (inside of) lips, and that indicates the presence of inflammatory changes, that supports the diagnosis of Sjögren’s syndrome.”
The lips contain salivary glands, and when Sjogren’s syndrome reduces saliva production, dry mouth results.
“In the absence of all these findings,” says Dr. Askari, “one can presume the dryness of the mouth and eyes are due to causes other than Sjögren’s syndrome.”
And these include “iron overload in the body referred to as hemochromatosis, hyperlipidemia (excess fat in the blood stream), sarcoidosis (formation of inflammatory cellular clumps that can exist throughout the body), and other immunologic disease, which can lead to the inflammatory changes of salivary and lacrimal (tear duct) glands.”
When a person has only the dry mouth along with dry eyes, this is called sicca syndrome.
Dr. Askari says, “Occasionally dryness of the mouth and eyes precede other manifestations of Sjögren’s syndrome for years.
“This is especially important in the close relatives of those who have already been diagnosed with primary Sjögren’s syndrome based on criteria established for this diagnosis.”
For a diagnosis of Sjogren’s syndrome, the dry mouth (or the eyes) must be present for three months; there must be objective findings such as a chronic enlargement of salivary glands; and a lip biopsy must be positive for antibodies.
There are two other causes of cottony dry mouth, but they are not chronic: salivary gland infection, and salivary gland “stones,” which are mineral deposits that become large enough to block the salivary gland portals through which saliva is secreted.
The latter is fairly common and can present with just a dry cottony mouth, but may also present with difficulty in swallowing, opening the mouth, and pain in the mouth or face.
Sometimes, though, there are zero symptoms.
Update: As of April 2024, Sjogren’s syndrome is now known as Sjogren’s disease.
Dr. Askari’s special interests include diseases of the muscles, fibromyalgia, general rheumatology, lupus and Sjögren’s syndrome.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
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10 Reasons the Weight Loss Has Stopped Despite Exercise & Diet
Some of the reasons you’ve stopped losing weight despite all that exercise and strict dieting will shock you.
#1. You haven’t been lifting weights.
This particularly applies to young females (afraid of bulking up) and people over 50 (thinking they’re too old or might get injured).
Shutterstock, Travelerpix
Muscle is the metabolic furnace of the body.
The more muscle you have, the faster resting metabolism will be, even during slumber. Lifting weights will dramatically jump-start metabolism.
#2. Focusing on long cardio sessions and doing only a little lifting.
Long, frequent sessions on cardio equipment, or that after-dinner “power walk” have limitations regarding fat loss.
Twenty minutes of high intensity interval training on a stationary bike three times a week will cause much more weight loss than will two hours of steady state walking seven days a week.
#3. Skipping breakfast
You might think you’re saving calories, but many times, the absence of a morning meal will cause greater hunger later on, causing you to eat more than you would have, had you eaten breakfast.
#4. Skipping meals or going long periods without any food.
For some, this may slow metabolism because the body learns to become efficient at storing fat.
For others, long periods of not eating result in fatigue, which then adversely impacts exercise.
#5. Not eating enough.
“You are not consuming enough calories,” says Amanda A. Kostro Miller, RD, LDN, whose specialties are nutrition counseling, weight loss and medical nutrition therapy.
“According to the Harvard School of Medicine, women should eat at least 1,200 calories per day.
“Men should eat at least 1,500 calories per day. Consuming less than these amounts may deter weight loss.”
#6. Poor sleeping habits.
They finally caught up with you and are interfering with your weight loss goals. Aim for 7-8 hours of quality sleep.
This maximizes release of human growth hormone during sleep.
Human growth hormone is a natural fat burner.
#7. Frequent napping.
A 20 minute snoozer is fine, but some people, despite sleeping 7-8 or even nine hours, will take a two hour nap most days.
This is complete inertia and completely unnecessary in an otherwise healthy adult who’s already getting sufficient sleep overnight.
#8. You don’t lift heavy enough weights.
Surprise! Those green dumbbells aren’t enough. And when you set the barbell down for your heaviest deadlift set’s last repetition…do you really feel like you can’t do more?
Shutterstock, Lisa F. Young
If you can do more than 12 repetitions, increase the resistance to keep your body in a shocked mode, rather than a maintenance state.
A shocked body burns more fuel (body fat) to adapt.
#9. Few compound exercises.
Clients who want to lose weight whose trainers have them doing things like standing on half balls and curling small dumbbells for 10 minutes are wasting their money.
Shutterstock, Reshetnikov_art
Compound exercises such as the deadlift (above) target multiple muscle groups simultaneously, forcing the body to dig deeper into fat reserves for energy and recovery fuel.
A top trainer knows that the cornerstone for weight loss includes the squat, deadlift, leg press, bench press, standing overhead press and pulling movements, all done with heavy resistance.
#10. Counting housework and yardwork as exercise.
This sabotaging approach leads to skipping structured workout sessions.
Bonus: MORE Reasons You’ve Hit a Weight Loss Plateau and Can’t Bust Past It
• “Your calorie goal is too high for your new weight,” says Kostro Miller.
“Now that you’ve lost weight, your body may actually need even less calories. Have your calorie needs reevaluated by a dietitian after weight loss.
• “You’re holding onto water weight,” continues Kostro Miller.
“People can hold onto water weight for a variety of reasons. For women, the time of the month can affect our water weight.
If you have certain health conditions that put you at risk for water retention, that can slow or stop weight loss.
If your diet is high in sodium, sodium can make you retain water.
• “Your weight loss diet is not sustainable. If you tried a fad diet and lost a lot of weight, don’t expect it to stay off.
Fad diets like the boiled egg diet, cottage cheese diet, etc., are designed to make you lose some weight initially, but then weight loss stops when you stop the fad diet.
Choose a sustainable weight loss plan that will help you in the long run.
• “Control your alcohol intake. Alcohol can throw off metabolism and can be a cause of weight fluctuations.”
Women should consume no more than four ounces of liquor/day, and for men, it’s eight ounces.
“Having several drinks in a night can make us temporarily retain water weight.”
Amanda Kostro Miller
has worked with U.S. veterans, people with eating disorders and those with various acute and chronic diseases.
Lorra Garrick is a former personal trainer certified through the American Council on Exercise. At Bally Total Fitness she trained women and men of all ages for fat loss, muscle building, fitness and improved health.
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Top image: Depositphotos.com
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Muscle Twitching Fear: Foot Drop Strength Test Guidelines
If twitching muscles have you panicking, here’s how to do foot drop strength tests.
If you’re terrified that the twitching muscles in your leg or foot might mean that you have ALS (and you would have gotten this idea after googling “twitching muscles,” no doubt), then invariably, you soon learned of a phenomenon called foot drop.
Foot drop itself is not a disease; it’s a symptom that can have many causes.
“Foot drop is typically neurological in nature,” says Dr. Bruce Pinker, DPM, who specializes in sports medicine and surgery of the foot and ankle.
In addition to a neurological cause, “It can be due to stroke (cerebral vascular accident – CVA), which may or may not resolve with physical therapy,” continues Dr. Pinker.
“Usually, in cases of foot drop, the forefoot drags on the floor — as the foot cannot clear the ground during the swing phase of gait.”
But how do you do strength tests for foot drop?
If you had this problem, for real, not just perceived, your gait would be altered to accommodate it.
Namely, you’d be having to lift your knee higher when walking.
Is that what you’ve been doing lately? If not, ask yourself why you’re convinced you have foot drop (other than googling “twitching muscles”).
Now let’s think of some everyday movements that foot drop would prevent you from doing.
Using the pedals of your car might come to mind. Think of how often, during just one 20-minute trip in your car, your foot must flex and extend to work the pedals.
Shutterstock/StepanPopov
There are muscles in the lower leg that move (flex and extend) the foot. If they are weak enough, the foot will drop.
If you have a disease causing enough foot drop to interfere with your walking, it will also interfere with using your car’s pedals.
What about actual strength tests?
The gas pedal usage is a test of flexion and extension with no resistance. But strength? Well, how about trotting up a flight of stairs?
That takes a lot more strength then using a gas or brake pedal.
Can you trot up a flight of stairs without stumbling or struggling?
If your ability to do this has not changed, then this should be reassuring.
Let’s take the foot drop strength test a bit further now. If you belong to a gym, load a calf raise machine with weights. Go up on your toes, then go down (extend, then flex).
Shutterstock/Denis Val
Though the calf raise equipment is designed to work the calves, the foot plays a key role in this because calf muscles move the feet!
For instance, your gastrocnemius and soleus muscles (major calf muscles) are responsible for plantarflexion (going up on the balls of your feet).
Your anterior tibialis muscle enables dorsiflexion (raising the foot/toes upward).
On the calf machine, these two joint actions are possible with weights. See what you can do.
Don’t try to break records; just do what you’ve either been doing, or if you’ve never used this machine, start with light weights.
After doing what you can (don’t overdo it, though; you don’t want sore calves), ask yourself how possible it is to have pathological foot drop if both feet can carry out the motion.
Another strength test is a hard sprint across a parking lot. To be able to do this you must have fully intact, fully functioning muscles and nerves.
Shutterstock/Franck Camhi
Do some jumping. Jump onto a boulder or bench. Leap across a puddle or up a few stairs.
Jump down from a few steps. Jump rope. Bunny hop. Do squat jumps. Kick a heavy bag.
“The activities you have mentioned would qualify as a self-test for whether or not one has foot drop,” says Dr. Pinker.
Unfair Strength Tests for Drop Foot
If you’re freaking out over twitching muscles and decide that a good strength test for drop foot would be to see how long you can balance on one leg, you will set yourself up for doom.
That’s because balancing on one leg, while in a state of fear, is not easy, even for a fit individual. Instead, just run down the street for your strength test.
Don’t try crazy things like seeing if you can hop up a flight of stairs on one leg.
Even a healthy fit person would find this very difficult. Don’t even try hopping across a room on the single leg.
These feats require a level of agility and strength that come from specific training.
The average person will struggle or may not even be able to do them.
And remember, exercise can cause some harmless muscle twitching.
Dr. Pinker
