Introduction:
Sjogren’s Syndrome is an autoimmune mediated disorder of the exocrine glands. The most common clinical presentation is the combination of dry eyes which is known as keratoconjuntivitis sicca and dry mouth which is known as xerostomia. There are two types of Sjogren’s syndrome viz. primary and secondary. The latter has an associated with autoimmune disorders like rheumatoid arthritis, systemic lupus erythematous (SLE) or systemic sclerosis. Incidence of primary SS(Sjogren’s Syndrome) is reported one in a thousand people predominantly affecting middle aged females.
Classification:
San Diego criteria for Sjogren’s Syndrome (SS) is as follows-
- A) Primary Sjogren’s Syndrome
- Signs and Symptoms of ocular dryness
- Signs and Symptoms of dry mouth eg. hoarseness of voice, dysphagia, thick and stringy salivation etc.
- B) Secondary Sjogren’s Syndrome
- Characteristic signs and sysptoms of Sjogren’s plus clinical features of RA,SLE, Polymyositis, scleroderma etc.
Diagnostic Tests:
Serological evidence of a systemic auto immunity
Elevated RA factor >1 : 320
Elevated ANA >1 :320
Presence of anti SS-A(RO)
Tear test
Schrimer’s test of tear production
Slit lamp test
Differential Diagnosis:
It is necessary to exclude Sarcoidosis, Pre-existant leucoma, Human immune deficiency virus(HIV), Hepatitis, Fibromyalgia and Keratitis sicca during differential diagnosis.
Contemporary And Traditional Correlation Of Pathogenesis :
In Ayurved, Sjogren’s syndrome can be compared with Vatik Vatarakta through primary SS sometimes shows only dryness of mouth (xerostomia) and dryness of eye(Keratoconjunctivitis sicca) which can be compared with Vataprakopa (vitiation of vata) in eye and mouth. As Ruksha Guna is antagonistic in nature to snigdha guna of kapha the vitiated vata thus reduces the snigdhansha in the concerned organs.
Sjogren’s Syndrome also shows an association with RA(Rheumatoid arthritis) and SLE(Systemic lupus erythmatosus) having arthralgia as the main symptom. Since this symptom has been specifically explained in the chapter Vatashonitam (Vatarakta) the condition can be compared with Vatarakta.
Ayurvedic Management :
Sjogren’s Syndrome is seen to be analogous to Vata predominant Gambhir Vatarakta having local symptoms like Raukshyam(Dryness of eyes and mouth) and systemic symptoms like Sandhishool (arthralgia), Granthi (lymphadenopathy), Twak Tamrata (vasculitis), CNS symptoms like Khanja and Pangu (multiple sclerosis) and Suptata (sensory loss). So the approach for management should follow that of Gambhir Vatarakta.
- a) For Local Symptoms:
- Gandush/Kawal:
Gandush is a therapeutic procedure of keeping the medicine into the oral cavity in such a dose so that it cannot be churned. Vagbhat has described three types of Gandush namely Snigdha, Shaman and Ropan. In xerostomia, Snigdha Gandush with Ksheerbala Tailam or Indukantham Ghrita should be given.
- Netra Tarpan
Vagbhat has indicated Netra tarpan for Ruksha and Shushka Netra. Tarpan can be given with Jeevantyadi Ghritam, Patoladi Ghritam etc.
- Nasyam
For Keratoconjunctivitis sicca and xerostomia, Bhrihan and Shaman type of Nasya can be given.ex Ksheerbala and Anu Tailam
- b) For Systemic Symptoms:
i.Therapies:
- Abhyangam /Parishechan- As Sjogren’s has been considered as Vatik Vatarakta ,Role of Abhyanga and Parishecha, as external therapies is important to alleviate Vata and pacify the symptoms. Abhyangam and Parishechanam can be done with Bala Tailam, Ksheerbala Tailam, Madhuyashtyadi Tailam
- Basti: Basti is the therapy of choice for Vatarakta, therefore keeping in mind the predominance of Vata in Sjogren’s, Ksheerbasti with Ghritam should be administered.
ii.Internal medication:
- Ksheer Kashayam: All the drugs having Madhur Tikta Rasa, Vata Shamak ,Rakta Prasadak properties and having an affinity towards curing Vatik Vatarakta can be given with Guduchyadiksheer Kashayam ,Vidaryadi Kashayam, Kokilakshakam Kashayam etc.