Approaches to the treatment of Sjogren's syndrome

Sjogren's syndrome (SS) is a systemic autoimmune disease characterized by c omplaints of sicca symptoms (dry eye and mouth) and can be associated with other autoimmune diseases (rheumatoid arthritis, systemic lupus erythematos us, progressive systemic sclerosis, etc). As a result, SS can be difficult to diagnose. Currently, there are several criteria standards for SS, includ ing the San Diego criteria and the European Study Group criteria. According to the San Diego criteria, the incidence of SS is about 0.5%, whereas fur the European Study Group it ranges from 3% to 5%. This almost 10-fold diffe rence in SS incidence has led to confusion fur both the clinician and resea rcher. The tearing reflex involves a neural loop in which afferent nerve si gnals from the ocular surface are relayed centrally to the medulla. The inp ut from the afferent nerves is then processed and sent back via efferent ne rves stimulating blood vessels and secretory glands to provide and pump wat er fur tears. Immune factors, such as cytokines, have a profound effect on the rearing mechanism by damaging secretory glands and releasing antibodies to influence the response of muscarinic M3 receptors. Thus, the interactio n of neural and immune factors affects the secretory response of glands and contributes to the pathogenesis of SS sicca symptoms. The recent developme nt of muscarinic agonists, such as pilocarpine and cevimeline, serves an im portant step in recognizing the interaction between the immune and neuroend ocrine systems.