Therapy of Dermatologic, Renal, Cardiovascular, Pulmonary, Gynecologic, Gastro-enterologic, Urologic and Fibromyalgia Manifestations Including Special Considerations at the Time of Surgery

Abstract

Therapy of Sjogren's syndrome (SS) patients requires attention to different clinical manifestations. These include treatment of 1. Dry eyes and mouth (glandular manifestations); 2. Dermatologic manifestations including dryness of other mucous membranes, including vaginal dryness; 3. Non-visceral manifestation of arthralgia/arthritis and myalgia/myositis; 4. Visceral manifestations that include immune complex-like deposition tissue injuries and "lupus-like" signs/symptoms that may affect lung, heart, abdomen, urologic, kidney, and neurologic systems; 5. Visceral manifestations that reflect the lymphocytic infiltrative processes in SS that reflect the "aggressive" lymphocyte, such as interstitial pneumonitis, autoimmune hepatitis, interstitial nephritis, lymphadenopathy, and lymphoma; 6. Vague symptoms of fatigue, which have been termed fibromyalgia or chronic fatigue syndrome and which greatly influence the patient's quality of life; 7. Increased risk of atherosclerosis and thrombotic disease, where late cardiovascular complications exceed the risk expected for elevations of standard risk factors such as lipid profiles and hypertension; 8. This chapter will also review the particular needs of the SS patient at the time of surgery (with attention to avoiding complications due to dry eyes/mouth and poor dentition) and the current recommendations regarding vaccinations.